New York and The No-Fault Law

New York requires automobile owners to have no-fault car insurance. As part of their auto insurance, each driver in New York must carry Personal Injury Protection (PIP) coverage which pays for medical expenses up to the limits of the policy. After a collision, each driver initially files a claim against their own Personal Injury Protection insurance for coverage of their injuries, regardless of who caused the crash.

Automobile owners are required to have at least $50,000 in PIP coverage in New York and have the option of purchasing additional coverage.

While New York’s no-fault system was established to ensure that people involved in accidents can pay for medical bills, it has become complicated and adversarial.

The Queens car accident lawyers of Tadchiev Law Firm, P.C., have extensive experience representing people injured in collisions in New York City. Our attorneys can help you navigate New York’s no-fault insurance system and understand whether your serious injuries entitle you to step outside the no-fault system and demand compensation directly from the at-fault driver’s insurance. If you’ve been hurt, call our Queens car crash lawyers for a free consultation to review your accident and options.

What Are the Benefits of Being a No-fault State?

The State of New York adopted a no-fault insurance system to reduce litigation involving car accident injuries. No-fault insurance claims can generally be resolved more quickly. You do not have to produce evidence showing a driver was at fault or wait for insurance adjusters to determine liability to get money from your insurance policy.

When you file a claim against your PIP policy, your insurer should pay for your medical expenses and those of your passengers, even if you were to blame for the crash. Since you get paid for your medical expenses no matter who was at fault, PIP insurance avoids many disputes about liability.

Unfortunately, the system does not always work as intended, and it can sometimes be challenging for those who’ve been injured in collisions to recover the full and fair compensation they need to rebuild their lives and move on from the crash.

What happens if your injuries and expenses exceed the limits of your PIP policy? What if the other party’s negligence caused the crash? In New York, you may have a right to file a claim against the at-fault driver’s insurance if a car accident resulted in serious injuries that exceed the limits of your no-fault insurance policy. The attorneys at The Tadchiev Law Firm, P.C. can help you understand your legal options.

Who Receives No-fault Benefits?

Personal Injury Protection no-fault insurance provides benefits to:

• The policyholder and members of their household
• Passengers in the vehicle when an accident occurs
• Any pedestrians or bicyclists injured by the policyholder in the accident

Who Doesn’t Benefit?

The following people are not covered under New York’s no-fault system:

• Motorcycle riders and passengers
• Drivers in uninsured vehicles
• Drivers who were intoxicated at the time of the crash
• Individuals who are not residents of New York

Private insurers may exclude certain individuals in specific circumstances, so make sure you read your policy carefully. Some people don’t realize who is not covered until it’s too late.

What Is Covered Under No-fault Rules in New York?

New York’s no-fault insurance system provides coverage of:

• Reasonable and necessary medical expenses, including ambulance costs, x-rays, surgery, prescription drugs, physical and occupational therapy, other rehabilitative costs, and any professional medical services needed within one year of the accident because of injuries sustained in the accident
• Up to $25 per day for expenses associated with your injuries and treatment, such as transportation costs to therapy or household assistance while you are injured
• 80 percent of your lost wages while out-of-work
• Burial and funeral expenses for any individuals killed in the accident

How To File a No-fault Claim in New York

If you are injured in a car accident in NYC, you’ll need to understand the process of filing a no-fault claim. Be sure to follow all the necessary steps.

1. Report the accident to local police and your insurance company. If property damage exceeds $1,000, or if anyone involved is injured, file an accident report with the New York Department of Motor Vehicles. The form to submit is called an MV-104 form.
2. Within 30 calendar days of the date of the accident, file a written notice of claim with the insurance company that has the no-fault insurance policy on the vehicle you were in when the accident occurred.
3. Within five business days of receiving the notice of claim, the insurer will send you an Application for Benefits and a letter explaining the no-fault benefits you are eligible to receive. You should complete and return the application as soon as possible.
4. If you receive medical treatment, be sure to tell the medical provider that your injury is related to a motor vehicle accident. You can either pay the medical bills yourself and submit the receipts for reimbursement to your insurance company or ask the medical provider to submit their bills directly to the no-fault insurance provider for payment. Insurers are required to submit payment within 30 days of receiving the claim and supporting documentation.
5. The insurance company may require you to undergo an independent medical exam by a doctor who is hired by the insurance company to evaluate the extent of your injuries, the amount of treatment you may need, and whether you are able to work. Make sure you comply with the request, as failing to do so could jeopardize your benefits.
6. The insurance company could also require you to appear for an examination under oath, in which the insurer’s lawyer will ask you questions under oath about the accident and your injuries. Make sure you appear for this examination as well.
7. If your no-fault claim is denied, you have a few options. First, you can file a written complaint with the New York Department of Financial Services. Second, you could file for no-fault arbitration. Third, you could file a lawsuit in court against the insurance company to pursue your benefits. No-fault arbitration is permitted if the insurer denies your claim in whole or in part, or fails to provide benefits in a timely fashion. The arbitration process is intended to resolve disputes as quickly as possible.

It can be helpful to consult an experienced car accident attorney at The Tadchiev Law Firm, P.C. who knows how New York’s no-fault system works and can explain your rights.

Serious Injury Claim

According to New York law, you could file a personal injury lawsuit against the at-fault driver’s insurance if you sustained a serious injury in the auto accident. The following injuries are types of serious injuries:

• Broken bones
• Permanent loss of use of some part of the body (organ, member, function, or system)
• Limited use of a body function or system
• Dismemberment
• Significant disfigurement
• Loss of a fetus
• Other injury determined to prevent you from returning to your usual activities for at least 90 of the 180 days following the accident

If you suffered a serious injury due to another driver’s negligence, you can pursue a personal injury lawsuit seeking compensation for your injuries within three years of the accident.

What Can I Recover from a No-fault Claim?

By submitting a no-fault claim, you could recover compensation for your medical bills, necessary medical treatment such as physical therapy, and other expenses associated with your accident up to your PIP coverage limit, which is typically $50,000.

The minimum required PIP coverage of $50,000 under New York’s no-fault system can be exhausted quickly if you have sustained serious injuries. Furthermore, no-fault insurance will not offer compensation for your pain and suffering or for property damage to your car. That’s when it can be helpful to explore your legal rights by consulting with an experienced car accident attorney. If you are eligible, our attorneys can help you pursue additional compensation by filing a personal injury lawsuit against the at-fault driver.

Get in Contact with Experienced Lawyers in Queens, NY to Help You File a No-fault Insurance Claim

If you were injured in an accident in Queens, NY, the experienced car accident attorneys at Tadchiev Law Firm, P.C. can help you file a no-fault insurance claim, fight for you if your claim was denied, or pursue a personal injury lawsuit against the at-fault driver for fair compensation if you suffered serious injuries in the accident. Call us or reach out to us online for a 100% free consultation to discuss your situation with us in detail. We’ll be ready to help.

About the Author

Boris Tadchiev
Boris Tadchiev is the founding partner at The Tadchiev Law Firm, P.C. He focuses his practice on advocating for the rights of individuals and families in personal injury cases involving motor vehicle accidents, premises liability, and wrongful death. He also represents healthcare providers in complex no-fault arbitration claims.