**Please note: If you have been involved in a car accident in New York State you must file an application for no-fault benefits with your insurance company within 30 days of the accident. This is a very strict deadline with few exceptions. You can find the form here: NF-2 Form.**
If you have been in a car accident in New York state, you need to understand New York’s no-fault insurance coverage and limitations. New York State’s no-fault insurance system is designed to provide prompt financial assistance to individuals injured in motor vehicle accidents, regardless of who was at fault. This system aims to reduce the need for lengthy legal battles over minor injuries and ensure that accident victims receive necessary medical care and lost wages without delay.
What Is No-Fault Insurance?
No-fault insurance, also known as Personal Injury Protection (PIP), is a mandatory component of all auto insurance policies in New York. Under this system, your own insurance company covers certain expenses resulting from a car accident, regardless of who caused the crash. This approach is intended to streamline the claims process and provide immediate financial support to those injured.
An Accident Scenario:
John is driving his car in downtown Rochester, New York, during rush hour. While he is stopped at a red light, another driver, Susan, rear-ends his vehicle. The impact causes John to experience neck and back pain, and his car sustains minor damage.
Police Report and Medical Treatment:
- John calls the police, and they arrive to document the accident. The drivers exchange insurance information.
- John goes to the emergency room that evening, where he is diagnosed with whiplash and lower back strain. The doctor advises rest and physical therapy.
- Over the next few weeks, John attends multiple physical therapy sessions and takes time off work due to his injuries.
Because New York is a no-fault insurance state, in the above scenario John’s own auto insurance carrier will cover his medical and lost wages expenses up to the amount of coverage, even though the accident was Susan’s fault.
Who Is Covered by No-Fault Insurance Benefits?
Eligibility for no-fault benefits extends to:
- Drivers and Passengers: Injured vehicle occupants involved in an accident.
- Pedestrians and Bicyclists: Individuals struck by a motor vehicle.
What Does No-Fault Insurance Cover?
No-fault insurance in New York typically covers the following expenses, known as Basic Economic Loss items, up to a limit of $50,000 per person:
- Medical Expenses: Costs for necessary and accident-related medical treatment, including hospital bills, surgeries, medications, and rehabilitation services.
- Lost Wages: Reimbursement for lost income if the injury prevents you from working. Typical coverage is limited to 80% of lost wages up to $2,000 per month for up to 3 years following the accident. However, you should check your policy as additional benefits, known as Additional Personal Injury Protection or APIP benefits, can be purchased.
- Other Reasonable and Necessary Expenses: Coverage for essential services such as transportation to medical appointments or household help during recovery may be covered.
What No-Fault Insurance Does NOT Cover
Fundamentally, no-fault insurance ensures you can receive prompt compensation, however, this coverage may not be enough. New York No-Fault Insurance does not cover:
- Medical expenses over $50,000 per person.
- Compensation for pain and suffering.
- Property damage.
- Damages above $50,000 per person.
- Notably motorcyclists are not covered by New York’s no-fault law. They typically have no benefits available under their motorcycle insurance policy to pay for medical bills and lost wages. Therefore, it is important that motorcyclists hurt in an accident contact an attorney for assistance right away.
If your injuries meet New York’s “serious injury threshold” you may be able to bring a claim against the at-fault driver to recover for the items of damage that no-fault insurance does not cover. (See explanation below under “When to Call a Personal Injury Attorney”).
Additional Optional Coverage to Consider
While basic no-fault coverage provides immediate support, it may not fully compensate for all losses. This is especially true for those earning more than $2,000 per month and for those suffering severe injuries.
Additional coverage can be purchased to raise the $50,000 benefit limit. The optional coverages listed below can provide greater financial protection in the event of serious injuries:
- Optional Basic Economic Loss (OBEL): Provides an additional $25,000 in coverage that can be applied to basic economic loss expenses.
- Additional Personal Injury Protection (APIP): Supplemental coverage, typically offered in $50,000 increments, that also extends the basic economic loss benefits.
Filing a No-Fault Claim
Step 1
To receive no-fault benefits, you must file a claim with your insurance company within 30 days of the accident. This involves completing the NF-2 form, also known as the Application for No-Fault Benefits. This form is intended to let the insurance company know that you will be submitting a claim for lost wages and / or medical expenses. Timely and accurate submission of this form is crucial, as delays or errors can result in denial of benefits. There are very few exceptions to this strict deadline.
Step 2
When you go to the hospital, doctor, physical therapist, or the pharmacy be certain to tell them this is a motor vehicle accident claim and that all bills should be submitted to the no-fault insurance carrier. Provide the insurance company name, claim number as well as the adjuster’s name, phone number and email address. If any bills are mistakenly sent to your health insurance company, notify both the provider and the health insurance carrier of the error as soon as possible.
If your physician does not want you to work, he or she needs to complete a disability note stating you are not able to work. This should be emailed or faxed directly to your no-fault adjuster. Even if your doctor writes a note that you cannot work for 6 months, many companies will require a fresh note every 30 days or they will not issue lost wage payments.
Step 3
To obtain your no-fault lost wage payments, ask your employer to complete an NF-6 Employer Wage Verification Report to prove you are employed and how much pay you are losing by being out of work. Ask your employer to fax or email the form directly to the insurance company. Ask them to copy you on the transmittal so that you know it has been completed and submitted. You can obtain a copy of the NF-6 form here.
If you are self-employed, you should complete an NF-7 Verification of Self-Employment Form. You can obtain a copy of the NF-7 form here.
The NF-6 and NF-7 must be submitted within 90 days after the work loss was first incurred. You will need to follow up to be certain that your employer submits the form in a timely fashion.
Delays in submission or mistakes in these forms will result in delayed payment.
Step 4
You may be eligible for short-term or long-term disability benefits through your employer. Contact your human resources representative and promptly apply for all benefits for which you are eligible. If you are not eligible, get a letter from your employer stating you are not eligible and why you are not eligible. The no-fault insurer is allowed to take an offset, or credit, for payments to which you are entitled under a disability policy through your employer. If you do not apply for those benefits in a timely manner, those benefits may be denied. The no-fault insurer will still reduce your lost wage payments by the amount you could have received.
New York No-Fault Insurance Claim Challenges
No-fault insurance aims to simplify and expedite obtaining some compensation after a car accident. However, dealing with no-fault insurance can present significant challenges despite its intent to streamline claims.
One of the primary hurdles in filing a no-fault insurance claim is the requirement for extensive documentation. Good record keeping and documentation is key. Insurance companies scrutinize both lost wage claims and medical claims to ensure that your claims are valid. You must have medical documentation to support your inability to work. Your injuries and medical expenses must be deemed to be directly related to the accident. If your documentation does not clearly demonstrate this connection, the insurer may deny or delay your claim.
Additionally, insurance companies may attempt to limit your compensation by arguing that specific treatments are unnecessary, unrelated to the accident, not beneficial to your condition or that you have reached the maximum limits of your coverage. This can be particularly frustrating when you are focused on recovery and may not have the time or energy to dispute these assertions.
Remember, delays in providing documentation will result in delays processing your payments. When you are out of work, even a short delay can be problematic. Stay proactive. Follow up with your no-fault adjuster to make sure they have everything they need to process your claim in a timely fashion.
When to Call a Personal Injury Attorney
To pursue a claim against a negligent driver in New York State, the law requires you to have sustained a “serious injury”. The intention is to keep minor injuries out of the court system. If you have suffered a serious injury, it is likely that the no-fault system has not provided you with adequate compensation for your pain, suffering, permanent injury, and other long-term damages. New York law defines “serious injury” as including:
- Death
- Significant Disfigurement: Noticeable and permanent scarring or disfigurement.
- Fractures: Broken bones resulting from the accident.
- Permanent or Significant Loss of Use: Permanent loss of use of a body organ, member, function, or system. In some cases, a significant but non-permanent loss of use can qualify.
- Substantial Disability: A medically determined injury or impairment that prevents you from performing usual activities for at least 90 of the 180 days immediately following the accident. These 90 days need not be consecutive but must all fall within the 6 months after the accident.
Determining what is a qualifying injury can be complex, please contact our personal injury attorneys if you have questions.
Importance of Legal Assistance
If you have sustained a serious injury in a motor vehicle accident, it is important to contact a personal injury attorney as soon as possible. An experienced attorney can help you to preserve evidence, comply with time limitations, navigate the complexities of the no-fault system, avoid costly mistakes, and properly evaluate your claim. Clients who try to negotiate on their own with the adverse insurance company often make mistakes that can be detrimental to their claim or miss important deadlines. The experienced personal injury attorneys at Lacy Katzen LLP are here to help. Contact us today for a free consultation.
