New York is a no-fault insurance state, meaning that insureds generally must pursue reimbursement from their insurance company for certain damages after an automobile accident, regardless of who was at fault.
No-fault insurance is a type of personal injury coverage—it does not pay for auto body repair of your car or any damage to another party’s car or personal property. No-fault benefits are also a primary form of health insurance, meaning that if your accident causes an injury, your no-fault benefits pay for treatment first. These payments can cover the costs of your medical bills, durable medical equipment, and prescription drugs. No-fault insurance also provides coverage to reimburse lost wages from the accident, housekeeping expenses, and transportation to and from medical providers if necessary.
New York no-fault laws require all drivers to purchase basic no-fault insurance policies with minimum coverage limits on every policy. In New York, the minimum no-fault benefits provide a $50,000.00 coverage limit to provide multiple types of personal injury protection including reasonable and necessary accident-related medical and rehabilitation expenses.
For example, New York no-fault insurance covers 80 percent of lost earnings through your job, up to $2,000 monthly for up to three years from the date of the accident. Additionally, no-fault insurance provides up to $25 a day for up to a year for other reasonable expenses stemming from your recovery, like household help and transportation to medical appointments. No-fault benefits also include a $2,000 death benefit payable to the insured’s estate if the insured passes away due to injuries sustained in a motor vehicle accident. Policyholders have the option to purchase additional coverage.
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At-Fault vs. No-Fault States
New York is one of 12 states with no-fault insurance laws—the other 38 are at-fault states, meaning that the driver who caused the accident is financially responsible for any resulting property damage and bodily injuries. In at-fault states, blame is assigned to one or more of those involved in the accident to determine who is financially responsible. If the blame is shared between two or more drivers, their insurance policies cover claims in proportion to their fault.
No-fault insurance systems aim to restore individuals hurt in car crashes to health and productivity as quickly as possible. No-fault insurance speeds up the claims process since it does not require an investigation into fault. New Yorkers generally must first file a no-fault claim under their own policy, for which personal injury protection coverage will apply, to pursue compensation and damages after an accident. However, if you were a pedestrian struck by a vehicle, you file a no-fault claim with the insurer of the car that struck you.
Importantly, no-fault insurance does not compensate for non-monetary damages, such as pain and suffering. If the victim suffers a serious injury as defined by Section 5102 of the Insurance Law of the State of New York, they can pursue a claim against the at-fault party if their economic losses exceed their no-fault coverage. For example, you may be able to recover compensation for:
- Dismemberment
- Significant disfiguration
- Death
- Loss of a fetus
- Fracture
- Permanent loss of use of a body organ, member, function, or system
- Permanent consequential limitation of a body organ or member
- A significant limitation of the use of a body function or system, or
- A “medically determined injury or impairment of a non-permanent nature prevents the injured victim from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than 90 days during the 180 days immediately following the occurrence of the injury or impairment
Who is Covered by No-Fault Benefits in New York After an Accident?
According to the New York Department of Financial Services, personal injury protection benefits cover the driver or passengers injured in your car, or any pedestrian injured by your car. These benefits protect you and your relatives residing in your household against economic losses from car accident injuries.
Exclusions From Receiving No-Fault Benefits
Though automobile insurers are required to provide personal injury protection benefits to all policyholders in New York, some circumstances make people ineligible to use these benefits. Anyone driving while intoxicated or impaired by drug use that contributed to the accident cannot use no-fault benefits, except for emergency health services, and the insurer has the right to recover the full amount of those payments later if the driver is convicted of a DUI.
Additionally, anyone riding a motorcycle or an all-terrain vehicle, committing a felony such as evading the police, racing, or riding in a stolen vehicle, or intentionally causing their own injuries, are not eligible for no-fault coverage.
How to File a No-Fault Insurance Claim in New York
After a car accident in New York, you must first file a claim with the insurance company covering the vehicle you were in, either as a passenger or a driver. However, if you were a pedestrian struck by a vehicle, you file a claim with the insurer of the car that struck you. If you were a pedestrian but you do not have the information of the vehicle which struck you, file a claim with your insurer or the insurer of a relative you live with.
Under New York no-fault regulations, a written claim must be filed with the insurer within 30 days of the accident. Medical bills must be submitted within 45 days, and lost wage claims must be submitted within 90 days.
The written statement should include as many details about the accident as possible, including the date, time, circumstances of the accident, and the people injured. Within five business days of receiving your claim, your insurer must send you an application for benefits and a letter explaining the available no-fault coverage. Complete and return this form as soon as possible.
If you need medical care after an accident, you can either pay your provider directly and submit your bills to the insurer for reimbursement or allow the provider to submit bills directly to the insurer for payment. Under New York law, the insurance company must pay within 30 days of the health care provider’s claim and your employer’s report of lost earnings, if applicable.
What if No-Fault Benefits Don’t Cover All My Expenses?
If your expenses after an accident exceed your No-Fault coverage, there are several options you can pursue. You may be able to apply for additional no-fault benefits, either for the vehicle you were in during the accident or for any automobile policy of a related member of your household. If no additional personal injury protection benefits are available, you can make a claim to your standard health insurance for your medical expenses.
You may also have grounds to file a car accident personal injury claim against the negligent party to recover costs you paid above your policy limit. You can also pursue recovery of your non-economic damages if you have a qualifying “serious injury” under Section 5102 of the Insurance Law of the State of New York. Serious injuries include fractures, disfigurement, dismemberment, permanent loss of an organ, significant limitation of the use of a bodily function or system, loss of a fetus, and more.
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How Can Lever & Ecker Help with Your No-Fault Claim?
Insurance companies have a reputation for finding ways out of paying claims. An attorney can help you navigate the claims process and negotiate with your insurance company to receive reimbursement for your medical expenses and lost wages due to your injuries. In addition, an attorney will help determine if you are eligible to file a personal injury lawsuit against an at-fault party. If so, they can investigate, gather evidence to support your claim, file court paperwork, negotiate with the opposition for the maximum settlement possible, and advocate for you in court.
At Lever & Ecker, we take a hands-on approach to every client’s case, guiding them through each step of the claims process. You can expect top-tier representation and an open line of communication. Our award-winning New York personal injury lawyers have more than 70 years of combined experience helping injury victims throughout New York from our White Plains, Bronx, and Queens offices. We’ll work with your schedule—whether that means meeting you after-hours, on the weekend, or at the hospital. No matter the circumstances, we’ll be there. And we’ll always treat you like family, never just a number.
Insurance companies don’t play fair. We’re here to level the playing field. Contact us about your claim today online or by calling (914) 288-9191.
