If you’ve suffered injuries in a New York car accident, you might wonder if you can pursue reimbursement for your damages. But is New York a no-fault state? New York is one of the handful of states that have adopted a no-fault insurance system for car accidents. This system is meant to streamline the claims process and provide prompt compensation for accident victims, regardless of fault.
If you have questions about how no-fault laws work, read on to learn more about filing a claim, what coverage applies, and how to file a fault-based claim against another party.
Understanding New York’s No-Fault Insurance Laws
In New York’s no-fault insurance system, each driver’s insurance company covers their policyholder’s medical expenses and lost wages up to a certain amount. This coverage kicks in regardless of who caused the accident. This no-fault system reduces litigation and allows injured parties to receive compensation more quickly than in a traditional fault-based system. Because New York is a no-fault state, every vehicle owner must carry minimum no-fault coverage, also known as personal injury protection (PIP).
Filing a No-Fault Claim
If you are involved in a car accident in New York, you must file a no-fault claim with your insurance company to receive compensation for your medical expenses and lost wages. The steps to file a no-fault claim are as follows:
Notify Your Insurance Company
Contact your insurance company to report the accident. The New York Department of Financial Services (DFS) requires you to report the accident to the proper authority within 24 hours. Otherwise, you could jeopardize your eligibility for PIP benefits.
Complete an Application for Benefits
You must complete an application for benefits and submit it as soon as possible. Your insurance company should send you the form within five days of receiving a notice of claim. You’ll need to supply information about the accident, your injuries, and any medical treatment you have received.
Submit Medical Expenses
You must provide copies of medical records and bills you’re asking the insurance company to reimburse. This documentation helps the PIP claim representative determine how much reimbursement you can receive. No-fault benefits are paid according to prescribed fee schedules. The health care provider is required to accept as full payment under New York law. Should your insurance company fail to pay your claim promptly, they could be responsible for reasonable attorney’s fees and 2% interest each month on unpaid amounts.
Cooperate with Your Insurance Company
Your insurance company may require additional information or documentation to process your claim. Be sure to provide this information promptly and cooperate with any requests for other documentation or examinations. Otherwise, your insurance company might deny your claim. You have legal rights under the no-fault system if you feel your claim was unfairly denied.
Understanding No-Fault Coverage in New York
New York’s no-fault insurance laws require every vehicle owner to carry a minimum amount of PIP coverage. This coverage typically includes reimbursement for these items up to your policy limit:
- Necessary medical costs related to the accident, such as doctor visits, hospital stays, diagnostic tests, and physical therapy;
- Some of your lost wages if you cannot work due to car accident injuries;
- Costs related to your injuries, such as transportation to medical appointments and household services; and
- A death benefit to the deceased’s estate in the unfortunate event of a fatality.
It’s important to note that PIP coverage does not include compensation for pain and suffering, and there are limits on the maximum amount of compensation you can receive. Another obvious item that is not covered is property damage (such as damage to your vehicle); property damage is typically covered by the insurance provider of the at-fault party.
Threshold Laws for Filing a Fault-Based Claim
In some situations, an injured party may still file a fault-based claim for compensation. These situations fall under New York’s “threshold” laws. These laws outline specific criteria that you must meet to step outside the no-fault system and pursue a personal injury lawsuit against the at-fault driver.
To file a fault-based claim, the injured party must have sustained a “serious injury” as defined by New York insurance law. Examples of serious injuries can include:
- Significant disfigurement,
- Bone fractures,
- Permanent limitation of use of a body organ or member,
- Substantial full disability for 90 days or more,
- Loss of a fetus, and
If your injuries meet the criteria for a serious injury, you may be able to file a personal injury lawsuit against the at-fault driver. In this case, you can seek compensation for damages not covered by PIP, such as pain and suffering, emotional distress, and loss of enjoyment of life. Additionally, you might recover the total amount of your lost wages rather than being limited by the PIP coverage.
Filing a fault-based claim is not the same as presenting a claim under your PIP coverage. You must prove the other driver was negligent and responsible for your injuries. Depending on the accident circumstances, the claims process can be complex. We recommended consulting with an experienced New York car accident attorney to discuss your options and the best course of action for your specific situation.
Contact Attorney Anthony A. Ferrante
Are you looking online for the answer to the question, Is New York a no-fault state? If so, you are probably in need of a car accident attorney. Contact Anthony A. Ferrante to learn how our firm can help. At Ferrante & Koenig, we know what it takes to build a solid case for pursuing a claim under either of New York’s threshold laws. When you need a legal advocate to help you pursue compensation for your injuries, the attorneys at Ferrante & Koenig stand ready to help. Contact our office today to schedule an initial consultation to learn more.