Navigating the Fundamentals of No-Fault Law in New York State

Navigating the Fundamentals of No-Fault in New York State

The New York No-Fault law is there to help. If you get hurt in a car accident in New York, your insurance will cover your bills, no matter who caused the accident. You don’t have to prove anyone did something wrong to get this help. There are some rules about what’s covered and what’s not, and sometimes, you can sue the person who caused the accident. Just remember, there’s a time limit to tell your insurance about the accident.

Information on New York’s No-Fault Law Benefits

No-fault benefits cover financial losses, comprising essential expenses like medically related costs, additional expenditures, lost wages, and burial expenses.

Medical Expenses

• Ambulance cost.
• Necessary x-rays, surgical interventions, and nursing care.
• Dental costs.
• Prescription drugs.
• Prosthetic devices.
• Psychiatric treatment.
• Physical and occupational therapy.
• Any necessary rehabilitation.
• Any non-medical remedial care and treatment that may be chosen for religious reasons instead of medical treatment.
• Any professional health services needed within one year of the accident if the services are required because of injuries incurred in the accident. This time may be extended in certain circumstances.

Other Reasonable and Necessary Expenses

The policy includes compensation of up to $25 daily for additional costs, like transportation expenses for attending medical appointments or therapy sessions. This provision extends to covering essential household assistance when medically required.

Lost Wages

This benefit covers 80 percent of the claimant’s lost wages. The awarded amount is non-taxable, which is why 20 percent of the wages is retained.

Burial Expenses

In the tragic event of a fatality resulting from the accident, No-Fault insurance will cover all associated funeral and burial expenses. The insurance policy offers coverage up to a maximum of $50,000 per injured individual. However, it’s important to understand that this $50,000 includes compensation received from all possible sources. For instance, if workers’ compensation benefits are provided due to the accident, that specific amount will factor into the calculation for the $50,000. Please note that this $50,000 is not an additional sum on top of any other benefits received. An offset will be applied in such cases.

Who Qualifies for No-Fault Benefits in New York?

In New York, individuals who are injured in motor vehicle accidents generally qualify for No-Fault benefits. This includes drivers, passengers, pedestrians, and cyclists involved in accidents with motor vehicles. However, certain categories of individuals may not be eligible, such as those driving uninsured vehicles, individuals engaged in criminal activities during the accident, or accidents involving certain types of vehicles like motorcycles. It’s important to note that specific circumstances can impact eligibility, so consulting with a legal professional familiar with New York’s No-Fault laws is advisable to ensure accurate understanding. 

Exceptions to Receiving No-Fault Benefits

Just like in most legal matters, exceptions exist within established rules. No-fault policy coverage is no exception. Those excluded from coverage according to New York’s no-fault statute comprise the following:

• Motorcycle riders.
• Motorcycle passengers.
• Owners driving their own uninsured vehicle.
• Owner’s driving or occupying their spouse’s uninsured vehicle.
• Those who are not residents of New York.

Individuals who could potentially be excluded as under your policy. 

Private insurers are granted the freedom to establish their own exclusions. Hence, it’s crucial for policyholders to carefully review their policy terms, ensuring comprehension of situations that might not be covered by their no-fault policy.

Here are instances that may not be covered:

• Individuals who intentionally cause their own injury, despite having coverage.
• Accidents involving an intoxicated driver as per legal definitions or influenced by controlled substances.
• When the injured person was engaged in a felony at the time of the accident, such as attempting to evade law enforcement.
• Situations involving a vehicle known to be stolen by the policyholder or occupants.
• Events involving racing or speed testing.

Steps for Filing No-Fault Insurance Claims in New York

In New York, you must submit a written claim to your insurer within 30 days of the accident. This claim should go to the insurance company that covers the involved car. Very rarely, this time frame may be extended if you can prove a valid reason for not meeting the deadline.

The written statement you provide needs to be detailed. Include the accident’s date, time, and circumstances, along with comprehensive information about each injured person. It’s crucial to note that No-Fault insurance doesn’t cover vehicle repairs. Instead, it focuses on compensating for personal losses suffered due to injuries sustained.

Taking Legal Action: Filing a Personal Injury Lawsuit Against the Responsible Party

A personal injury lawsuit lets seriously injured victims claim compensation for their pain and suffering. These damages aren’t covered by No-Fault policies, so a lawsuit must be filed against the driver responsible for the accident. To make a claim, victims need to have a serious injury as defined by New York law, which includes but not limited to the following:

• Permanent loss of a body organ or function of a bodily system
• Death
• Dismemberment
• Disfigurement
• Loss of a fetus
• Bone fractures
• One that results in essentially total disability for at least 90 days

When Your No-Fault Insurance Benefits Claim Gets Challenged by an Insurance Company

Getting benefits might not be as simple as it seems. Insurance companies often try to avoid paying claims. The policy could say disputes must go to arbitration. Depending on the accident, the insurer might face a lawsuit for breaking the contract, not acting fairly, or bad faith.

To learn more about New York’s no-fault insurance laws, or to discuss filing a personal injury claim with an attorney, contact us online or call 844-3-RIGHT-BY-YOU (844) 374-4482 for a free case evaluation. We will help you understand your legal options after an accident, and how no-fault insurance may affect your claim.