We cannot begin to stress the importance of wearing a seatbelt while riding in a motor vehicle. 

New York State law requires that if you are sitting in the front seat of a motor vehicle, as either a driver or passenger, you must wear a seatbelt.  As the driver, you may be fined for your failure to wear a seatbelt.  If you are a passenger in the front seat and over the age of 16, you may also receive a fine for your failure to wear a seatbelt. 

Every passenger under the age of 16 must wear a seatbelt or use an appropriate child restraint system (such as a safety seat or booster seat).  It is the driver’s responsibility to make sure every passenger under the age of 16 is wearing the appropriate restraining system.  If violations are found, the driver may be fined up to $100 and receive points on his or her license for each violation.  

Fines and/or points on your license may seem like a harsh penalty, but it pales in comparison to the injuries you may suffer if you are involved in a motor vehicle accident and you don’t have your seatbelt on.  People who do not wear their seatbelts will often suffer injuries ranging from facial lacerations, whiplash and chipped teeth to knee injuries, broken noses, paralysis and death. 

We have seen clients’ lives change dramatically because they failed to wear a seatbelt.  Something as simple as wearing a seatbelt may have allowed them to walk away from an accident unharmed. 

Take your safety and the safety of others in your vehicle seriously – wear your seatbelts! 

You were hurt in a motor vehicle accident and filed for No-Fault benefits.  You have treated with various doctors and therapists for your injuries.  As mentioned in an earlier blog (Part 2), the no-fault carrier will likely “verify” your injuries.  In doing so, you may be required to appear for a so called independent medical examination (IME).  An examination under oath (EUO) may also be demanded by the insurance company.  More often, the no-fault carrier will seek to have you examined by one or more of their physicians at an IME.

You must appear for the IME and/or EUO.  If you fail to appear (or no-show), your no-fault benefits may be retroactively denied (meaning, all benefits from the date of the accident onward!).  Do not make it easy for the no-fault carrier to deny your benefits – DO NOT MISS IME or EUO appointments!  If the appointment the insurance company sets up is inconvenient, you may contact them and reschedule.

Even if you do appear at the IME, the no-fault carrier’s doctor may determine that you are not as injured as you, and your doctors, say you are.  In that case, some or all of your benefits may be denied. 

For instance, if you treat with a physical therapist and an acupuncturist, the no-fault carrier’s IME doctor may find that you need only one physical therapy visit per week (as opposed to the three visits recommended by your doctor) and that you don’t need acupuncture at all.  In that case, No-Fault will stop paying for acupuncture and will only pay for physical therapy once per week.  If you still want to treat with an acupuncturist, you will have to pay for the visits yourself or have the visits billed to your personal health insurance, if that is an option. 

Sometimes, the no-fault carrier’s IME doctor will find that you don’t need any further medical treatment – from any medical provider.  In that instance, you, your lawyer and your doctors or other medical providers will be given notice that your medical benefits have been terminated as of a certain date.  Any treatment you receive after that date certain you will be responsible for, unless you have health insurance.  If you have health insurance and have received a No-Fault denial of benefits, ask your medical provider (doctor, therapist, etc) to bill your health insurance carrier for your continued treatment. 

Once again, and it bears repeating, the most important thing to do if you’ve been hurt in an accident is to make sure you get good medical care.  Seek medical treatment immediately, follow through with your doctors’ recommendations and, if at all possible, continue to follow the recommendations of your own health care providers, even after you’ve received a no-fault denial. 

New York State law requires that every auto insurance policy issued in New York must provide the mandatory minimum of $50,000 in personal injury protection or “PIP”.  As you may recall, PIP provides coverage for the following: medical expenses; lost wages; other necessary expenses; and a death benefit.  These categories are considered “basic economic loss”. 

If you aren’t already aware, you have the option of purchasing additional coverage through either APIP or OBEL.  APIP stands for additional personal injury protection.  OBEL stands for optional basic economic loss.  Both options provide extra protection beyond the mandatory minimum of $50,000.  Either option may be purchased through your insurance carrier for an additional premium – typically, the premium is minimal. 

APIP –

APIP coverage is typically offered by insurance carriers in increments of $50,000.  Remember, basic personal injury protection (PIP) provides coverage up to $50,000, so APIP coverage would increase that coverage in increments of $50,000. 

An APIP policy will extend your basic economic loss coverage.  There are different types of APIP coverage.  You may purchase APIP protection for lost wages, medical expenses or additional expenses.  One thing to consider when purchasing a motor vehicle insurance policy is whether to purchase APIP coverage for lost wages.  If you recall from the last blog, lost wage benefits under the minimum no-fault policy only provides for 80% of your wages up to $2000 per month.

If you earn more than $2500 per month, you will not be compensated for your entire loss and you may have difficulty making ends meet while you are rehabilitating.  However, APIP coverage allows you to increase that monthly amount so that your monthly salary is covered.  For example: if you earn $4000 per month, you may want to consider purchasing an APIP policy that will increase your lost wage earnings to $4000 per month.  If you are injured in a motor vehicle accident and are unable to work, APIP will cover 80% of $4000, but the underlying no-fault policy will pay the first $2000; APIP would cover the remaining amount. 

Important Note: your APIP insurance carrier has the right to recover the monies they have paid on your behalf if you have a successful personal injury claim against the person who caused the accident.  For example, if they paid for additional lost wages or medical expenses, they will seek the return of that money.  Typically, the APIP insurance carrier will look to the other driver for reimbursement.  However, if you settle your claim with the other driver’s insurance carrier and you do not protect your APIP carrier’s right to reimbursement, you could be responsible for paying the money back out of your settlement proceeds.  It is best if you have an attorney representing you at this point to make sure that your rights are protected. 

OBEL

OBEL coverage also provides additional coverage beyond the $50,000 in basic economic loss coverage.  With OBEL coverage, you decide who will receive the money.  For instance, you may seek to have the optional coverage reimburse your physical therapist or you may seek to have the optional coverage go towards lost wages.  This coverage comes into play after you have exhausted the initial $50,000 of basic economic loss coverage. 

Coming up… No-Fault Benefits (Part 5 – Denial of Benefits)

You were hurt in a motor vehicle accident and filed for No-Fault benefits.  Did you know that no-fault may reimburse you for lost wages? 

If you are injured in a motor vehicle accident and are unable to work because of your injuries, you may be reimbursed by no-fault for the wages you lost.  No-Fault will reimburse 80% of your pay up to $2000 per month.  And no-fault lost wages are tax-free!

No-Fault requires that you file for New York State disability through your employer.  You must be employed with your current job for at least four weeks to apply through your employer.  If you’ve been there for a shorter period of time, then New York State looks to your prior employer.  New York State disability will reimburse you for half of your pay, up to $170 per week. 

New York State disability will pay you first, then No-Fault will reimburse the remaining amount, if any.  For example:  You earn $250 per week, or $1000 per month.  No-Fault will pay 80% of your salary up to $2000 per month – 80% of $1000 is $800.  Therefore, you are entitled to receive $800 per month in lost wages.  But before you are paid by No-Fault, you will first be reimbursed by New York State disability.  New York State disability will pay half of your salary up to $170/week.  In this instance, you will receive $125 per week from New York State disability for a total amount of $500 per month ($125 = half of $250 weekly salary).  No-Fault will then pay $300 in lost wages ($800 – $500 = $300).   

There are occasions where No-Fault will not reimburse you for lost wages.  For instance, if your employer pays you $500 per week while you are out of work (or $2000 per month), then you are not entitled to lost wages through no-fault.  Remember, no-fault will pay 80% of your salary up to $2000 per month.  In the above example, your employer is already paying you $2000 per month while you are out. 

You may be entitled to more than $2000 per month if you have purchased optional coverage through either APIP or OBEL.  Either plan may entitle you to receive more than $2000 per month.  These plans will be discussed in a later blog.

Most importantly, in order to receive lost wages you must provide disability notes to no-fault every thirty days.  Some times a doctor will write on a note that you cannot work for the next three months – this is not good enough – you must provide a note every 30 days to continue to receive lost wages. 

What happens if your employer requires that you use your accrued sick or vacation time while you’re out of work?  In that case, you will not receive lost wages through no-fault.  However, you may be reimbursed for the accrued sick or vacation time you had to use.  No-Fault will send a form to your employer who must verify that you were required to utilize your accrued time.

Important Note: New York State disability will cover your lost wages for up to 26 weeks.  If your disability continues beyond the first 26 weeks, No-Fault requires that you apply for Social Security Disability. 

Important Note: lost wages through no-fault may be paid up to three years after the date of the accident.  However, this does not mean you will be entitled to lost wages for that entire period.  As said above, you must continue to provide disability notes to prove you cannot work because of injuries you suffered from the accident.  Also, if no-fault coverage is denied for any reason, you may also lose your right to receive lost wages. 

Coming up… No-Fault Benefits (Part 4 – APIP and OBEL)