Understanding the PIP Claims Process in New York

New Yorker with an arm injury - understanding the PIP claims process in New York

There are two distinct car insurance models in the United States. The first is a traditional fault-based insurance model. The other is the no-fault insurance structure. New York is one of a handful of states in the country that subscribes to the no-fault insurance system. With no-fault insurance, when you are involved in an accident, you turn to your insurance company for compensation. However, understanding the no-fault model and how personal injury protection coverage works can be challenging.

At Finz & Finz, P.C., we want to help you understand the PIP claims process in New York and how a personal injury attorney can help you recover maximum compensation for your injuries.

Understanding New York’s No-Fault System

In a traditional fault-based insurance structure, when a person is injured in a car accident, they file a claim with the at-fault driver’s car insurance company to pursue compensation. However, New York subscribes to a no-fault car insurance system. Under a no-fault system, following an accident, you turn to your car insurance provider to compensate you for your losses, no matter who is to blame for causing the crash.

Anyone who registers a vehicle in New York must carry personal injury protection or PIP coverage in addition to liability and uninsured motorist coverage. PIP coverage pays you for your accident-related financial losses, no matter who is responsible for causing the accident. Most basic no-fault auto insurance coverage includes:

  • Death benefits
  • Payment for reasonable and necessary medical expenses following an accident
  • Reasonable expenses like household help and transportation to medical appointments
  • Up to 80 percent of lost earnings from work

Personal injury protection coverage typically pays for your expenses until you reach your policy limit.

Filing a PIP Claim in New York

The first step in the claim process involves notifying the proper accident agencies, including your insurance company and law enforcement. No matter what, it is always best to involve law enforcement immediately. However, you must also remember that anyone involved in a car accident in New York must report the accident to the New York Department of Motor Vehicles within ten days of the crash if the damage caused is over $1,000 or if individuals were injured or killed. You can include the mandatory DMV form with the other claims forms required by your insurance company.

The sooner you inform your insurance company about the accident, the better. Depending on your policy, there may be a time limit for filing your claim. Most insurance companies require individuals to submit a claim within 30 days of the accident. The longer you wait, the more scrutiny your claim may face. Evidence may also be lost or destroyed the longer you wait.

Generally, your insurance company needs written notice of the claim. This notice typically includes the injured individual’s identity and information about the accident. Remain as factual and detailed as possible. Include the date, time, location, and circumstances of the incident. It is vital to involve law enforcement because a police report can help provide your insurance company with the details they need. Avoid embellishing your accident or offering opinions to the insurance representative.

What Comes Next?

In most cases, your insurance company issues an Application for Benefits and a letter within five business days of receiving your notice of claim. The Application for Benefits is what you use to file your official claim. Complete and return it as soon as possible. The accompanying letter explains your rights, obligations, and next steps.

In the meantime, continue getting the necessary medical care you need. While seeking medical attention immediately after an accident is crucial, it is just as important to continue following your doctor’s prescribed treatment plan in the days and weeks after a collision. Always make clear to your medical provider that your injuries were caused by a New York car accident. Benefits get paid following specific prescribed fee schedules. By law, healthcare providers must accept this fee schedule as full payment.

Insurance providers must make payments within 30 days of your healthcare provider’s claim. They must also provide supporting proof of medical necessity. Failing to make necessary payments can trigger two percent monthly interest on the unpaid amounts.

What If My Claim Is Denied?

If your no-fault claim gets denied, you may have several options to resolve your claim. First, you can file a complaint with the New York Department of Financial Services. You can also request arbitration. Arbitration is a process designed to help resolve disputes without going to court. Arbitration is a quicker process than going to court, and the results are legally binding. Arbitration works in cases where part or all of your claim faces denial, the insurer fails to make payments, or when an insurer fails to inform you promptly of your claim’s denial.

Finally, you may also be able to file a lawsuit in court seeking the compensation you deserve. The option that is best for you depends entirely on the unique circumstances of the accident and your claim.

The Serious Injury Threshold

Filing a third-party liability claim against an at-fault driver may also be possible to pursue further compensation for economic losses beyond that covered by your no-fault benefits. And to recover compensation for non-economic losses like pain and suffering, you must meet New York’s serious injury threshold.

You may be eligible to file a lawsuit against an at-fault or careless driver if your injuries include:

  • Bone fracture
  • Full disability for at least 90 days
  • Permanent limitation of the use of a limb or body organs
  • Permanent limitation of the use of a bodily system or body functions
  • Significant disfigurement
  • A significant limitation of the use of a bodily system of body functions

Contact an Experienced New York Car Accident Attorney for Help

Filing a successful no-fault car accident claim in New York can be challenging. You need evidence to support your claim and someone to help you manage communication with sometimes aggressive insurance adjusters. Do not attempt to navigate the no-fault claims process alone. Seek help from an experienced New York City car accident lawyer with Finz & Finz, P.C. We want to pursue maximum compensation for your financial losses.

Start with a free case review today. Contact our New York office to arrange your legal consultation.


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Finz & Finz, P.C. is a New York and Long Island personal injury law firm based out of Mineola, NY. It was founded in 1984 and is highly rated, with many honors and awards of excellence.