New York No-Fault FAQs by the No-Fault Attorneys at HURT-911®
These New York No-Fault FAQs will help you understand No-Fault insurance and how the New York No-Fault Insurance Lawyers at HURT-911® will protect your rights to No-Fault insurance benefits.
What is No-Fault Insurance Coverage?
What does No-Fault mean?
No Fault means No-Fault insurance and is frequently misunderstood. No-Fault has nothing to do with who was at fault for a car accident. No-Fault is not liability coverage.
No-Fault gets its name from the fact that no-fault insurance coverage is available to an insured regardless of who’s at fault.
Before the New York No-Fault law was enacted, auto insurers would file lawsuits against each other, fighting over which insurance company would pay for medical bills and lost wages.
The No-Fault law eliminated costly legal fighting between insurance companies by eliminating the need to make the decision of who was at fault for causing the accident. Under New York No-Fault law, a driver who caused a car accident will still get no-fault coverage from his/her own insurance company.
This means that anyone who was injured will have their medical bills and lost wages paid by the insurance company insuring the car they were sitting in at the time of the car accident.
What is No-Fault Insurance Coverage?
No-Fault insurance is like health insurance and disability insurance when you’re in a car accident.
What is the Difference Between No-Fault and PIP?
No-Fault insurance is also called Personal Injury Protection or “PIP” and is the same insurance coverage.
An advantage of No-Fault insurance coverage is that if you have a personal injury claim or lawsuit, No-Fault insurance cannot have a lien against your personal injury settlement.
You can buy additional personal injury protection insurance coverage over the New York State minimum of $50,000 called APIP or Additional PIP.
If you do not have adequate health insurance, you should buy additional personal injury protection insurance coverage.
Who Can Get No-Fault Benefits?
No-fault insurance coverage is available only to people injured in car accidents, bus accidents, and pedestrians.
What Type of Accidents Does No-Fault Insurance Apply To?
No-Fault applies to car accidents, bicycle accidents, pedestrian accidents, and some other motor vehicle accidents. It does not cover motorcycle accidents or non-motor vehicle accidents like slip and fall accidents. However, a pedestrian injured by a motorcycle is covered by No-fault insurance.
What is the NYS Law for No-Fault?
No-Fault is regulated by Article 51 of the New York Insurance Law, which requires no-fault insurance coverage for car accidents.
Department of Insurance Regulation 68 implements New York’s No-Fault law.
Which No-Fault Insurance Company Will Pay My Medical Bills?
No-Fault benefits are paid by the insurance company for a car according to predetermined rules. You do not get to choose which insurance company will pay.
No-fault benefits are usually paid by the insurance company for:
- The car you were sitting in at the time of the accident
- The car which struck you if you were a pedestrian or bicyclist
- The motorcycle if you were a pedestrian or bicyclist hit by a motorcycle
- Motorcycle riders and passengers on motorcycles do not get No-Fault insurance benefits
There are instances that will change which No-Fault insurance company will pay your benefits, but that gets a little too complicated to discuss here. That’s one of the reasons you should have a knowledgeable No-Fault lawyer in New York.
Who Provides No-Fault Insurance in a Hit and Run Accident or if the Car Was Stolen or Uninsured?
In a hit-and-run car accident (the police report will say “left the scene” and not give any information for the car or driver) or if the other car was stolen, there is no insurance coverage for the other car. However, that’s OK, just keep reading to see how you will get No-Fault insurance.
If You Were a Driver or Passenger in a Car
If you had a car accident with an uninsured car and you were a driver or passenger in a car that was insured, the insurance company for the car you were in is the No-Fault insurance company and will pay your medical bills.
If the car you were in at the time of the car accident was not insured and was not owned by you, but you own a car or you live with a relative who owns a car, your or your relative’s car insurance is the No-Fault insurance company and will pay your medical bills.
If the car you were in at the time of the car accident was not insured and was not owned by you, and you do not own a car, your No-Fault insurance is provided by MVAIC (Motor Vehicle Accident Indemnification Corporation), an NYS insurance agency.
If the Injured Pedestrian or Bicyclist Owns a Car or Lives With a Relative Who Owns a Car
A pedestrian or bicyclist riding a bicycle who is hit by an uninsured car must file a No-Fault claim within 30 days of the accident with their own auto insurance company if the injured person owns a car or with their relative’s auto insurance company if living with a relative who owns a car.
If the Injured Pedestrian or Bicyclist Does Not Own a Car or Live With a Relative Who Owns a Car
If the injured person does not own a car, a No-Fault claim must be filed within 30 days of the accident with MVAIC (Motor Vehicle Accident Indemnification Corporation), which is an NYS insurance agency that provides insurance coverage for pedestrians and bicyclists who are injured by a vehicle that is uninsured, and no other auto insurance is available.
Is a Car With Out-Of-State Plates Covered by No-Fault Insurance if I Have an Accident in New York State?
Yes. When a car from a state that is not a No-Fault state has an accident in New York, the driver, passengers, and injured pedestrians are covered by New York No-Fault insurance.
If a Pedestrian or Bicyclist Is Hit by a Car With Out-Of-State Plates, Which Insurance Is the No-Fault Insurance?
A pedestrian who is hit by a car with out-of-state plates but the accident happened in New York State will get a minimum of $50,000 of No-Fault insurance coverage from the out-of-state car.
A bicyclist riding a bicycle that is hit by a car with out-of-state plates but the accident happened in New York State will get a minimum of $50,000 of No-Fault insurance coverage from the out-of-state car.
How Much No-Fault Insurance is There if the Car has Out-of-State Plates?
Cars From States Without No-Fault Insurance That Have a Car Accident in New York
Most other states do not have No-Fault insurance coverage.
If a car from a state without No-Fault insurance coverage drives into New York, the car will have the New York minimum of $50,000 in No-Fault insurance coverage if it is involved in a car accident in New York.
Cars From States With Lower No-Fault Insurance That Have a Car Accident in New York
Many other states have lower insurance limits than New York. For instance, Florida has a minimum of only $10,000 of No-Fault insurance coverage.
When a car with Florida plates is involved in a car accident in New York, the driver, passengers, and pedestrians struck by the car are entitled to the New York minimum of $50,000 in No-Fault insurance coverage even if it had only $10,000 No-Fault insurance coverage in Florida.
We have seen insurance companies try to claim that their state minimum applies, but it does not. Once a car enters New York State, New York’s minimum insurance coverage limits come into effect.
If you were a driver or passenger injured in a car with out-of-state plates, but the car accident happened in New York State, you are entitled to the New York minimum of $50,000 No-Fault insurance.
If you were a pedestrian injured by a car with out-of-state plates but the car accident happened in New York State, you are entitled to the New York minimum of $50,000 No-Fault insurance.
If I Was a Passenger in a Car With Out-of-State Plates, Which Insurance is the No-Fault Insurance?
Someone who is a driver or passenger in a car with out-of-state plates that has a car accident in New York will get No-Fault insurance from the out-of-state car.
Someone who is a pedestrian hit by a car with out-of-state plates will get No-Fault insurance from the out-of-state car.
If I Was a Passenger in an Uber Car or Lyft Car Which Insurance is the No-Fault Insurance?
A passenger in an Uber car or Lyft car who is injured in an accident while occupying, entering, or exiting the Uber car or Lyft car will get No-Fault insurance from the Uber or Lyft car’s underlying insurance, which is usually American Transit or Hereford.
Pedestrians and bicyclists injured by an Uber car or Lyft car will get No-Fault insurance from the Uber or Lyft car’s underlying insurance, which is usually American Transit or Hereford.
People injured in an Uber accident or Lyft accident have substantial insurance to compensate for pain and suffering.
Who Provides No-Fault Insurance if the Driver Was Drunk?
New York law permits car insurance companies to exclude No-Fault insurance coverage for treatment of injuries caused by a car crash that you caused while driving drunk.
A drunk driver should file a No-Fault insurance claim anyway.
A passenger in a car driven by a drunk driver can file a No-Fault insurance claim.
If the driver of the other car was drunk, it has no effect on your No-Fault insurance claim.
Who Provides No-Fault Insurance if the Car Was Stolen?
A stolen car is not insured. If the other car was stolen, it does not affect your No-Fault insurance because you have No-Fault insurance coverage with your own car insurance company.
A passenger in a stolen car who did not know the car was stolen may be able to file a No-Fault insurance claim with the New York State MVAIC.
Can I Use My Health Insurance or Medicare to Pay My Medical Bills?
No, not initially. NYS law says that No-Fault is primary and health insurance or Medicare is secondary. This means that No-Fault MUST be the first insurance to pay your medical bills.
Because No-Fault is primary insurance coverage, that means medical bills for treatment of injuries from a car accident will not be paid by health insurance or Medicare until No-Fault has denied you further medical treatment.
If you request your doctors to bill your health insurance for Medicare instead of No-Fault, they will likely not agree, but if they do, your health insurance company or Medicare could seek reimbursement from you when they find out you were injured in a car accident. It will also make it more difficult to settle your case.
If you do not file a no-fault application within 30 days of your accident, you will lose important no-fault benefits such as payment for lost wages and household help.
Q. How will my health insurance or Medicare find out that I was injured in a car accident?
A. They have computer software that looks at the medical ICD codes to look for codes that have to do with medical treatment for trauma. When they see these codes, they began to investigate to determine if there was a car accident or some other accident where a lawsuit might be involved.
When Can I Submit Medical Bills to My Health Insurance Company or Medicare?
You can submit medical bills to your health insurance company or Medicare only when No-Fault will not provide coverage because:
- Further medical treatment was denied by a No-Fault doctor after an exam, or
- No-Fault has paid out the maximum coverage you have ($50,000 minimum), or
- You did not file a No-Fault claim and no hospital or doctor filed a No-Fault claim within 30 days of the car accident and it is too late to file.
- You were a motorcyclist or a passenger on a motorcycle
TIP: If you have a problem getting treatment, get a letter from the No-Fault insurance company denying your claim and give that to the doctor. Your doctor will now accept your health insurance.
Who Is Covered By No Fault Insurance?
No-Fault insurance is available to anyone injured in a car accident, bicycle accident, or pedestrian accident if you were not working in the course of your employment when the accident occurred. If you were working for your employer at the time of your accident, your bills will be paid by worker’s compensation, and you should advise us immediately.
The car does not have to be moving! No-Fault will even pay you benefits if you were getting into a car or getting out of a parked car. We obtained No-Fault benefits for a client who was hit in the nose by the car door when she was getting out of a parked car.
The no-fault law does not provide coverage for occupants of a motorcycle in a motorcycle accident. However, a pedestrian or bicyclist struck by a motorcycle is entitled to No-Fault benefits.
The No-Fault insurance company is usually the company insuring the car in which you were sitting at the time of the accident or the car that struck you if you were a pedestrian or bicyclist.
What Does No-Fault Insurance Pay For?
No-fault insurance pays for various benefits, including:
- Medical treatment, ambulance, hospital, doctors, therapists, dentists, radiology, and other diagnostics
- Medical appliances
- Household help
- Transportation to doctors (taxi, bus, or mileage)
- Lost wages or lost income (80% of your lost gross wages is paid by No-Fault less lost wages paid by New York State Disability. A NYS Disability form must be given to your employer within 30 days of your accident)
- Funeral expenses (see more information about wrongful death)
How and When Do I Have to File a No-Fault Application?
A claim for no-fault insurance benefits must be filed within 30 days of the date of the car accident, and an application (NYS Form NF-2) must be filed within a reasonable time thereafter.
Your car accident lawyer should both file your claim and fill out the NF-2 application form for you. There are questions on the NF-2 application form that you could fill out improperly, causing you to lose no-fault benefits.
The no-fault insurance company is most often the car in which the injured person was sitting or the car which struck a pedestrian or bicyclist. However, determining the proper no-fault insurance company can be complicated and can take time. Therefore, it’s important to call a lawyer as soon as possible after a car accident to make sure that an application for no-fault benefits is filed with the correct insurance company within the 30-day time limit.
If you were injured in a car accident; hit by a car while on a bicycle; hit by a car while a pedestrian; or just injured by a car whether it was moving or not, we will file a No-Fault claim and your No-Fault application for you. Just call the 1-800-HURT-911® Personal Injury Dream Team™ right now 7 days/nights for a free consultation with no obligation at 1-800-HURT-911 >> 1-800-487-8911
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How To Fill Out a NY No-Fault Application Without a Lawyer
- You do not have to enter your phone number on the No-Fault application. We do not enter our clients’ phone numbers on the No-Fault application because we don’t want the insurance company talking to you or getting a statement. Additionally, we want all communications in writing.
- For your injuries, list every part of your body because you only have 12 months to notify No-Fault of an injury, and sometimes injuries appear after 12 months. We enter: “MULTIPLE PERSONAL INJURIES INCLUDING, BUT NOT LIMITED TO HEAD, BRAIN, JAW, NECK, BACK, LIMBS, JOINTS, TENDONS, LIGAMENTS, BODY, PSYCHOLOGICAL.”
- For the accident description, write only a short description such as “one-car collision,” “two-car collision,” “accident with a pedestrian,” “accident with a bicycle,” “accident with a motorcycle,” etc.
- You can answer all the other questions on the No-Fault application, especially your lost wage information.
Should I Sign a Legal Document for My Doctor Called an Assignment?
YES! The hospital and doctors you visit usually request that you sign a paper called an “Assignment.” It allows the hospital or doctor to be paid directly by your no-fault insurance company. You should sign this paper (see why in the next paragraph).
Do I Have to Pay for Any Part of the Hospital or Doctors’ Bills?
When you have a car accident in New York, you do not have to pay any part of the ambulance or hospital as long as you file an application for No-Fault benefits within 30 days of your car accident.
You will not be responsible to pay any part of your doctor’s bills if you sign an assignment with your doctor. Read the topic above, “Should I Sign a Legal Document for My Doctor Called an Assignment?”
The advantage of signing an assignment is that the medical provider will not be allowed to bill you for any charges other than what they are paid by no-fault insurance. If the hospital or doctor’s bill is $1,800 but is paid only $487 from no fault, you are not responsible for the balance of $1,313.
IMPORTANT — If you visit a doctor who does not ask you to sign an assignment or is unwilling to let you assign the claim to the doctor, you will be responsible for the difference between what no-fault pays you and what the doctor charges you. When a doctor does not have you sign an assignment, they will usually tell you that they will give you a bill that you can submit to No-Fault. This will cost you!
Another advantage of No-Fault insurance coverage is that if you have a personal injury claim or lawsuit, No-Fault insurance will not have a lien against your personal injury settlement.
How Much Time Do I Have to Submit Medical Bills
Bills for medical expenses must be submitted to the No-Fault insurance company within 45 days of incurring the expense.
We can fax the no-fault information to your doctor or medical provider. If the doctor sends the medical bill in after 45 days, you will not be responsible for the bill.
TIP — People injured in a car accident often get stuck paying the ambulance bill because the ambulance often sends the bill directly to you and usually a lot more than 45 days after your accident. By that time, it’s too late. You should make sure that the ambulance bill is sent to the no-fault insurance company within 45 days. The ambulance bill can cost as much as $500-$2,000. We can notify the ambulance company of your no-fault information and let them know that if they do not submit the bill within 45 days, you will not be responsible.
See our page about lost wages and how much you are entitled to receive.
Receipts for household help should be signed and indicate the name and address of the person providing the service, together with a copy of a picture ID from the provider.
Taxi & Transportation to Doctors
Receipts for transportation to your doctors who treat you for injuries caused by your car accident and transportation to No-fault exams should show the name of the company; the date; the address from which you were picked up; and the address at which you were dropped off.
Other Necessary Expenses
The time period for submitting other necessary expenses is no more than 90 days after the necessary expenses were incurred. Receipts for expenses must show the amount you spent and the name of the company or person you paid.
Most people purchase No-Fault insurance policies with a $200 deductible per accident. You are responsible to pay the deductible. However, it’s possible that you can be reimbursed the $200 by your health insurance policy if your health insurance policy does not have a deductible. If your health insurance policy does have a deductible, the $200 No-Fault insurance deductible can be applied toward your health insurance deductible.
How Much No-Fault Insurance Coverage Do I Have?
The minimum no-fault coverage required by New York State is $50,000 and is referred to as basic no-fault coverage.
You can purchase additional no-fault coverage referred to as APIP (Additional Personal Injury Protection) and OBEL (Optional Basic Economic Loss). Many people purchase APIP and OBEL for additional coverage.
The amount of coverage will be shown on the declarations page of your insurance policy. The declarations page is the page that shows all of your coverages and how much you are being charged. No-Fault will usually be shown as Personal Injury Protection or “PIP.”
If your No-Fault insurance comes from an out-of-state car, the insurance is automatically increased to the New York minimum of $50,000 No-Fault insurance (this is the same as with pedestrian accidents earlier on this page).
Do I Have to Go to the No-Fault Insurance Doctor For an Examination?
After a no-fault application is filed, you will be required to be examined by the no-fault insurance company’s doctors. The insurance companies refer to this exam as an IME or Independent Medical Exam. We refer to them as No-Fault exams because they really are not independent since the insurance company is paying the doctor to do the exam.
Most often, the no-fault insurance doctor will deny you further treatment. The IME doctor will usually deny further treatment by stating either that you have recovered from your injuries or that since you have not recovered after receiving treatment for several months, further treatment will not help you.
If the no-fault insurance doctor allows you to have further treatment, you will be scheduled for another no-fault exam every 30 days until you have been denied further treatment.
The no-fault insurance doctor can only deny you benefits in his/her field. For instance, a neurologist can only deny you treatment by a neurologist and cannot deny you treatment by an orthopedic surgeon.
Your first no-fault exams will usually take place within 3-6 months after your accident.
Your examination is required to be held in the county in which you live. If you need to take a taxi, you must obtain a properly filled-out receipt to be reimbursed. You can also be reimbursed if you have to take the day off from work.
You are allowed to change the date of the examination only once. If you miss a rescheduled no-fault examination, you will be denied all medical benefits.
There are several reasons why it is very important for you to go to the No Fault insurance physical, even if you will be denied further treatment. The most important is that your failure to appear at the examination can result in a denial of all your benefits. Additionally, while usually overlooked by many lawyers, we are usually able to use the No-Fault examination report to help your case.
If you have been denied further treatment by the No-Fault insurance doctor after an IME (Independent Medical Exam-we call them No-Fault Insurance Exams or No Fault Insurance Physicals), you can now start submitting your medical bills to your health insurance company or Medicare. If you do not have any medical insurance, we can arrange for your doctor to get paid at the end of your case.
No-fault medical examinations should not be confused with defense insurance medical examinations when you have a lawsuit.
TIP: After your No-Fault insurance benefits have been denied, you should continue to send your medical bills to No-Fault, even though No-Fault will not pay them and even though major medical insurance or Medicare is paying the bills or the doctor has accepted a lien!
The reason for submitting these bills to No-Fault is that No-Fault will not consider a bill that has been sent to them more than 45 days after the date of treatment. If you continue to timely send the bills to No-Fault, it may then be possible to sue the No-Fault insurance company at a later date.
Denial of No-Fault Benefits
The Explanation of Benefits from no-fault is called a denial which is why you continue receiving denials.
Every time a doctor gets paid, you will receive a denial of no-fault benefits showing how much the doctor was paid and what portion of the bill was denied. You are not responsible for the difference. See what you are and are not responsible to pay when you see a no-fault doctor.
If you are denied further medical treatment after you have been examined by the No-Fault doctor, you MUST NOT use the form to file an arbitration to fight the denial. If you fight the No-Fault denial either by arbitration or in court, YOU COULD KILL YOUR LAWSUIT.
Can My Lawyer Fight a Denial of No-Fault Benefits?
Your personal injury lawyer should not arbitrate a no-fault denial or file a lawsuit against the No-Fault insurance company to reopen your no-fault claim until after your personal injury case is finished. Otherwise, it could jeopardize your personal injury case.
We have successfully reversed no-fault denials without arbitration or a lawsuit where our client needed surgery.
Can My No-Fault File or Case Be Re-Opened After a Denial?
Insurance companies frequently say they closed your no-fault file when it was not closed, and your no-fault file can easily be reopened. However, a no-fault claim can rarely be closed.
Your no-fault claim can be closed if it runs out of money because all of it was paid for your medical treatment or if you violated policy terms such as failing to appear for a physical exam.
If you were denied further no-fault benefits because of a no-fault physical, your claim has not been closed, and it may be possible to re-open it. We have done that many times. However, it is time-consuming, and we have only done that when one of our clients needed surgery but could not get surgery because further medical treatment was denied.
6 Ways to Get Medical Treatment After a No-Fault Denial
- If you have health insurance, simply use your health insurance.
- You may qualify for Medicaid. Medicaid will pay 90 days retroactively.
- You may have a limited amount of Medical Payments coverage (see the next paragraph below).
- We can arrange for you to receive medical treatment, and the medical facility will get paid from your personal injury settlement.
- You can get a personal injury settlement cash advance to pay for medical treatment and surgery.
- We may be able to get your No-Fault denial reversed.
What is Med Pay or Medical Payments Coverage?
Medical payments coverage or “Med Pay” Is additional insurance coverage for medical payments. This is completely separate from and has nothing to do with no-fault. It is usually sold in small increments of $1,000 to as much as $20,000.
Medical payments coverage can be used for any medical-related expense but should be used by you to submit bills that are not covered by no-fault insurance, such as over-the-counter medication, No-fault deductible, and copayments and deductibles from your health insurance after your no-fault insurance has been denied.
Phil Franckel is well-known in New York and has been a personal injury lawyer since 1989. He is a Founding Partner of 1-800-HURT-911, LLP®, the Personal Injury Dream Team™, and a former Member Board of Directors of the New York State Trial Lawyers Association. He has an Avvo Top 10 Rating, Avvo Client’s Choice Award with all 5-star reviews, Avvo Top Contributor Award, Multi-Million Dollar Trial Lawyers Award, and others. See Mr. Franckel’s bio for areas of expertise.
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