Understanding No Fault Benefits In New York

Injured in a New York car accident and wondering how your medical bills are going to be paid and by whom? Well, you have come to the right place for answers here in part I of our series on New York No Fault law.

What is no fault?

New York is a no fault state. That means that every motor vehicle (car, van, truck, etc.) garaged in New York state must be covered by an insurance policy which provides the state minimum level of benefits for any occupant of the motor vehicle who is injured in a car accident, regardless of fault (with certain exceptions). These benefits are known as no fault benefits.

Who pays the medical bills when I am injured in a car accident?

The insurer of the vehicle that you were occupying during the accident is known as the no fault carrier. The no fault carrier is obligated to pay the accident related medical bills and related expenses up until the point that the benefits have either been paid in full or more commonly, been terminated by the carrier.

What do no fault benefits cover?

  • Accident related medical, hospital, surgical, nursing and dental services;
  • prescription drug and prosthetic services;
  • Ambulance services;
  • psychiatric, physical and occupational therapy and rehabilitation;
  • Other expenses shall consist of all reasonable and necessary expenses, other than medical expense and work loss, up to $25 per day for a period of one year from the date of the accident causing injury.
  • any other professional health services

Does no fault cover lost wages?

Yes: 80% of Lost wages up to a maximum payment of $2,000 per month for a maximum period of three years from the date of the accident.

Will my no fault benefits be based on time alone?

These medical expenses will not be subject to a time limitation, provided that, within one year after the date of the accident, it is ascertainable that further medical expenses may be sustained as a result of the injury.

What is the minimum amount of no fault benefits?

By law, every New York automobile insurance policy has to provide for a minimum of $50,000 in no fault benefits. For a small additional premium, a person can purchase additional personal injury protection or APIP which increases the coverage to $150,000. Check your insurance policy to see if you have APIP and call your agent and ask that this coverage be added to your policy if it isn't there.

Passengers, Pedestrians And No Fault Benefits In New York

Motor vehicle passengers injured in car accidents in New York can usually expect to have no fault benefits paid by the vehicle's insurer. Unfortunately, there are exceptions as we discuss here in Part III of our series on New York no fault benefits.

Bus Passengers

You are riding on the Bee line bus in Westchester County or maybe a city bus in New York, Syracuse or Buffalo or are an occupant of a school bus and are injured in a bus accident. Think that the city or county's insurer is going to pay your medical bills or lost wages? Think again.

What happens if I am injured while riding a bus or a school bus?

This is one of the exceptions to the general rule that you look to the host vehicle for payment of no fault benefits following a car accident. You must first look to:

  1. Your own auto insurer if you own a car, or if none
  2. The auto insurer for any vehicle owned by a relative with whom you reside

What if I am injured on a bus and I don't own a car?

You can only file an application for no fault benefits with the insurer for the school bus or bus if you do not own a motor vehicle or live with a relative in New York who owns a motor vehicle. Only in this situation can you seek no fault benefits from the insurer of the bus if you are not an owner, operator or employee of an owner or operator of the bus.

What if I am an owner, operator or employee?

You are eligible for no fault benefits from the bus company's insurer regardless of whether you own a car or reside with a relative who does.

Motorcycles

Motorcycle drivers and passengers are out of luck if they are injured in an accident as no fault benefits are not provided to motorcyclists. Some motorcycle insurance policies have what is known as med-pay coverage which is limited in scope, but will cover some of the medical bills if applicable.

Pedestrians Injured By Motor Vehicles

All too frequently we hear about people struck by a motor vehicle while crossing the street or even walking on the sidewalk. Where do pedestrians get no fault benefits from?

The at fault vehicle must furnish no fault benefits. It doesn't matter if the offending vehicle is a school bus, motorcycle or tow truck. As long as the vehicle in question falls within the definition of motor vehicle, that vehicle's insurer is on the hook for no fault benefits.

Hit And Run Accidents

Sometimes the driver of the at fault vehicle has no regard for the law and drives away after knocking down a pedestrian without concern for the injured pedestrian's health. If the pedestrian cannot identify the vehicle, it is of critical importance that the police are notified of the incident immediately and a report filed within 24 hours of the incident.

Who pays no fault benefits in a hit and run accident?

  1. Your own auto insurer if you own a car, or if none
  2. The auto insurer for any vehicle owned by a relative with whom you reside
  3. If you live in New York and neither own nor reside with a relative who owns a motor vehicle, then you need to seek benefits from the Motor Vehicle Accident Indemnification Corporation - MVAIC
    1. Note that there time sensitive deadlines for seeking benefits from MVAIC so having an attorney involved at the outset of the claim is very important

What happens if I am injured while on the job?

It gets a bit complicated. Assuming that you are occupying a car while in the course of your employment and have the misfortune of being involved in a car wreck you must:

  1. Notify your employer of the incident immediately.
  2. File an application for worker's compensation benefits with your employer's worker's compensation carrier. You will receive worker's compensation benefits in lieu of no fault benefits.
  3. Report the accident to the insurer for the vehicle that you were occupying. You may be eligible for payment by the no fault carrier of the difference in lost wages that are paid by worker's compensation.

Worker's compensation benefits paid in lieu of no fault benefits up to the $50,000 threshold are not subject to the customary worker's compensation lien against the proceeds of any personal injury claim or lawsuit. However, permission to settle the claim or lawsuit must still be obtained from the worker's compensation carrier before a case can be settled.

When is an injured person not eligible to receive no fault benefits?

If you were injured as a result of any of the examples below...

Driving a motor vehicle while drugged or intoxicated; Riding a motorcycle; or Riding a Snowmobile; or any person while:

  1. committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer
  2. operating a motor vehicle in a race or speed test
  3. operating or occupying a motor vehicle known to that person to be stolen
  4. repairing, servicing or otherwise maintaining a motor vehicle if the conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the injury occurs on the business premises

Let's hope that you or anyone that you care about never falls into of these exceptions.

We began our discussion on New York no fault benefits in Part I of our series. We continue the discussion here in Part II and focus on what steps have to be taken in order to obtain No Fault Benefits.

How do I obtain no fault benefits?

The car accident occurs and the clock starts to run. You must take a series of steps to protect yourself and insure that the no fault benefits will be furnished.

Identify The No Fault Carrier And Report The Accident

  • The no fault carrier is the insurer for the vehicle that you were occupying during the accident.
  • If you were injured in a motor vehicle that you own, then contact your auto insurer at the claims number provided in your policy.
  • If the injury occurred while you were a passenger in a car owned by a member of your household, you are covered under the owner's policy and are eligible for no fault benefits through that policy.
  • If you are hurt while a passenger in any other private passenger vehicle, the insurer for that vehicle will be obligated to furnish no fault benefits

If you are neither the owner or a resident relative of the vehicle's owner, it can be a bit trickier.

For example, if you were injured while riding as a passenger in a taxi-cab or an airport limousine, you will need to obtain the police report of the accident. The police report will have the identity of the carrier, the name of the policy holder and in some cases, the policy number. Once you can identify the no fault carrier, you can contact the claims office for that carrier (there is usually an 800 number to report the claim). This should be done promptly - do not wait.

What if I am struck by a car or bus while I am a pedestrian?

The no fault carrier for the vehicle which struck you is obligated to furnish no fault benefits. This applies even if you are the owner of a motor vehicle. So long as you were stuck by a car and injured while a pedestrian, the no fault carrier for the offending vehicle will be responsible for providing no fault benefits.

How much time do I have to notify the no fault carrier?

This is very important. You have 30 days (and that is it!) from the date of the accident to notify the carrier of the accident and your claim for no fault benefits.

  • The notice must be in writing and set forth details sufficient to identify yourself along with reasonably obtainable information regarding the time, place and circumstances of the accident.
  • A copy of the Police Report should be provided to the no fault carrier to satisfy the notification requirement.

What happens after I contact the carrier and provide notice of the accident?

The no fault carrier will mail you a number of documents. These will include an Application for No Fault Benefits. The application must be filled out completely, signed in three places and returned to the no fault carrier promptly. We recommend that this completed form be mailed to the carrier by certified mail so that there is no question that the form is actually received by the carrier. The application for no fault benefits seeks information such as your name, date of birth, address, social security number as well as a description of your injuries.

The completed application must be returned to the no fault carrier within 30 days of the accident if the original notice (described above) was not in writing.

It is important to involve an attorney in this process at the earliest possible date to ensure that the application is properly completed and timely returned to the no fault carrier.

What information do I provide to my doctors and other providers?

The carrier will assign a claim number to your case. This claim number must be provided to each of your health care providers along the following information:

  • The date of your accident
  • The identity of the Carrier
  • Your date of birth

Each of your providers will have you sign a form assignment of benefits. Signing this form allows your doctors and other health care providers to bill the no fault carrier directly for services rendered to you. If there is a dispute between the provider and the carrier and you have signed an assignment of benefits form, the provider and not you will be responsible for resolving the dispute.

What if I am coming up to the 30-day time period and I have not reported the accident or do not know who the no fault carrier is?

This happens all too frequently. It is in situations like that where it is critical to contact a personal injury lawyer and get legal advice immediately. The sooner that an attorney is involved in your claim, the better it will be for you. The stakes are high and you don't want to risk being on the hook for payment of potentially large medical bills.

Call us if you have any questions on these or any other issues related to no fault law in New York.

We discuss bus passengers, motorcycles and other exceptions to the rules in the next part of this series.

New York No Fault Application