A Consumer Guide. An Explanation of New York s New York s No-Fault Insurance for Motor Vehicles

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1 79 Wall Street Huntington, NY (fax) A Consumer Guide An Explanation of New York s New York s No-Fault Insurance for Motor Vehicles If you have been injured in a car accident or motor vehicle accident in New York, you may qualify for No-Fault insurance coverage. New York s No-Fault Insurance Law offers benefits (immediate medical coverage and quick payments for expenses) and restrictions (on lawsuits for pain and suffering). This document provides an overview of New York s No-Fault insurance law and regulations and offers guidelines for you to follow if you are involved in an accident. This document does not provide legal advice, which you can only receive by consulting an attorney. Here is what you will find: An Overview of New York s No-Fault Insurance Program Who Is Eligible for No-Fault Coverage in New York Filing a No-Fault Claim No-Fault Benefits: Medical Expenses No-Fault Benefits: Lost Earnings No-Fault Benefits: Related Expenses Seeking Compensation Beyond No-Fault Insurance Threshold Requirements to Seek Compensation Beyond New York s Motor Vehicle No- Fault Insurance Benefits An Overview of New York s No-Fault Laws New York is one of 12 states that have a No-Fault auto insurance program. No-Fault Insurance applies to motor vehicle accidents. As the name suggests, No-Fault insurance coverage does not depend upon who is to blame in an accident. New York State s No-Fault law requires insurance companies to pay up to $50,000 for accident-related medical expenses, lost earnings and incidental costs, no matter who is at fault. The coverage includes the driver and passengers and the covered expenses include not only medical costs, but lost wages for up to three years and related expenses. New York s No-Fault law enables people to receive payment for medical expenses, lost wages and other expenses without having to go to court to prove who was at fault in an accident. Under this law, the injured parties do not have to sue to prove fault and collect benefits. However, there is a trade-off: New York s No-Fault Law also limits the ability of people injured in a motor vehicle accident to sue for additional damages or pain and suffering. To pursue a claim for pain and suffering or damages beyond what No-Fault Insurance covers, one must

2 meet the Serious Injury Threshold, meaning you must have a qualifying injury as determined by New York State law. If you believe you should receive compensation beyond the No-Fault coverage, you will need to bring a legal action to collect that compensation. You should consult with a New York attorney experienced with motor vehicle cases and New York s No-Fault law. We have extensive experience in this field and would be glad to discuss any questions you may have. You can call us at or send an to Who is Entitled to Receive Coverage through New York No-Fault Insurance? New York No-Fault covers any person injured in a motor vehicle collision in the State of New York with the exception of drivers or passengers of a motorcycle. New York s No-Fault insurance does not cover drivers or passengers on a motorcycle. New York No-Fault covers injuries in one vehicle accidents (e.g. when a car strikes a telephone pole) and multiple car accidents. What accidents are covered? o Single vehicle accidents (e.g. when a car strikes a telephone pole) o Multiple vehicle accidents (e.g., when two or more cars collide) What vehicles are covered? o All cars o All buses o All trucks o All vans o All yellow taxis o All livery cabs o All limousines o Motorcycles are not covered Who is covered? o A driver of a motor vehicle injured in a motor vehicle accident o A passenger in a car injured in a motor vehicle accident o A pedestrian injured in a motor vehicle accident o A bicyclist injured in a motor vehicle accident o A passenger in a bus injured in a motor vehicle accident o A passenger in a taxi, livery cab or limousine injured in a motor vehicle accident o A passenger in a truck injured in a motor vehicle accident the schlitt law firm: remarkable service Page 2 of 6

3 Who Provides the No-Fault Coverage? No-Fault insurance is part of the coverage provided for every motor vehicle (except motorcycles) sold in New York or by an insurance company that sells coverage in New York. The injured person usually receives coverage through the insurance company that insures the vehicle in which the person was injured. For example, the driver or passenger would receive coverage through the insurance company that insured the car. Here are some more specifics on who provides the No-Fault coverage: An injured driver receives coverage through the insurance company of the car that he is driving. An injured pedestrian receives coverage through the insurance company of the car that hit the pedestrian. A bicyclist receives coverage through the insurance company of the car that hit the bicyclist. A passenger on the bus receives coverage through the bus insurance company. A passenger in a taxi, livery cab or limousine receives coverage through the vehicle in which he or she rode. A passenger in a truck receives coverage through the truck s insurance company. Filing a No-Fault Claim If you have been in a motor vehicle accident, you should contact your auto insurance carrier and notify them of the accident. Your auto insurance company is your No-Fault carrier. You will then submit all medical expense, claims for lost wages and claims for reimbursement of other expenses to that carrier. If you were a passenger in an accident or a pedestrian or bicyclist struck by a car in New York, you are entitled to No-Fault benefits. You will need to contact the insurance company for the driver to file for your No-Fault benefits. You must file a notice within 30 days of the accident or you may lose your benefits. Claiming No-Fault benefits in New York requires you to file a Notice of Accident form (the NF-2) to the insurer of the car you were in when the accident occurred. Pedestrians or bicyclists should send the NF-2 form to the insurer of the vehicle that hit them. You must file a written notice within 30 days. You will do best to submit the NF-2 form within 30 days of the accident to qualify for benefits. Do not delay. If you are unsure if you need benefits, send the form to protect your rights. the schlitt law firm: remarkable service Page 3 of 6

4 No-Fault Benefits: Medical Expenses The No-Fault benefits should cover your medical expenses. If you receive medical care due to injuries suffered in a motor vehicle accident, make sure your doctors and other health care providers know that your case involves a motor vehicle accident. Tell them that No-Fault insurance will cover your medical expenses. You will need to give them the name of the insurance company along with the policy number and/or claim number. Your doctor or other medical providers should bill the No-Fault insurance company directly, but if they send you a bill, you should contact the No-Fault carrier. New York State regulations set the reimbursement rate for healthcare providers paid by No-Fault. No-Fault Benefits: Lost Earnings Basic No-Fault coverage entitles you to receive 80% of your accident-related lost earnings up to $2,000 a month paid over a maximum of three years. To qualify, your employer must submit proof of your wages, the reason you cannot work and your loss of income. Your employer must submit that information within 90 days of the accident. If your employer fails to submit the necessary information on time, you lose out on your benefits. The lesson: make sure your employer sends the information to the No-Fault carrier. No-Fault Benefits: Other Expenses You are entitled to receive coverage for any expenses you incurred because of the accident. For example, if you need to fill a prescription, No-Fault should pay for that medicine. If you need to take a taxi or a bus to a doctor s appointment, No-Fault should cover that expense. Even if you have to hire someone to help with housework or babysitting because of your injuries, No-Fault should pay for those expenses that you would not have otherwise incurred if you had not had the accident. Seeking Compensation Above and Beyond No-Fault Insurance While No-Fault coverage will pay for most medical expenses, lost wages and other expenses, it will not cover beyond $50,000 and does not compensate for pain and suffering. If you believe you should receive compensation beyond the No-Fault coverage, you will need to bring a legal action to collect that compensation. You should consult with a New York attorney experienced with motor vehicle cases and New York s No-Fault law. We have extensive experience in this field and would be glad to discuss any questions you may have. You can call us at or send an to the schlitt law firm: remarkable service Page 4 of 6

5 Threshold Requirements to Seek Compensation Beyond New York s Motor Vehicle No-Fault Insurance Benefits To seek compensation beyond the No-Fault limits, New York State Insurance Law requires you to prove that you sustained a serious injury as a result of the accident. New York Insurance Law [ 5102(d)] defines serious injury as follows and you must satisfy at least one of these eight definitions: 1. Personal injury which results in death; 2. Dismemberment; significant disfigurement; 3. Fracture; 4. Loss of a fetus; 5. Permanent loss of use of a body organ, member, function or system; 6. Permanent consequential limitation of use of a body organ or member; 7. Significant limitation of use of a body function or system; or 8. A medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person's usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment. Many motor vehicle accidents result in soft-tissue injuries which can be very painful and debilitating. Recent court rulings in New York are making it harder to meet these insurance threshold requirements. Soft tissue injuries must meet item six, seven or eight and require documentation of specific injuries, extensive treatment and lost or limited functionality. Being unable to work for 90 out of 180 days following the accident may automatically meet the serious injury threshold. Here are some of the key indicators that can help meet the serious injury threshold: Making immediate complaints about pain or injuries at the scene of the accident. Receiving emergency room treatment or urgent care treatment on the day of the accident or as soon as possible in the next few days. Receiving a definitive diagnosis. For example, it is important to say more than you have a sore back, but to cite specific injuries verified through tests such as an MRI. Missing time from work due to the injury. Receiving consistent treatment for multiple months. Documenting a loss of motion of the cervical and/or lumbar spine. While an individual need not meet all of these indicators, the more of them met, the greater the likelihood of meeting the serious injury threshold. Understanding and meeting the threshold standards requires the counsel of an experienced New York attorney. We have extensive experience in this field and would be glad to discuss any the schlitt law firm: remarkable service Page 5 of 6

6 questions you may have. You can call us at or send an to I hope you found this information helpful. If you or a loved one has been hurt due to the negligence of another, you may want to consult a New York personal injury attorney. I would be glad to answer your questions and assist you. You can call me at or send an to Carol L. Schlitt New York Personal Injury Attorney The Schlitt Law Firm NYlawthoughts.com This material is intended for informational uses only. It is not meant as legal advice. To receive legal advice, you should consult an attorney. copyright by Carol L. Schlitt The material presented in this blog may not be reproduced or appropriated in any way without the explicit permission of the author. the schlitt law firm: remarkable service Page 6 of 6

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