September 10, 2024 
If you’ve been in a car accident, you understand how stressful and confusing it can be to deal with insurance companies, especially if you’ve suffered a personal injury. In New York State, you’ve likely come across the term “no-fault insurance.” But what exactly does this mean, and how does it work?
New York is a no-fault state, meaning that each driver is required to hold no-fault insurance to cover their medical expenses and lost wages in the event of an accident, regardless of who is at fault. To help you navigate the intricacies of no-fault insurance in New York, we’ve compiled everything you need to know about what’s included, who’s protected, and how to file a claim if you’ve been involved in an accident.
What Is No-Fault Insurance?
No-fault insurance, also known as Personal Injury Protection (PIP), helps cover the costs of medical expenses and lost wages incurred after a car accident, regardless of who is at fault. This system is designed to reduce litigation over minor accidents and ensure that people receive prompt compensation for their injuries.
New York’s no-fault insurance provides a minimum of $25,000 of coverage per person and $50,000 in total coverage for out-of-pocket medical expenses caused by an accident. Some examples of costs that no-fault insurance covers include:
- Ambulance costs
- Necessary medical procedures such as x-rays, surgeries, and hospital stays
- Dental expenses for injuries sustained in the accident
- Lost wages, up to 80% of your income or a maximum of $2,000 per month, for up to three years
- Funeral and burial costs, up to $2,000 in case of a fatality
- Prescription drugs for medications related to injuries
- Physical or occupational therapy required for recovery
- Medical devices or prosthetics resulting from your injuries
Although no-fault insurance can help cover a broad range of expenses after an accident, it does not cover every possible cost, especially in the event of a serious injury. Even if you’re collecting no-fault benefits from your own insurance policy, you may also have a valid personal injury claim against the at-fault driver’s liability insurance for certain damages not covered by PIP.
The Difference Between No-Fault and Liability Coverage
While no-fault insurance helps cover medical expenses and lost wages for injured parties regardless of fault, liability coverage protects the driver who is at fault. Liability insurance covers personal injury claims made by the other party, including medical bills, lost wages, and pain and suffering resulting from the accident.
New York State requires drivers to carry both no-fault and liability insurance, with the following minimum coverage amounts for liability insurance:
- $25,000 per person for bodily injury
- $50,000 per person for death
- $10,000 for property damage per accident
These minimum requirements are intended to ensure that, in the event of a serious accident, both parties have access to compensation.
Who Can Claim No-Fault Benefits?
No-fault auto insurance in New York covers the following individuals:
- The policyholder (the person named on the insurance policy)
- Passengers who were in the policyholder’s vehicle at the time of the accident
- Pedestrians who are hit by the vehicle
Additionally, members of the policyholder’s household may be covered under certain circumstances. For example, if a member of your household is injured in an accident involving another vehicle that doesn’t have insurance, they may still be entitled to no-fault benefits through your policy.
Who Is Excluded From No-Fault Benefits?
While New York’s no-fault insurance system is comprehensive, there are individuals who are not eligible for these benefits:
- Motorcyclists and their passengers: New York’s no-fault insurance does not apply to motorcyclists. Motorcyclists must rely on other forms of coverage, such as health or disability insurance, for injuries sustained in accidents.
- Owners of uninsured vehicles: If you are driving your own uninsured vehicle, you are not eligible for no-fault benefits.
- Those driving or riding in their spouse’s uninsured vehicle: New York State does not provide no-fault coverage in this situation.
- Non-residents of New York State: No-fault benefits typically apply to New York State residents involved in accidents within the state.
There are also exclusions under your own insurance policy that may prevent you from receiving benefits. Private insurance companies can create specific exclusions, so it’s crucial to review your policy carefully. Common exclusions include:
- Individuals who intentionally cause their own injuries
- Drivers who are found to be intoxicated or under the influence of drugs at the time of the accident
- Those injured while committing a felony
- Individuals driving or occupying a stolen vehicle
- Drivers engaging in illegal street racing or “speed-testing”
How to File a No-Fault Insurance Claim in New York
If you’ve been involved in a car accident in New York, it’s important to act quickly to protect your right to no-fault benefits. Here’s a step-by-step guide to filing your claim:
- Notify your insurance company: In New York, you must submit a completed no-fault application form (or provide another accepted written notice) to your insurance company within 30 days of the accident. This is a strict deadline, and failing to meet it can result in the loss of your no-fault benefits.
- Provide detailed information: Your claim should include as much information as possible about the accident, including the date, time, location, and circumstances. You should also document any injuries sustained, medical treatments received, and any lost wages due to your injuries.
- Submit medical bills: You must provide copies of your medical bills and receipts for any treatments you’ve received related to the accident. Keep all documentation related to your recovery, including prescriptions and therapy appointments.
- Track lost wages: If you are claiming lost wages, you’ll need to submit evidence of your income, such as recent pay stubs or tax returns, as well as documentation from your employer showing that you have missed work due to your injuries.
In rare circumstances, if you are unable to file within the 30-day window, you may be able to receive an extension. You’ll need to provide written proof to your insurance company explaining the reason for the delay.
The No-Fault Threshold and Serious Injury
While no-fault insurance is designed to cover your medical expenses and lost wages, it may not cover all of your damages in the event of a serious injury. After your no-fault coverage has been exhausted, you may choose to file a claim with the at-fault driver’s insurance company to recover damages not covered by your own no-fault. To pursue a claim beyond your own no-fault benefits, one must meet the serious injury threshold, which is contingent upon proving a “serious injury” as defined by New York State law. The serious injury threshold ensures that only individuals who have suffered significant harm beyond minor injuries can pursue additional compensation from the at-fault party.
Categories of Serious Injury
Under New York law, several specific categories qualify as a “serious injury,” allowing accident victims to seek compensation beyond their no-fault benefits. These categories include:
- Death
- Dismemberment
- Fracture
- Loss of a fetus
- Permanent loss of use of an organ, limb, function, or bodily system
- Significant limitation of the use of an organ, limb, function, or bodily system
Additionally, if an injury leads to permanent partial disabilities or impairs the injured person’s ability to perform their usual daily activities for an extended period, this can also qualify as a serious injury. Meeting this threshold is crucial for those seeking compensation for pain and suffering, as well as other non-economic damages that are not covered by no-fault insurance.
By proving that you’ve sustained a serious injury under New York’s legal definition, you can pursue a claim for these additional damages and seek further compensation for the impact the injury has had on your life.
Filing a Personal Injury Lawsuit
If you’ve been seriously injured in a car accident, you may be eligible to file a personal injury lawsuit to recover compensation beyond what’s covered by New York’s no-fault insurance. While no-fault insurance helps cover medical expenses and lost wages, it does not provide compensation for non-economic damages such as pain and suffering, emotional distress, or loss of enjoyment of life. Filing a lawsuit allows you to pursue these additional damages, provided you meet the criteria set by New York law.
Damages You Can Recover
In a personal injury lawsuit, you may seek compensation for both economic and non-economic damages. Economic damages cover the tangible costs of your injuries, such as:
- Medical bills (past and future)
- Lost wages and loss of future earning capacity
- Rehabilitation and therapy costs
- Property damage (such as vehicle repairs)
Non-economic damages, on the other hand, cover the less tangible effects of your injuries, including:
- Pain and suffering
- Emotional distress
- Loss of consortium (the impact of your injuries on relationships with loved ones)
- Loss of enjoyment of life
In cases involving gross negligence or reckless conduct, you may also be eligible to receive punitive damages, which are intended to punish the at-fault party and deter similar behavior in the future.
Contact a Personal Injury Attorney
If you’ve been injured in a car accident and are unsure how to file a no-fault claim or pursue additional damages, it’s wise to consult with an experienced personal injury attorney. Navigating the complexities of no-fault insurance, liability coverage, and personal injury claims can be overwhelming, especially while recovering from an injury.
To learn more about New York’s no-fault laws or to discuss a potential personal injury claim against another driver’s liability coverage, contact the knowledgeable team at Cellino Law. Our attorneys are available to answer your questions 24/7 at 888-888-8888.