No Fault

In New York State, auto insurance provides for no-fault coverages for operators and passengers of motor vehicles. For coverage to apply, the accident must have occurred in New York. Regardless of fault, the injured party can apply for benefits for basic coverage of up to $50,000.00. This covers medical and hospital costs, doctor bills, ambulance, testing and prescriptions. It also covers for lost wages.

Many clients confuse NYS No-Fault benefits with legal claims against at fault drivers and owners. For example, No-Fault does not cover nor provide for pain and suffering nor for the future costs of medical care. It has a basic limit of up to $50,000.00, although additional converages [Optional Basic Economic Loss, Additional PIP or personal injury protection or spousal liability coverages] can be purchased. It generally does not apply to motorcyclists. It covers pedestrians struck by vehicle.

To obtain benefits, applicants must file within 30 days of accident with the company providing coverages for the driver or passengers. Wage losses will be paid after verification from the applicant’s employer or in the case of self-employment, tax returns and other financial information.

After benefits begin, insurance companies providing benefits have the right to have you examined by a physician hired by them. This can result in more than one examination and by physicians in other fields of medicine. This doctor may determine that you no longer need benefits or that your benefits can be reduced. If you have secondary coverages, this may not seem much but if you don’t, you will be cut off from medical care and treatment. So, we advise all our clients to get the medical care they need and to follow the advice of their treating physicians.

You can also obtain $25.00 per day for household help, provided that your doctor finds it is medically necessary. You can also collect for mileage expenses to and from medical care and treatment. If you are in a vehicle that is not covered by insurance, you can make application with New York Motor Vehicle Accident Indemnification Corporation [otherwise MVAIC] for no-fault benefits. However, this requires specific time periods and forms, so we recommend that you consult with an attorney to do this properly.

If your claim is denied, you may be tempted to submit the matter to arbitration. However, we urge all of our clients to first discuss this remedy with your attorney as a negative finding can have an adverse effect on any legal claim you may have outside of no-fault. Most often, however, reimbursement to the medical provider is disputed and rather than paying the full amount of the medical bill, the bill will be adjusted downward.

As a general rule, you should consult with an experienced injury attorney for all of your questions pertaining to New York State no-fault so you can take full advantage of the coverages provided to you and for which the contract of insurance provides.