Understanding New York No-Fault Law

By | March 15, 2017

New York became a No-Fault state in 1970. No-Fault laws were enacted in New York in order to ensure that motor vehicle accident victims would be able to receive payment for medical expenses, lost wages and other incidental costs associated with an injury from a motor vehicle accident regardless of fault.

The payment of such expenses is covered by an automobile insurance policy.  Whose policy covers your expenses depends on the type of motor vehicle accident you were involved in. If you are a passenger or operator of a motor vehicle other than a motorcycle, the insurance carrier of the vehicle you are in at the time of the accident will cover your accident-related expenses. If you are a pedestrian or riding a bicycle, the insurance carrier of the vehicle you were struck by will cover your accident-related expenses. If you are a passenger on a bus, your household vehicle’s insurance carrier will cover your accident-related expenses.

Unfortunately, if you were the operator or passenger of a motorcycle you will not be eligible for No-Fault benefits. In that scenario, you will need to use your private health insurance to pay for your medical expenses.

There are certain requirements that must be met in order to receive No-Fault benefits. The most pressing requirement to qualify for No-Fault benefits is the completion of a No-Fault application. You must complete and file a No-Fault application with the appropriate insurance carrier within 30 days of your accident. Failure to do so may jeopardize your eligibility for No-Fault benefits.

The following no-fault benefits are available to all motor vehicle accident victims: 

Medical expense: Your carrier will pay for all medical treatment associated with your accident-related injury. Generally, there are no deductibles or need for referrals/pre-authorizations. The only caveat is that your health care provider accepts no-fault insurance.

Lost wages: Your no-fault carrier will pay 80% of your lost wages up to $2,000 dollars a month. In order to be eligible for these benefits you will need to provide proof of disability from a doctor and proof of employment.

Out of pocket expenses: No-Fault will pay for expenses related to traveling to medical providers, medications and other recovery-related out-of-pocket expenses up to $25 dollars a day for the first year.

Your No-Fault benefits have certain limits. First, you generally have $50,000 dollars of coverage. Once that amount is exhausted your claims will be denied unless you have purchased additional coverage.

Further, your carrier has the right to request that you attend an independent medical examination from time to time. If it should be determined at that exam that you have recovered from your injuries, the insurance carrier will deny any further payments, even if your policy has not yet been exhausted.

In certain scenarios, you may disagree with the insurance company’s determination that you have recovered from your injuries. In that scenario, you have the right to file an appeal with an independent arbitrator. Generally speaking, the appeals process is complicated.

While it is possible to handle your own No-Fault claim, it is not advisable. There are many issues that will likely arise during your No-Fault claim that may require the help of an attorney.

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