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Understanding New York No-fault Benefits

In New York, if you are injured in a motor vehicle accident you are entitled to receive no-fault benefits. These benefits are provided regardless of who may be at fault for the accident and are part of the financial responsibility requirements of the Insurance Law that requires every owner of a motor vehicle registered in the State of New York to purchase certain minimum insurance coverages. These coverages must include the following:

  1. Minimum Liability Coverage that affords protection to others against the harm that your car or any car you drive with the owner's permission might cause to another person or property;

  2. Uninsured Motorist Coverage that affords protection against the injuries you,

  3. your family members that reside with you or passengers in your vehicle might suffer in a hit-and-run accident or in an accident with an uninsured vehicle,

  4. No-Fault Coverage (Personal Injury Protection) that pays medical expenses and lost earnings for a driver or passenger injured in, or a pedestrian injured by, your car.

Personal Injury Protection

Personal Injury Protection (or PIP) will pay for economic losses associated with the accident regardless if who may be at fault; hence the term: "no-fault." Economic losses include medical expenses, lost earnings, and certain other reasonable and necessary expenses related to the injuries sustained up to $50,000 per person. This coverage is the "basic No-Fault coverage." Additional coverage or supplemental PIP may be purchased as a supplement to this basic coverage.

Since the Insurance Law provides these no-fault benefits regardless of fault, a lawsuit brought for injuries against the person responsible for a car accident may only seek economic losses that are in excess of the provided no-fault benefits and for non-economic damages for pain and suffering, but if a "serious injury" has been sustained as defined by the Insurance Law. For a discussion of the "serious injury law" see our blog at http://vrinjurylawyers.com/blog1/tag/serious-injury/ and find a car accident lawyer in NY if you have further questions.

Basic PIP Coverage The PIP coverage will pay for all reasonable and necessary related medical and rehabilitation expenses in accordance with established fee schedules. Your medical provider may not bill you more than these fee schedules allow.

You can receive 80% of lost earnings, up to a maximum payment of $2,000 per month for up to three years from the date of the accident; subject to certain statutory offsets for New York State disability, Worker's Compensation and Federal Social Security disability benefits.

You can receive up to $25 a day, for up to a year from the date of the accident, to reimburse other reasonable and necessary expenses; including household help and transportation expenses to and from medical treatment.

Exclusions from PIP Coverage

Under most insurance policies, a person will be ineligible for No-Fault benefits: if you were driving while intoxicated and contributed to the accident, intentionally caused your own injuries, were riding an all terrain vehicle (ATV), were riding a motorcycle as an operator or passenger, (a pedestrian struck by a motorcycle or ATV is a covered person), were injured while committing a felony, were injured while in a vehicle known to be stolen, or you were an owner of an uninsured vehicle.

Time Limitations to File a Claim

Written notice of a no-fault claim must be filed within 30 days of the accident. Medical bills must be submitted with 45 days of the treatment. Lost wage claims must be submitted within 90 days.

Additional resources provided by the author

Helpful Resources

A complete set of no-fault forms can be found here: http://www.ins.state.ny.us/r_finala/2004/pdf/rf68ca2f.pdf.

How to file a request for no-fault arbitration: http://www.ins.state.ny.us/csarbhow.htm.

Consumer complaint application: https://awebproxyprd.ins.state.ny.us/onepage/StartForm.jsp?link=/ciims_forms/StartForm.jsp.

Medical fee schedule: http://www.ins.state.ny.us/r68/r83.htm.

Frequently asked questions about the medical fee schedule: http://www.ins.state.ny.us/faqs/faqs_reg83_nffeesch.htm.

American Arbitration Association: https://nysinsurance.adr.org/public/NYOverview.jsp.

No-fault arbitration request form: http://www.adr.org/si.asp?id=4691.

No-fault Regulation 68: http://www.ins.state.ny.us/r68/r68_new.htm.

Article 51 of the New York Insurance Law: http://www.ins.state.ny.us/r68/r68_art51.htm.

Article 52 of the Insurance Law: http://www.ins.state.ny.us/r68/r68_art52.htm.

Source: http://www.ins.state.ny.us/auto/2007/auto0702.htm

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