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What are “No-Fault” benefits?

“No-Fault” insurance benefits are those benefits that are paid by the insurance company of the car you were driving; a car you were a passenger in; or if you were struck by as a pedestrian, the car that struck you, regardless of whose fault the accident was.

First things first, not all U.S. States qualify as such. New York, however, is a “no-fault” insurance state, which means that insureds are generally reimbursed by their insurance company for damages regardless of who was responsible for causing the accident. Insureds can be reimbursed for medical costs and other losses that might arise after the accident.

These “no-fault” benefits include payment of medical bills, prescription drugs, lost wages, housekeeping and/or transportation to and from medical providers, all as the result of the accident.


“No-fault” applies to any driver, cyclist, passenger, or pedestrian injured by a motor vehicle in New York.

Generally, there are several conditions that you must satisfy in order to qualify for “no-fault” coverage in New York:

  • The incident must have taken place in New York.
  • The injured person was a qualified party: a driver or passenger of the insured vehicle; a cyclist; or a pedestrian who was struck by a motor vehicle.
  • The motor vehicle must be one of the following: a bus; car; truck; taxi car; or other vehicle covered by New York’s “No-Fault” law.
  • The vehicle involved in the incident must be registered in New York.
  • That vehicle must also have an insurance policy that was sold in New York or issued by a company licensed to do business in New York.

For what reasons can an insurance company stop paying my “no-fault” benefits?

It should be noted that the insurance company has an interest in denying as many accident payouts as possible. For that reason, once you have started receiving treatment the “no-fault” insurance company will begin the process of “verifying” your injuries.  In essence, the no-fault insurance company will attempt to show that you are not injured. If they are able to show that you are done treating, the insurance company can stop paying for your associated medical costs, lost earnings, etc.

Bear in mind that just because a “no-fault” auto insurance company must provide up to $50,000.00 in protection, this requirement does not mean they must pay out $50,000.00 worth of coverage. As stated above, it is in their best interests not to expend the maximum amount of coverage per accident.

Through this process of “verification,” in order to confirm that you are injured, the “no-fault” insurance company may send you to one of their own doctors for an “Independent Medical Examination” (IME). You MUST attend the IME if one is scheduled; if you fail to attend/reschedule the IME twice, the no-fault insurance company may retroactively deny your benefits. In other words, it is possible for the insurance company to deny benefits from the date when you were first injured, and then seek to obtain reimbursement for any amounts already paid for wages, treatment, or other related expenses. Appearing for your IME appointment is an important first step to ensure that your regular treatments with your medical providers are covered.

What to expect at your IME

It is very important to note that the IME doctor is not your treating physician. Therefore, as a rule of thumb, while you must be truthful about your injuries, you should refrain from offering any unnecessary information to the IME doctor.

Once you arrive at your IME, you will be required to fill out paperwork. While you should complete the same to the best of your ability, do not hesitate to contact your attorney if something appears incorrect.

Before your IME, the IME doctor will have already reviewed all medical records associated with the incident. The insurance company will have provided these records to the doctor in advance. You will undoubtedly be asked about how the accident occurred, where, how your treatment is going, any complaints you have with regard to your treatment, if you were employed at the time of your accident, what your current employment is if any, and they will intimately how your sustained injuries are affecting your daily life. The IME doctor will also ask you about any past injuries or preexisting medical conditions.

Once your IME is complete, the IME doctor will note all findings in a formal report and provide that to your attorney, as well as opposing counsel. Please note that it is crucial that you fully understand each question before providing an answer, and that you ask for clarification if you do not understand, as your answers to the IME doctor’s questions will be noted in their report.

If the IME report concludes that particular treatments/specialties are already “resolved,” then the “no-fault” insurance carrier will deny your benefits for that particular specialty (e.g. pain management, psychiatry, orthopedics, neurology, chiropractic, acupuncture). A finding that an injury is “resolved” would conclude that no further treatment will benefit that resolved injury. Conversely, if the IME report finds that particular treatments or specialties are still “resolving,” then you will remain eligible for “no-fault” benefits with regard to those injuries.

What if I am denied “no-fault” benefits?

If you are denied “no-fault” benefits for any of the abovementioned reasons, you have three (3) options with regard to the next steps:

  • You may take the insurance company to Court.
    • Suing the insurance company for “no-fault” benefits is a long, costly process. It is also very difficult to accomplish successfully without the aid of an attorney, so be sure to speak with your attorney regarding the same if that is an avenue you wish to pursue.
  • You can file a written complaint with New York State’s Department of Financial Services.
  • You can file for No-Fault arbitration through the American Arbitration Association (AAA).

Who is NOT eligible for “no-fault”?

The following motorists are generally NOT eligible for “no-fault” coverage:

  • Motorcyclists
  • Vespa or Scooter Riders (depending on the engine size of the scooter; generally, if the Vespa or scooter is capable of traveling over 20MPH, that individual is not eligible for “no-fault” coverage)
  • Someone injured from the operation of a motor vehicle while intoxicated

How Can I Apply for No-Fault?

In order to file for “no-fault” benefits in New York, follow these simplified steps below:

  • Contact the correct insurance provider
    • The insurance provider you need to contact depends on your role in the accident. You may either need to contact your own insurance provider or the insurance provider of the person who hit you. PALERMO LAW P.L.L.C. may be able to help you determine which insurance company will provide “no-fault” insurance coverage for your accident, and oftentimes they can help you file as well!
  • Complete the following: Application for No-Fault Benefits (Form NF-2)
    • Download Form NF-2 above or contact your insurance provider to have the form mailed to you directly. Fill out each section with accurate information. If you have questions about completing Form NF-2, our Personal Injury attorneys at PALERMO LAW P.L.L.C. can help!
  •   Review and mail your application
    • Read over your application to ensure that all information is accurate and correct. Be sure to take a copy of the application for your own records prior to mailing the original.

Are there any time restraints I should be aware of?

Yes! There is a very short timeframe in which you may apply for “no-fault” coverage. As an insured party, you only have thirty (30) days from the date of your accident, in order to file an application for these benefits with the insurance company.

You can read more about “no-fault” coverage FAQs on the New York State Department of Financial Services webpage located here, or by contacting our offices, PALERMO LAW P.L.L.C., for a free Personal Injury consultation.

About the Author

Julia Mastrotto is an Associate Attorney at Palermo Law PLLC. Her area of focus is personal injury law with a heavy focus on automobile and premises liability matters.

Julia represents clients in personal injury matters zealously and with the objective of helping those who have been injured, to obtain the justice and compensation that they deserve. She finds the field meaningful, in that she enjoys bringing a sense of relief and comfort to people who have been injured.