New York No-Fault Benefits aim to provide simplicity to those injured after a car accident. Also known as “Personal Injury Protection” (PIP), No-Fault benefits ensure that regardless of who caused the accident, insurance will cover your medical expenses and other financial losses up to a certain coverage limit. The goal is to ensure that everyone involved in a car accident can receive prompt medical attention and financial assistance without the delays associated with determining fault.

Who Is Covered Under New York No-Fault Benefits?

In New York, No-Fault benefits coverage extends to:

- You, as the vehicle owner.
- Any passengers in your car at the time of the accident.
- Pedestrians or bicyclists hit by your car.
- Anyone driving your vehicle with your permission.

Coverage does not extend to motorcyclists or passengers on motorcycles, drivers of uninsured vehicles, and individuals who sustain injuries while committing a felony, driving under the influence, or participating in unlawful acts like vehicle theft or street racing.

What Do New York No-Fault Benefits Cover?

New York No-Fault benefits pay for three different categories of economic loss after a car accident. No-Fault benefits only cover economic loss, meaning financial loss, caused by the accident, and not non-economic loss (i.e., pain and suffering).

Here's a breakdown of what No-Fault benefits will pay for:

• Medical Expenses: No-Fault benefits will pay for your medically necessary treatments for injuries caused by the accident. Even if you have private health insurance, your No-Fault coverage will be the primary payor of your medical bills for injuries caused by the car accident. The only time your No-Fault medical coverage won’t be primary is if you were in a car accident while working and therefore entitled to Workers’ Compensation. In that case, Workers’ Compensation will be the primary payor for your medical treatments.

Make sure each time you see a new medical provider you give them the name of your No-Fault insurance company and your Claim Number so they can bill the insurance company directly. Important: your medical provider must submit medical bills within 45 days of treatment or the No-Fault insurance company may refuse to pay.

• Lost Wages: Your No-Fault insurance will pay 80% of your gross monthly lost wages up to a limit of $2,000 per month. No-Fault will not pay your lost wages indefinitely; lost wages are only paid for up to 3 years after the accident. No-Fault lost wage payments are not taxable, which is why there is a 20% withholding from your lost wage payment.

To begin receiving your No-Fault lost wages, you must first submit certain documents and information to the No-Fault insurer, and every month thereafter, continue to submit certain documents to continue receiving those payments. Read our article “How to Get Your Lost Wages Paid by Your New York No-Fault Insurance” for detailed instructions on how to receive your lost wages from your No-Fault insurance carrier.

• Other Reasonable and Necessary Expenses: Your No-Fault benefits will also provide coverage for other “reasonable and necessary expenses” you incur as a result of the accident, up to a daily limit of $25 per day. This can cover things like mileage traveling back and forth to medical appointments, medical supplies, or other expenses you incur for treatment.

You must submit these expenses to the insurance company within 90 days of when the expense was incurred. We recommend submitting this proof by fax to the No-Fault insurance company so you have a record of when and what was sent.

To submit a claim for mileage reimbursement, you must provide a detailed itemization of each trip. It must include the date, the address where your trip started, the address of where you drove to (the medical appointment), and the calculated distance. No-Fault insurance will only pay for trips to medically necessary appointments or to IMEs the No-Fault insurance company requires you to attend.

Why Isn’t the Other Driver’s Insurance Paying My Bills?

Many wonder why their medical bills, lost wages, and other expenses are not being paid by the other driver’s insurance when that other person was clearly at fault. New York’s No-Fault benefits are not, as their name suggests, based on who was at fault for the crash. Otherwise, people injured in car accidents would spend years waiting to get their medical bills and lost wages paid for a judicial determination of who was at fault.

Instead, New York simply looks at whether you were injured through the use or operation of a motor vehicle. If you were, the law requires the insurance company of the vehicle you were using or operating at that time to provide you with No-Fault benefits.

Do I Have to Pay Back My No-Fault Insurance Company?

No, you do not. Medical bills, lost wages, and other reasonable and necessary expenses paid under basic No-Fault coverage, i.e., the minimum $50,000 of coverage required in New York, do not have to be paid back by you.
 

How Much Do New York No-Fault Benefits Pay For?

No-Fault coverage can vary depending on the exact coverage of your policy. In New York, the mandatory minimum No-Fault coverage all drivers must carry is $50,000. Thus, your No-Fault coverage will pay for the combined total of your medical bills, lost wages, and other reasonable and necessary expenses up to $50,000.

How Long Do I Have to File a Claim for New York No-Fault Benefits?

You must file a written claim with your insurance company within 30 days of the accident. It’s important to act promptly after a car accident because failing to meet this deadline could result in losing your right to claim benefits.

After notifying your No-Fault insurer, you need to fill out a formal application for benefits. In New York, this form is known as the “New York Motor Vehicle Insurance Law Application for Motor Vehicle No-Fault Benefits.” Your insurance company will provide this form. Make sure to include comprehensive details about the accident. This encompasses the date, time, and surrounding circumstances, along with thorough information about the injuries sustained.

Does New York No-Fault Insurance Cover Repairs to My Vehicle?

New York No-Fault insurance does not provide any type of coverage or payments for vehicle repairs. Any reimbursement related to a vehicle or other property is made under the property damage portion of the insurance policies involved.

Conclusion

Navigating the intricacies of New York's No-Fault insurance system can be extremely difficult after a car accident. Our attorneys at Horn Wright, LLP, have vast experience handling claims for No-Fault benefits to make sure you receive the compensation you’re entitled to after a car accident. Contact our firm today and within minutes you can be speaking with an attorney about your case.