New York No-Fault Law
What is New York’s “No-Fault Law?
New York’s “No-Fault” law provides compensation to people injured in or by vehicle accidents, including pedestrians and bicyclists. As the name implies, those injured are entitles to benefits up to the statutory maximum payment amounts regardless of who is at fault. Thus if you are injured in a vehicle crash, you are entitled to no-fault benefits from your insurance company even if you were responsible for causing the accident (unless one of the circumstances noted below exists).
No-fault benefits include payment or reimbursement for:
- Medical bills and the costs of medical treatment,
- Lost wages,
- Medications and other related treatment expenses,
- Travel expenses incurred for treatment.
- Certain other qualifying expenses.
Currently, New York benefits are capped at $50,000, which is the total amount that can be received, unless supplemental no-fault benefit coverage is purchased. In addition to this total cap, no-fault also provides other limitations, such as the amount that can be paid with respect to lost wages (which is capped at 80% of the lost wages, up to a maximum amount of $2,000 per month).
When are No-Fault Benefits Not Applicable?
No fault insurance is not available to those injured while driving or riding motorcycles, mopeds, or ATVs. Additionally, if you are a driver and you have not obtained the required no-fault insurance, you will not be entitled to no-fault benefits since there will not be any policy in place to provide such benefits.
No-fault insurance benefits are not available in certain cases in which drivers are engaging in certain egregious acts, including if a driver is:
- Driving while drunk or impaired by drugs that contribute to the accident,
- Injured through an action by which the driver intentionally causes his or her own injuries;
- Injured during the course of committing a felony,
- Driving a stolen vehicle, or
- Injured while racing.
What Injuries are Considered “Serious Injuries”?
Article 51 of the Insurance Law provides that a plaintiff in a personal injury action arising out of negligence in the use or operation of a motor vehicle must establish that he/she has incurred a basic economic loss exceeding $50,000 or must establish that he/she has suffered “serious injury”. Insurance Law § 5104(a), (b). Serious injury is defined as personal injury which results in one of the following:
- Significant disfigurement,
- Loss of a fetus,
- permanent loss of use of a body organ, member, function or system,
- Permanent consequential limitation of a body organ or member
- Significant limitation of use of a body function or system
- 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 90 days during the 180 days immediately following the occurrence of the injury or impairment.
Insurance Law § 5102(d).
It is important to remember that the total compensation for no-fault damages normally is $50,000, and does not include any award for pain and suffering. If significant pain and suffering has been incurred, a separate lawsuit against those responsible must be brought.
What Must Be Done to Receive No-Fault Benefits? Important Deadlines and Requirements.
The no-fault provisions require that a notice of claim be provided to the appropriate person’s insurance agency within thirty days following the accident. So, an injured driver, and the driver’s passengers would need to file this notice with the driver’s insurance company, not the driver of the other vehicle who may have hit them, within this time period. Similarly, an injured bicyclist or pedestrian would need to file this notice with the insurance company for the driver who struck them. Thereafter, claims for reimbursement must also be timely submitted to the insurance company (usually within 45 days of treatment).
Reimbursement and Documentation
If you’ve been injured in an accident for which no-fault benefits are being sought, you should carefully document each and every expense incurred as the result of your accident. To the extent possible, all expenses should be carefully itemized, and not lumped together. For example, travel costs should detail the dates and mileage for every trip and the health care provider seen, or the purposes of the trip. Medical expense and each prescription should also be individually itemized. If you purchase items such as medication, you will want to have the original receipt, not just an itemized item on a credit card statement.
We Help Clients Recover No-Fault Benefits From Their Insurance Company
If you have been seriously injured in a vehicle accident, we can help you submit the required claim form to your insurance company. Doing so will help you obtain benefits quickly while you recover. This is especially important as the legal process to recover against another driver at fault can take significant time; often months or even more than a year.
We can also assist in determining whether you have other coverage available that may provide compensation. Please call us today for a free consultation to learn how we may be able to help.