If you are injured in a car accident in New York, No-Fault insurance helps pay for your medical treatment up to a set limit. New York operates under a No-Fault insurance system, which requires every auto insurance policy to include Personal Injury Protection (PIP) coverage.
This system allows injured individuals to receive medical benefits regardless of who caused the accident. In New York, No-Fault insurance generally provides up to $50,000 per person for accident-related medical expenses.
If Your Treatment Costs Exceed PIP Coverage, Help May Still Be Available
When injuries are severe, medical bills and related costs can quickly surpass the $50,000 No-Fault (PIP) limit. If your damages exceed available PIP benefits, you may be eligible to seek additional compensation through a personal injury lawsuit.
A knowledgeable Long Island car accident attorney can help pursue maximum compensation, including damages for pain and suffering, permanent scarring or disfigurement, loss of enjoyment of life, and other long-term consequences of serious injuries.
Under New York law, individuals who suffer a “serious injury,” as defined by the state’s Insurance Law, may file a claim against the at-fault party to recover compensation beyond No-Fault benefits.
What Injuries Are Considered “Serious” Under New York Law?
New York Insurance Law defines a “serious injury” as a personal injury resulting in any of the following:
- Death, dismemberment, or significant disfigurement
- A fractured or broken bone
- Loss of a fetus due to injury
- Permanent loss or significant limitation of a body organ, limb, function, or system
- A substantial limitation of a bodily function or system
- Inability to perform usual daily activities for at least 90 of the first 180 days following the accident
How New York No-Fault Insurance Covers Medical Care
Under New York No-Fault law, accident victims may receive up to $50,000 per person in medical and rehabilitation benefits. Covered expenses may include:
- Medical treatment and necessary surgical procedures
- Physical therapy and rehabilitation services
- Ambulance and emergency transportation
- Diagnostic testing such as X-rays, CT scans, and MRI imaging
- Required medical equipment and supplies
- Prescription medications related to accident injuries
Who Pays for No-Fault Damages in New York?
Your own auto insurance policy provides No-Fault benefits through Personal Injury Protection (PIP), covering medical expenses, lost wages, and related costs for drivers and passengers in the vehicle. These benefits are available up to the limits of the policy.
No-Fault insurance serves as the primary source of payment before health insurance applies. Pedestrians and bicyclists injured by a motor vehicle are covered under the No-Fault policy of the vehicle involved, while passengers receive coverage through the vehicle they were riding in.
Who Is Eligible for No-Fault Insurance Coverage?
No-Fault benefits apply to drivers and passengers in the insured vehicle, as well as pedestrians and bicyclists injured in a motor vehicle accident.
Who Is Not Eligible for PIP Coverage in New York?
Standard No-Fault (PIP) coverage does not apply to motorcyclists or their passengers. However, pedestrians and bicyclists struck by a motorcycle may still be eligible for PIP benefits.
Vehicles Without Insurance
If you are injured while traveling in an uninsured vehicle, coverage is not provided through that vehicle’s policy. Instead, compensation may be available through your own insurance, a household family member’s active policy, or the Motor Vehicle Accident Indemnification Corporation (MVAIC). Pedestrians and bicyclists injured by uninsured vehicles may also seek benefits through these options.
How No-Fault Insurance Medical Payments Work
To obtain No-Fault benefits, a claim must be filed with your own auto insurance carrier for medical expenses and lost wages. Medical providers usually bill the No-Fault insurer directly, with PIP benefits applied before health insurance. Eligible losses are paid up to policy limits regardless of fault.
Processing Timelines for No-Fault Benefits
Under New York Insurance Regulation 68, No-Fault claims must be submitted in writing within 30 days of the accident. Medical bills must generally be submitted within 45 days, and lost wage claims within 90 days. Limited exceptions may apply with proper written justification.
Does No-Fault Insurance Cover Visits to My Own Doctor?
Not all healthcare providers accept No-Fault insurance. Before seeking treatment, it is important to confirm that your doctor accepts No-Fault coverage to ensure proper billing and payment.
Independent Medical Examinations in No-Fault Claims
After treatment begins, the No-Fault insurer may review your injuries and require you to attend an Independent Medical Examination (IME) to evaluate the nature and extent of your condition.
Consequences of Missing an IME
Attending scheduled IMEs is essential. Missing two appointments may result in retroactive denial of No-Fault benefits, potentially requiring repayment of medical bills, lost wages, or other expenses already paid.
Can No-Fault Coverage Be Denied?
After reviewing medical bills, a No-Fault insurer may deny payment for treatment deemed unnecessary or unrelated to the accident, often following an IME evaluation.
If No-Fault benefits are discontinued, remaining accident-related medical care may be covered through your health insurance.
Filing an Arbitration Claim
If a claim for medical expenses, lost wages, or related costs is denied, arbitration may be pursued to resolve the dispute without court involvement.
In New York, arbitration is administered through the American Arbitration Association via its New York Insurance ADR Center.
Overview of the AAA
The American Arbitration Association is a non-profit organization that resolves disputes through arbitration, mediation, and other voluntary methods. For over 30 years, it has administered New York’s No-Fault Dispute Resolution Program on behalf of the AAA.
This program helps efficiently resolve No-Fault auto insurance disputes for consumers, healthcare providers, and insurance companies across New York State.
