What Is No-Fault Coverage

New York is a “No-Fault” state. No-Fault laws were enacted to ensure that victims of motor vehicle accidents, whether they were at fault for their accident or not, will receive payment for medical expenses, lost wages, and other accident-associated costs. This payment is made by an automobile insurance policy. But it’s important to understand whose policy will make this payment. To clarify, if you are the passenger/operator of a motor vehicle, the insurer of the automobile you were in will cover your No-Fault payments. If you are walking or riding a bike and are struck by an automobile, the insurer of that automobile will cover your No-Fault payments. If you are injured in a bus accident, the automobile insurer of your household will cover your No-Fault payments.

If you were the operator or passenger of a motorcycle involved in an accident, unfortunately, the No-Fault law does not apply. You will need to rely on your private health insurance to cover your accident-related expenses.

It is imperative that you file your No-Fault application within 30 days of your accident. Failure to do so may result in denial of coverage. At Palermo Law, we handle the No-Fault application for our clients. There are aspects of the form that a personal injury attorney should really help you out with to ensure you do receive No-Fault payments and that they cover treatment for all of your accident-related injuries.

What Does No-Fault Cover?

It’s important to understand that No-Fault only covers your accident-related expenses up to $50,000 dollars (unless you have chosen to purchase additional personal injury protection, or APIP).

Medical Expenses: No-Fault will cover all medical expenses associated with injuries you’ve incurred from your accident, usually without the need for referrals or pre-authorization. Unfortunately, not all healthcare providers accept No-Fault coverage.

Lost Wages: For No-Fault to cover lost wages, you must provide proof of disability from a medical provider and proof of employment. No-Fault will cover 80% of your lost wages up to $2,000 dollars a month.

Out-of-Pocket Expenses: Out-of-pocket expenses include transportation to medical providers, medications, and any other costs you make “out of pocket” that are directly related to the treatment for your injuries. No-Fault will cover these out-of-pocket expenses for up to $25 a day.

How Long Will No-Fault Cover My Expenses For?

Automobile insurance carriers in New York, by law, must offer a minimum of $50,000 dollars. Should you choose to only pay a monthly premium that results in a $50,000 dollar minimum, once this amount is exhausted, No-Fault coverage will be denied. Furthermore, you may be required by the insurance carrier covering your payments to undergo an independent medical exam. Should your exam suggest you are recovered, no longer in need of treatment, and able to work again, No-Fault coverage will be denied. If you disagree with the independent medical examiner that you are recovered, you do have the right to file an appeal with an arbitrator. Put simply, the appeals process can be complicated.

For general information on filing a New York State No-Fault Application, click here.