If you or a loved one are involved in an auto accident in New York, it is essential to have a good understanding of your rights under the state’s no-fault insurance system. Part I of this multi-part series covers the basics of no-fault. This article takes a deeper dive.

Filing a claim for no-fault benefits is the first step to securing your rights. As discussed in Part I, no-fault covers both medical costs and lost income for the injured person. If an auto accident takes place in New York, there is no question of whether an injured party is entitled to no-fault benefits – it is the right of anyone who was in any car involved, as well as pedestrians or cyclists who were struck by a car.

New York mandates that every auto insurance policy issued in the state includes no-fault coverage. In certain circumstances, even policies issued in other states will provide no-fault. It falls under the heading of “Personal Injury Protection” and is better known as “PIP” in other states, including New Jersey.

The Meaning of “No-Fault”

This type of insurance coverage is popularly referred to as “no-fault” because the injured party does not need to demonstrate who was at fault. Anyone who was injured is entitled to medical and lost income benefits, even if they caused their own accident.

Here are a few scenarios:

  • A pedestrian struck by a taxi cab in New York City receives no-fault from the cab.
  • A passenger in his friend’s vehicle involved in a hit-and-run accident in Bronx receives no-fault from the friend’s auto insurer.
  • A driver who is injured in a collision in Queens due to his failure to stop at a stop sign receives no-fault from his own auto insurer.

What No Fault Covers

Medical expenses: No-fault covers all necessary and related medical expenses arising from the accident. Of course, it does not cover medical costs that do not arise from the accident, such as the injured person’s blood pressure medications. Covered medical expenses can include (but are not limited to):

  • Ambulance
  • Emergency room or urgent care center
  • Hospital and outpatient tests, such as x-rays, CT scans, MRIs and EMGs
  • Hospital and nursing home admissions
  • Post-hospital treatment by specialists, such as orthopedists, neurologists and physiatrists
  • Surgeries and procedures at a hospital
  • Physical therapy
  • Chiropractic care
  • Prescription medications

Lost Income: In addition to medical expenses, no-fault covers the injured person’s lost income at a limit of $2,000 per month. In order to receive this compensation, the claimant must be under a doctor’s care, and the doctor must certify each month that the client cannot work due to their injuries.

Key Details

No-Fault Is Limited to $50,000: The no-fault insurance benefit has a limit of $50,000 for medical expenses and lost income combined. Sometimes, albeit rarely, the vehicle owner may have purchased a higher level of coverage with a limit of $75,000 or $100,000.

Once the insurance company pays out its limit, it is not responsible for any further benefits. If the injured party requires further medical care, they must turn to their regular medical insurance, i.e. private health insurance, Medicare, or Medicaid.

No-Fault Is Unrelated to a Lawsuit: An injured person’s receipt of no-fault benefits does not entitle them to recover money for personal injuries in a lawsuit. The right to a lawsuit is a separate matter, and involves certain requirements. Chiefly, in order to pursue a lawsuit, the injured person must prove that he has sustained a “serious injury” as defined by law. This will be discussed in Part III of this series.

In sum, an injured person is entitled to medical and lost income regardless of fault, regardless of whether that person wants to pursue a lawsuit, and regardless of the severity of their injuries. The law is intended to provide quick and certain medical and income benefits.

NO-FAULT FAQ

Does the insurance company pick my doctors?

No. You have full freedom of choice as to doctors and hospitals.

When do I have to file for no-fault benefits?

An application must be filed within 30 days of the accident. If you fail to file within that timeframe, the insurance company may still honor your claim if it has been apprised of the accident – but the sooner you file, the better.

How do I get my medical bills paid?

Medical bills must be submitted to the insurer within 45 days of the date of service. However, the injured party should not worry about this. Most hospitals and doctors who treat auto accident patients send their bills directly to the insurer. The medical providers take responsibility for submission and collection of bills.

How much treatment will I receive? Who determines this?

Your doctors will determine the amount and type of your medical treatment. You may need relatively little treatment. If you need significant treatment, such as surgery and/or therapy, then you will receive it. Eventually, the insurance company will have its doctor examine you to determine whether further treatment is necessary.

How is lost income paid?

If you qualify and cannot work, you will receive a maximum of $2,000 a month, which is a combination of disability benefits provided by your employer (if you are employed in New York) and the no-fault income benefit. If you do not have statutory or private disability insurance from your employer, then the entire $2,000 will be paid by no-fault.

Does receipt of no-fault benefits automatically entitle me to file a lawsuit?

The law requires that you have a “serious injury” in order to file a lawsuit. The fact that you were injured is not sufficient; your injuries must meet the specific legal criteria for serious injuries. Even if you have undergone extensive therapy, you might not qualify. Your attorney will be able to determine whether you can prove a serious injury as defined by law. This matter, and the right to recover in court, will be discussed in future installments of this series.