If you’ve been in a car accident in New York State, you will likely encounter the state's no-fault insurance system. This system can be confusing, but understanding how it works is crucial for getting the benefits you need to recover from such a motor vehicle accident. The Long Island car accident lawyers at Rosenberg & Gluck, LLP have compiled this guide to explain the key aspects of New York's no-fault insurance system, including the no-fault benefits it covers, who is eligible, and how to file a claim.
What Is the No-Fault Law for Insurance?
New York state law requires all drivers to have no-fault insurance, also called Personal Injury Protection (PIP). This coverage is designed to pay for your economic losses after an auto accident, regardless of who the at-fault driver was. Every auto insurance policy in New York must include a minimum of $50,000 in PIP coverage. If you are injured, the insurance company for the vehicle you were in—or the vehicle that struck you as a pedestrian or cyclist—will cover your medical bills, a portion of lost wages, and related necessities like travel expenses for medical visits.
It is important to remember that there is a strict 30-day time limit to file and request those benefits from your insurance company. So accident victims need to make sure that the application is filed promptly and correctly within 30 days.
Enhancing Coverage: APIP and OBEL Coverage
Beyond the required PIP, you have options to expand the protection from your insurance company with Additional Personal Injury Protection (APIP) and Optional Basic Economic Loss coverage (OBEL):
- APIP (Additional Personal Injury Protection): APIP allows you to increase your no-fault coverage in increments of $50,000. This can boost your total coverage to $100,000 or more, helping cover higher medical expenses or lost wages if you are seriously injured. APIP is especially valuable if your monthly salary or medical bills exceed what the basic PIP provides. Note that if APIP pays benefits and you later receive compensation from a lawsuit, your own insurance company may be able to recover amounts paid under APIP from your settlement.
- OBEL (Optional Basic Economic Loss): OBEL provides an extra $25,000 on top of the basic PIP limit. This enhanced coverage can be used for medical expenses, lost wages, or other necessary accident-related costs. OBEL gives you flexibility—you can direct it toward whichever economic loss (like rehabilitation, in-home help, or specialized treatments) is most urgent or exceeds your PIP and APIP coverage.
Adding APIP and OBEL to your policy gives you a greater financial safety net if a car accident results in serious injuries or a longer recovery period, helping to ease the burden of costs that go beyond the standard PIP limit.
Who Can Receive No-Fault Benefits?
No-fault benefits apply to a "covered person" injured in a "covered accident." A covered person includes the driver, passengers, or owner of an insured vehicle. It also extends to pedestrians and cyclists who are struck and injured by a motor vehicle.
However, certain individuals are not covered. This includes motorcyclists and their passengers, who are excluded from standard no-fault policies. If you are injured while riding a motorcycle, you cannot claim these benefits.
What Is a Covered Accident?
A covered accident is any incident involving the use or operation of a vehicle. This can range from a multi-car pile-up, a single car hitting a pole, or a pedestrian being struck at a crosswalk.
What Benefits Does No-Fault Insurance Provide?
Basic no-fault coverage in New York is intended to cover specific economic losses resulting from an accident. The $50,000 minimum coverage includes:
- Medical Expenses: All necessary and reasonable health service expenses, including medical treatments and rehabilitation for your injuries. This includes surgical procedures, physical therapy, ambulance services, hospital bills, diagnostic tests like X-rays and MRIs, occupational therapy, and prescription medications.
- Lost Wage Claims: 80% of your lost income, capped at $2,000 per month, for a maximum of three years following the accident.
- Other Necessary Expenses: Up to $25 per day for up to one year to cover other reasonable expenses incurred by your injuries, such as household help or transportation to medical appointments.
- Death Benefit: A $2,000 benefit payable to the estate of a person killed in a covered accident.
Even if you file on time, an insurance company can deny your claim for several reasons.
- Independent Medical Examination (IME): The insurer may require you to see a medical provider of their choosing for an IME to verify your injuries. If you miss two scheduled IMEs, the insurer can deny your benefits retroactive to the date of accident. Meaning, if they have already paid some benefits, you could be responsible for even those costs.
- Unnecessary Treatment: The insurer may determine that a specific medical service was not necessary or unrelated to the accident and refuse to pay for it.
- Disqualifying Actions: You may be ineligible for benefits if you were driving while intoxicated, intentionally caused your own injuries, were committing a felony, or were driving an uninsured vehicle that you own.
If your claim is denied, you have the right to challenge the decision through arbitration with the American Arbitration Association (AAA). This process can help resolve disputes between you, your healthcare providers, and the insurance company.
Steps to File for No-Fault Benefits
To file a no-fault claim in New York, an eligible injured person should:
- Get the NF-2 no-fault application for benefits from your insurer (if you're a driver) or request it if you’re a pedestrian or cyclist.
- Complete and submit the form within 30 days of the accident—late filings are not accepted.
- Send it to the insurer for the vehicle you were in or for the vehicle that hit you if you were a pedestrian or cyclist.
Take Action Today
Have you or a loved one been seriously injured in a car accident? Navigating New York’s no-fault insurance claims can be overwhelming, especially if you’re facing mounting medical bills or struggling to get the benefits you deserve. Whether you need legal advice or full representation, you don’t have to face this process alone. Contact Rosenberg & Gluck, LLP for a free consultation—our experienced attorneys are ready to fight for your rights and help you secure the compensation you’re entitled to.