What Is No-Fault Insurance Coverage, And What Does It Cover?
According to New York State law, the minimum coverage of an insurance policy that you can carry, and that allows you to register your car and obtain license plates include what is called “No-Fault,” insurance. This type of coverage is also referred to as Personal Injury Protection (PIP), and is intended to pay medical bills and lost wages.
No-Fault coverage doesn’t only cover lost earnings if you are unable to work and medical expenses, but also additional compensation for necessary expenses for drivers, passengers, or pedestrians who’ve been injured by your car. This may include transportation to and from your doctor in the case of a personal injury. This type of coverage does not include repairs to any cars that were involved in the accident — including yours.
What PIP Covers
No-Fault insurance is required by New York State, as is Liability and Uninsured Motorist insurance. According to New York State’s Department of Financial Services, No-Fault Insurance or Personal Injury Protection (PIP), will cover:
- Reasonable and necessary accident-related medical and recovery expenses.
- 80% of lost earnings from work to a maximum of $2,000 a month for up to 3 years from the date of the accident. This is subject to offsets for disability, Worker’s Compensation and Federal disability benefits.
- Up to $25 a day for reimbursement of necessary household help expenses, as well as travel expenses to travel for medical treatments.
- $2,000 death benefit (in addition to the $50,000 basic No-Fault insurance limit) payable to the victim’s estate.
Lost Wages And No Fault Law
If you were in a motor vehicle accident and filed for no-fault benefits, but haven’t yet consulted with an attorney, you may be surprised to know that part of your lost wages may be covered.
Basic No-Fault auto insurance typically covers 80% of lost earnings from work, up to $2,000 per month for up to three years from the date of the car accident. One other benefit is that when it comes time to file your tax returns, these pay-outs will be tax-free.
If you’ve experienced lost earnings from a serious injury, 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 benefits will reimburse you for half of your pay, up to $170 per week.
An Example Lost Wage Payout for a Motor Vehicle Accident
If you’re experiencing economic loss and desperately need to cover your medical bills and other expenses, New York State disability will pay you first, then No-Fault will reimburse the remaining amount if any for your lost wage claim.
For example: if you earn $250 per week or $1,000 per month. No-Fault will pay 80% of your salary up to $2000 per month – 80% of $1,000 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 example, 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).
Are There Situations Where No-Fault Will Not Reimburse My Lost Wages?
There are situations under most policies that would disqualify a person from being able to recover lost income or doctor expenses through No-Fault benefits. For instance, No-Fault would not cover lost wages from an accident if a person were:
- driving while intoxicated or under the influence of drugs
- intentionally causing his or her own injuries
- injured during the commission of a felony
- riding an all-terrain vehicle or motorcycle as the driver or passenger
- injured while in a vehicle that is known to be stolen
- an owner of an uninsured vehicle
Employee Benefits & No-Fault Coverage for Lost Wages
Another instance where No-Fault will not reimburse you for lost wages is if you receive a benefit from your employer that exceeds the maximum No-Fault payout.
For example, if your employer pays you $500 per week while you are out of work this amounts to $2,000 per month. In this instance 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. There may be exceptions, for example, if you are required to use your sick or personal time to receive this payment (read more below).
What About Optional Coverage Through An Independent Insurance Carrier?
You may be entitled to more than $2,000 per month if you have purchased optional coverage through either APIP or OBEL. Either plan may entitle you to receive more than $2,000 per month. Read the next part in this blog series for detail. If you have any immediate questions, contact us to speak with an experienced Long Island personal injury lawyer.
What if I Have to Use My Sick Time or Vacation Time?
If your employer requires you to use sick time or vacation time while you are recovering from your car accident, you will not be covered through No-Fault insurance. However, you may be reimbursed for the accrued sick or vacation time you had to use. A form will be sent to your employer. Your employer will then submit a wage verification form to show that you were required to use your accrued time, and then no-fault will send these benefits once they are viewed.
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.
Lost wages through no-fault insurance claims may be paid up to three years after the date of the car accident. However, this does not mean you will be entitled to lost wages for that entire period. You must continue to provide a disability form to prove you cannot work because of the injuries you suffered from your car accident. Also, if No-Fault coverage is denied, you may also lose your right to receive lost wages. If this happens, it’s often a good idea to consult with a qualified attorney. In most cases, you can speak to a lawyer for an initial free consultation.
How to File for No-Fault Benefits to Reimburse Lost Wages
If you’d like to file a No-Fault claim, it should be made with the insurance company that covers the car in which you were either the driver or the passenger, or were struck by in the event that you were an injured pedestrian.
According to New York State disability benefits law, a written notice should be provided by the eligible injured party (or their representative) to the insurance company. This notice should include all of the pertinent details of the accident including the names of the involved parties, as well as the time, date of the accident, location and circumstances of the accident. Any lost wage claims should be sent to the applicable No-Fault insurance carrier within 30 days of the date of the car accident.
If for any reason you can’t comply with this time frame, written proof of the reason for this must be submitted.
What Steps Must I Take to Continue Receiving Reimbursement for Lost Wages?
If you have ever had to file for unemployment insurance in New York State after being let go from a job, you are probably familiar with the process. Every week, you must either call the NYS unemployment office or log into your online account to claim your benefits. Otherwise, the state will assume you no longer need your unemployment insurance, and your benefits will stop.
The No-Fault insurance company essentially wants to know that you are indeed still unable to work and earn money for yourself and your family. Therefore, in order to receive lost wages, you must provide disability notes to No-Fault insurance every thirty days.
Sometimes your doctor may just write on a note that you cannot work for the next three months. Unfortunately, this is not good enough, and no-fault insists that you must provide a note every 30 days to continue to receive lost wages.
Though it can be frustrating to see your doctor every month when you’re laid up to request a note for no-fault, it’s important to do this so you don’t lose the support you need while you are injured.
Where to Report a No-Fault Claim with Popular Auto Insurance Companies
Knowing which insurance carrier you need to contact to file your report in order to receive compensation is often half the battle. Below are a list of some of the most common providers:
- National General
- The General
- PURE Insurance Company
- State Farm
- Farmers Insurance
- The Hartford
Make sure to have your insurance policy handy to make your claim.
A qualified attorney can often recover damages that you have coming after an injury. They can help you to navigate New York’s No-Fault law to make sure that your income is protected before you’re able to return to work.
Call a New York Personal Injury Attorney Today
No one ever thinks that they will get into a motor vehicle or other type of accident. Whether you’re a pedestrian injured in a motor vehicle accident, a bicyclist, the driver, or a passenger in a car involved in a car accident, you may end up with severe injuries that prevent you from returning to work right away.
If you’ve suffered a serious injury and are looking at mounting medical bills and lost wages as a result of your injury, this can be scary. Suddenly you are unable to provide for yourself and must depend on insurance to try to recover lost income or reimbursement for damages until you’re able to return to work. Contact Rosenberg & Gluck, LLP’s personal injury attorneys for a free consultation and let us see what we can do for you.
Check out the whole series:
- No-Fault Benefits (Part 1 – Overview)
- No-Fault Benefits (Part 2 – Medical Treatment)
- No-Fault Benefits (Part 3 – Lost Wages) — Current
- No-Fault Benefits (Part 4 – APIP and OBEL)
- No-Fault Benefits (Part 5 – Denial of Benefits)