“No-fault” is one of the most misunderstood terms in New York auto insurance. It does not mean nobody is at fault for a crash. It means that, after a motor vehicle accident, certain medical and related costs are paid by the injured person’s no-fault coverage regardless of who caused the accident. This article explains the basics. It is general information, not advice about a particular claim. People who want to speak with Bisogno & Meyerson, LLP can start with the firm’s no-fault information page.
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What No-Fault Covers
New York’s no-fault system is set out in Article 51 of the Insurance Law and its regulations. It is sometimes called personal injury protection. Basic no-fault coverage generally provides payment for necessary medical expenses, a portion of lost earnings subject to limits, and certain other reasonable and necessary expenses, regardless of fault. Policy limits and the exact items covered depend on the statute, the regulations, and the policy. This article does not list dollar limits, since they should be confirmed against the actual policy and current rules.
No-fault does not pay for vehicle damage. Property damage, collision coverage, and similar claims are handled separately.
Whose Policy Applies
Which no-fault policy pays depends on who was hurt and how. In general, an occupant of a vehicle looks first to the policy covering that vehicle, and a household policy may come into play in some situations. A pedestrian or cyclist struck by a motor vehicle may look first to a household policy and otherwise to the policy connected to the vehicle that struck them. Special rules apply to motorcycles, to out-of-state vehicles, and to people injured while working. The order of priority can be technical, so ask an attorney or your insurer which applies.
The 30-Day Notice
A person who wants no-fault benefits must give written notice of the claim to the insurer, ordinarily within 30 days of the accident. Late notice can be excused in some circumstances, but it should not be relied upon. The insurer then sends forms, which must be completed and returned within the time stated, and providers submit bills within their own deadlines. Missing these steps is a common reason for denials. Keep copies of everything you send and a record of when you sent it.
Denials, Examinations, and Disputes
Insurers may deny or limit claims, for example by saying that treatment was not medically necessary or that a person failed to attend an independent medical examination. A denial is not necessarily final. Disputes can sometimes be sent to no-fault arbitration or to court, depending on the issue, and those processes have their own time limits. If you receive a denial letter, keep it and check the deadline stated in it.
No-Fault Does Not End the Story
No-fault benefits are separate from a claim against the person who caused the crash. Under Insurance Law § 5104, an injured person generally cannot sue another driver for pain and suffering unless the injury meets the “serious injury” threshold in Insurance Law § 5102(d). The statute lists categories of serious injury, which include, for example, death, dismemberment, significant disfigurement, fracture, permanent loss of use, and certain permanent or significant limitations. Whether an injury meets the standard is decided on the medical evidence, often through records and examinations. A person who cannot meet the threshold may still be entitled to no-fault benefits.
Economic losses beyond basic no-fault limits can sometimes be pursued in a claim against a responsible party, and additional coverage may exist, such as optional supplemental coverage or uninsured and underinsured motorist coverage. Review your own policy.
Fault Still Matters
Even though benefits are paid without regard to fault, fault is relevant to a lawsuit. New York follows pure comparative negligence under CPLR 1411, which reduces damages by the injured person’s share of fault. Our blog explains what comparative negligence means in New York. Most personal injury lawsuits must be started within three years under CPLR 214. See also how long personal injury cases take.
Rideshare, Taxi, and Commercial Vehicles
Accidents involving rideshare, taxi, and commercial vehicles can involve additional insurance layers and different responsible parties. The firm’s pages on Uber accidents in New York City and on filing auto accident claims discuss related issues.
Practical Tips
Get medical care and tell your providers the injury came from a motor vehicle accident. Keep the accident date, the police report number, the insurer’s claim number, and every form. Return forms on time. Do not assume the insurer or a provider will handle deadlines for you. If you are unsure whether you need legal help, read our post on whether you need a lawyer after a car accident.
Talk With Our Firm
Bisogno & Meyerson, LLP has concentrated in personal injury and workers’ compensation work since 1994. A free consultation is a conversation about facts, deadlines, and options. It is not a prediction of any benefit or recovery, and every case is different, so speak with an attorney about your own situation. A short firm overview describes the practice.
Call (718) 745-8880 or contact us. Attorneys on the site are Patrick Bisogno, Esq.; Michael C. Meyerson, Esq.; and George A. Silva, Esq.
Attorney Advertising. This page is general information from Bisogno & Meyerson, LLP, not legal advice. Contacting the firm does not, by itself, create an attorney-client relationship.