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How Does No-Fault Insurance Work In New York?

Get the answers from an experienced car accident attorney.

When you’re hurt in a car accident, understanding how the insurance situation works is critical to get the compensation you need. New York is among the minority of U.S. states that use a “no-fault” car insurance system. That doesn’t mean fault doesn’t matter; it means that each person involved in an accident files a claim with their own insurance company first.

The stated intent of a no-fault system is to provide motorists with stability and reliable coverage for accident-related injuries, but the outcome can be more complex. Keogh Crispi, P.C. understands New York’s system, and we can guide you through every step of the process. If you’ve been hurt in a crash, don’t go up against the insurance company alone; contact us today for a free consultation with an experienced attorney.

What does no-fault insurance cover in New York?

New York law requires every car insurance policy to include $50,000 in no-fault benefits (with the option to purchase more). There are two types of expenses covered by no-fault:

  • Medical expenses: all your medical treatment related to the accident, including ambulance fees, hospital costs, surgical, nursing, medication, prosthetics, therapy, rehabilitation, and dental services, is covered by no-fault, up to the policy limit.
  • Lost wages: if you are unable to work or need to work reduced hours due to your injuries, no-fault will cover 80 percent of your lost wages up to $2,000 per month. This benefit applies for up to 26 total weeks of disability (not including the first week), up to three years from the date of the accident, or up to the policy limit, whichever is least.

No-fault insurance does not cover damage to your vehicle (you need collision coverage for that), or other losses related to your injury such as pain and suffering.

Who is and isn’t covered by no-fault insurance?

In general, if you are injured in a car accident in New York, you should be covered by no-fault insurance. Whose insurance covers you depends on the situation:

  • If you were in a car (either as an operator or a passenger), you can file a no-fault claim with the insurance company that covers the car you were in.
  • If you were hit by a motor vehicle as a pedestrian or cyclist, you can file a no-fault claim with the insurance company that covers the vehicle that struck you.
  • If you were injured as a pedestrian in a hit-and-run with an unknown driver, or by an uninsured vehicle, you can file a no-fault claim with your own car insurance, or with a family household member’s car insurance.
  • If there is no available policy – for instance, if you were hit as a pedestrian by an uninsured driver and no one in your household owns a car – you can file a claim with the Motor Vehicle Accident Indemnification Corporation (MVAIC).

The most common exception to no-fault coverage is motorcycles. If you were riding on a motorcycle when the accident happened, whether as an operator or passenger, you cannot get no-fault benefits. (If you were a pedestrian hit by a motorcycle, you’re still covered.) No-fault insurance also generally does not apply if you were driving under the influence, driving in a drag race or speed test, driving in the commission of a felonious activity (such as evading police), or knowingly driving a stolen car at the time of the accident.

How long do no-fault insurance benefits last?

The medical expenses portion of your no-fault insurance has no end date. If you need treatment for injuries caused by the accident many years later, that treatment should still be covered. However, the need for future treatment must be medically ascertainable within one year of the accident. For example, if you sustained a knee injury in a car accident and your doctor can determine within a year of the accident that you will need a future knee replacement due to the injury, no-fault insurance should cover that knee replacement.

The wage loss portion of no-fault insurance ends three years after the date of the accident, if the benefits aren’t exhausted before then – for instance, if your disability is intermittent and you don’t have to take 26 consecutive weeks.

What if the insurance company tries to deny my claim?

Here we run into the problem with no-fault insurance: while the insurance company can’t deny claims based on fault, they can dispute whether a particular expense was accident related. For instance, the insurance company could argue that you had a pre-existing condition or that you are exaggerating the extent of your injuries and refuse to pay for treatment on that basis.

That’s one of the reasons it’s so important to see a doctor as soon as possible after a car accident. Getting medical care creates a record of your injuries that makes it harder for the insurance company to dispute them later. It’s also why you need to choose an attorney who knows how the insurance companies operate and will relentlessly advocate for your rights.

If New York is a no-fault state, can you sue the other driver?

The short answer is “it depends.” In order to file a lawsuit against the at-fault driver, you need to meet the state’s definition of “serious injury.” New York law defines “serious injury” as any of the following:

  • Death
  • Dismemberment
  • Significant disfigurement
  • A fracture (broken bone)
  • Loss of a fetus
  • Permanent loss of use of an organ, member, function or system of the body
  • Permanent consequential limitation of use of a body organ or member
  • A non-permanent injury or impairment that stops you from performing your usual daily activities for 90 of the 180 days immediately after the accident.

Some of those standards are quite clear-cut, but others are open to interpretation. Whether your injury is considered “serious” or not can make a dramatic difference, since taking legal action against the other driver can provide compensation not covered by no-fault, such as excess wage loss or pain and suffering. Again, choosing a lawyer who knows how to maximize the value of your claim will make all the difference.

We are firmly in your corner throughout the claims process.

You were hurt badly enough by the car accident. You shouldn’t get hurt again by the insurance company. When you come to us, we’ll listen to your story and review the applicable insurance coverage to get a sense of the value of your case. If you choose to hire us, we’ll take over day-to-day negotiations with the insurance company so that we can protect your rights and allow you to focus on healing. Your job is to go to your medical appointments and follow your doctor’s instructions. We’ll keep you informed about the legal situation.

Our legal team will thoroughly investigate your accident and fight for the full monetary compensation you deserve from the insurance company. At each stage, we will prepare you for what’s coming next and work with you to develop a winning strategy. We do all this on a contingency fee basis, which means we don’t get paid unless and until we win your case. If we don’t win, you don’t owe us a dime.

It’s important to speak with us right away, before you talk to the insurance company, so that we can protect your rights from the beginning of the process. Contact us online or give us a call to schedule your free consultation with an experienced New York car accident attorney.

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