What is No-Fault Insurance? What Does it Cover?
No-fault insurance is coverage under the automobile insurance policy of the New York vehicle you occupy at the time of an accident. You may also be eligible for this coverage if you are a pedestrian hit by a vehicle.
This coverage is designed to pay for your lost wages, medical bills and other medically-necessary expenses. This means that your doctor must put everything in writing. It is called no-fault insurance because it is available regardless of who caused the accident.
Is New York a “No-Fault” State?
Yes, New York is a “No-Fault” state, which means regardless of who caused the accident, insureds are generally reimbursed by their insurance company for damages.
How Much Coverage Does No-Fault Insurance Provide?
Each insured automobile carries a minimum of $50,000 in no-fault coverage for each occupant of the vehicle.
Monthly wage losses are paid at 80% of your gross wages, up to a maximum of $2,000.00 per month – from all sources – unless you elect a special rider on your policy to extend to a higher monthly lost wage. Wages are reduced by 20% to stimulate taxes – this means that no fault payments are not taxable.
Medical supplies such as a wheelchair or crutch rental, mileage to and from your doctors, as well as payment for any household chores your doctor writes that you cannot perform, may be reimbursed as well. The $50,000 includes payments from all sources, including New York State Disability.
What Types of Extra No-Fault Coverage Are There?
Ask your insurance agent for information concerning optional basic economic loss “OBEL” coverage, additional personal injury protection (APIP) coverage, and medical payments coverage. Often times these types of additional coverage are available for a very small cost. They would extend your coverage beyond the basic $50,000.
Who Is Not Covered by No-Fault Insurance?
In most cases, the following people would not be eligible for no-fault coverage:
- Motorcycle drivers
- Motorcycle passengers
- If you are in your own uninsured vehicle there is no coverage for you
- If you occupy your spouse’s uninsured vehicle, there is no coverage for you
- Non-New York residents may not be eligible for coverage
Are You Eligible for No-Fault Coverage If You Occupy Someone Else’s Uninsured Vehicle?
If the vehicle you are in is uninsured, and you do not reside in the same household as that person, you may be eligible to make a claim for no-fault benefits from your own automobile insurance policy, or the automobile policy of a relative you live with.
If you do not have your own automobile insurance in your household, you could be eligible to make a claim for no fault benefits from the motor vehicle accident indemnification corporation. Proof of no insurance and proof that you do not live with someone who has automobile insurance is required. The same or similar deadlines apply to these types of alternate coverage.
Am I Covered By No-Fault Insurance If I Am In A Rental Vehicle?
In most cases, yes. You would be eligible for no-fault coverage available through the rented vehicle, and still have the ability to use any extra coverage you may have paid for on your own automobile insurance policy.
What If No-Fault Denies Payment?
There are various options available to you and/or your medical providers if no-fault denies payment for specific treatment, medical testing, or even for a particular specialist. There are various avenues available to contest or refute the denial.
No-Fault Insurance Deadline Information
The applicable no-fault carrier must be placed on written notice within 30 days of an accident. In most cases, there are no exceptions. This means that you must submit an application for no-fault benefits within 30 days of an accident, in order to be able to make a claim for past and future lost wages, medical bills and other medically-necessary medical expenses. In limited circumstances, this time frame may be extended.
Is There a Deadline for Submitting Medical Bills For Payment?
Yes. Medical bills must be submitted to the no-fault carrier within 45 days of the date of treatment. Therefore, it is imperative that you give your medical providers the no-fault information as soon as possible. Any treatment that is denied payment because of the 45 day rule, could result in your becoming personally responsible for the payment of that bill. Never assume that the bill is being taken care of. Be certain to submit all bills, including duplicates, immediately upon receipt.
Is There An Expiration Date For Medical Treatment?
Essentially, no. There is no law that says your benefits expire after “x” days/weeks/years. As long as your medical providers have indicated you will need treatment beyond the first year from the date of the accident, then no-fault will continue to pay for your medical treatment and prescriptions until the dollar amount is completely used up.
Do I Need A Referral To See A Doctor?
In most cases, no. Under no-fault, you do not need a referral to see a specialist such as a neurologist, orthopedist, acupuncturist, or chiropractor. Therefore, if you do not have a primary care physician, you can usually still see a specialist without a referral. You do need a referral for diagnostic tests such as X-Ray’s, MRI’s and CT scans as well as physical therapy.
Who Can Help Me With No-Fault Insurance After I’ve Been Involved in an Accident?
Dealing with insurance companies after an accident can be overwhelming and frustrating, especially if you’ve been seriously injured. At Maynard, O’Connor, Smith & Catalinotto, we can help you navigate the complexities of no-fault insurance coverage to make sure you obtain the compensation you deserve.
In need of assistance after an accident? If you or a loved one has been injured in a car accident in Upstate NY, call us now at (800) 721-3553 or contact us online to request a free case review with one of our experienced personal injury attorneys.
Uninsured and unsure of what to do? Even if you are uninsured, there may be ways to claim no-fault benefits. We can assist you with that as well. Review the following resources to learn more about your options, then contact us for more information.
No-Fault Benefits Through MVAIC Coverage – Learn about MVAIC coverage, including eligibility requirements and the no-fault benefits it can provide if you are uninsured and involved in a car accident.
Motorcyclists Excluded from No-Fault Coverage – Find out why motorcyclists in New York State are not covered by no-fault insurance, and learn what to do if you’ve been involved in a motorcycle accident and are seeking recovery.
Editor’s Note: This content was originally published in 2016 but has been updated as of January 2020.
