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If you were hurt in a car crash in New York, it is important to understand how the state’s no-fault insurance system works. Under this system, your own insurance covers medical expenses and lost wages regardless of who caused the crash. This means you can receive help right away without having to prove another driver was at fault.
No-fault benefits go beyond medical bills and also cover other financial losses related to your accident. When injuries are severe enough to meet New York’s legal threshold, you may have the right to seek additional compensation for pain, suffering, and other losses.
A knowledgeable New York car accident attorney can guide you through the insurance process, explain your legal options, and help you pursue the maximum recovery allowed under the law.
Call Finz & Finz, P.C. today at 855-TOP-FIRM to speak with an experienced car accident attorney who will protect your no-fault benefits and help you pursue full financial recovery after your accident.
Key Takeaways About No-Fault Car Accident Claims
- No-fault insurance provides immediate coverage for medical expenses and lost wages up to policy limits without determining fault.
- New York requires all drivers to carry minimum no-fault coverage of $50,000 per person for basic economic losses.
- Serious injuries meeting specific legal thresholds allow victims to step outside no-fault and pursue additional compensation through lawsuits.
- No-fault benefits cover economic losses only, excluding pain and suffering unless the serious injury threshold is met.
- Filing deadlines for no-fault claims are strict, with applications due within 30 days of the accident.
The Basics of New York’s No-Fault Insurance System
New York adopted no-fault insurance in 1973 to provide faster compensation for accident victims while reducing court congestion. The system requires every vehicle owner to maintain Personal Injury Protection (PIP) coverage paying benefits regardless of fault. This coverage follows the injured person, not the vehicle, creating complex coverage scenarios in multi-vehicle accidents.
New York Insurance Law Article 51 establishes the framework requiring minimum coverage of $50,000 per person. This basic coverage pays medical expenses, 80% of lost wages up to $2,000 monthly, and reasonable transportation expenses for medical treatment.
Coverage Included in New York No-Fault Insurance
No-fault benefits extend beyond simple medical bills to encompass various economic losses from your accident. Coverage includes hospital bills, surgery costs, diagnostic testing, physical therapy, and prescription medications.
It also covers essential services you cannot perform because of your injuries, such as childcare or household tasks. No-fault insurance specifically covers these economic losses:
- All necessary medical expenses related to accident injuries
- Lost wages at 80% of gross income, capped at $2,000 monthly
- Transportation costs to medical appointments at IRS mileage rates
- Essential services up to $25 daily for household tasks you cannot perform
These benefits provide immediate financial relief without lengthy legal proceedings. However, the coverage limits often fall short of actual losses in serious accidents.
When You Can File a Lawsuit Outside New York’s No-Fault System
New York law permits lawsuits for pain and suffering only when injuries meet the “serious injury” threshold defined in Insurance Law Section 5102(d). This restriction prevents minor injury lawsuits while preserving rights for seriously injured victims. Meeting this threshold allows you to pursue additional compensation beyond the limits of no-fault coverage.
The serious injury categories include death, dismemberment, significant disfigurement, fractures, and permanent loss of use of body organs or members. Soft tissue injuries qualify if they prevent normal activities for 90 of the first 180 days following the accident. Insurance companies aggressively challenge whether injuries meet these thresholds.
How to Prove a Serious Injury in a New York Car Accident
Medical documentation becomes paramount in establishing serious injury for litigation purposes. Objective medical evidence like MRI results, surgical reports, and range-of-motion testing carries more weight than subjective complaints. Your doctor’s assessment of your lasting limitations and future treatment needs plays an important role in determining whether your injuries qualify.
Insurance defense attorneys scrutinize medical records searching for gaps in treatment or inconsistencies suggesting exaggeration. They hire doctors to perform “independent” medical examinations aimed at minimizing your injuries.
Having experienced legal representation protects you from these tactics designed to keep cases within no-fault’s limited compensation.
Steps to File a No-Fault Insurance Claim in New York
No-fault applications must reach the insurance company within 30 days of your accident to preserve benefits. This deadline applies even if you’re hospitalized or unaware of the requirement. Missing this deadline could cause you to lose your right to no-fault benefits, which would make you responsible for your own medical bills.
The application requires detailed information about the accident, injuries, employment, and treating physicians. Incomplete or inaccurate applications trigger denials that delay benefits and complicate treatment. Insurers often use small mistakes as reasons to deny valid claims.
Common Reasons No-Fault Insurance Claims Are Denied
Insurers often use a range of tactics to deny or end no-fault benefits, which forces injured people to fight for coverage. They request excessive documentation, schedule unnecessary examinations, and dispute treatment recommendations.
Common denial reasons that require immediate legal response include:
- Late filing of initial application or medical bills
- Failure to attend insurance medical examinations
- Lack of medical necessity for ongoing treatment
- Reaching maximum medical improvement despite ongoing symptoms
These denials often lack merit but require formal arbitration or litigation to overturn. Insurance companies count on injured victims lacking resources or knowledge to challenge improper denials.
Difference Between No-Fault and Liability Claims in New York
There are key differences between no-fault and liability insurance that determine how you can recover compensation after a car accident. Understanding how these systems work helps you know which benefits you are entitled to, what limitations apply, and when you may be able to pursue additional damages beyond your no-fault coverage.
To pursue damages beyond your no-fault coverage, your injuries must meet New York’s “serious injury” threshold. No-fault insurance covers only economic losses such as medical bills, lost wages, and certain out-of-pocket costs. It does not compensate for pain and suffering, emotional distress, or loss of enjoyment of life.
If your injuries qualify, you can file a liability claim against the at-fault driver to seek full compensation for both economic and non-economic damages, including pain, emotional anguish, and permanent impairment. Success depends on proving the other driver’s negligence using evidence such as police reports, medical records, witness statements, and accident reconstruction.
How to Coordinate Multiple Insurance Benefits After a Car Accident
Multiple insurance coverage creates coordination challenges requiring strategic planning. Your health insurance may cover medical expenses exceeding no-fault limits but maintains subrogation rights against settlements. Disability insurance might supplement lost wage benefits while preserving claims for future earning capacity.
Understanding how different coverages interact affects total recovery. Some benefits reduce others, while certain coverages stack to increase compensation. Our car accident attorneys maximize recovery by carefully sequencing claims and protecting subrogation interests.
Time Limits and Deadlines for No-Fault Claims
Strict deadlines govern every aspect of no-fault claims, with missed deadlines eliminating benefits regardless of injury severity. The initial application deadline of 30 days from the accident date cannot be extended. Medical providers must submit bills within 45 days of treatment, though subsequent bills have 45 days from the previous submission.
Written notice of intention to claim lost wages must occur within 30 days after missing work. Proof of lost wages requires submission within 90 days of the work loss. These overlapping deadlines create traps for unwary accident victims focused on recovery rather than paperwork.
Arbitration and Appeals in New York No-Fault Insurance Disputes
Disputed no-fault claims proceed through mandatory arbitration rather than court litigation. The arbitration process moves faster than traditional lawsuits but requires careful preparation. Arbitrators have authority to award benefits, interest, and attorney fees for wrongfully denied claims.
Appeals from adverse arbitration decisions must meet strict timing and procedural requirements. Master arbitrators review appeals for errors of law or clearly erroneous factual findings. Court appeals from master arbitration require demonstrating arbitrary and capricious decisions.
How to Handle Insurance Companies After a Car Accident
Insurance adjusters begin minimizing claims immediately after accidents, using recorded statements to challenge injuries and benefits. They request authorizations allowing access to your entire medical history, searching for pre-existing conditions. These fishing expeditions seek ammunition to deny benefits or reduce claim values.
Never provide recorded statements without legal representation protecting your interests. Insurance adjusters receive training in extracting damaging admissions from innocent comments. Even casual comments like saying you feel fine or mentioning activities you have resumed can be used against your car accident claim.
Preparing for Independent Medical Exams in No-Fault Claims
Insurance companies frequently demand “independent” medical examinations by their chosen doctors. These doctors typically minimize injuries and recommend discontinuing treatment. Missing these examinations results in benefit termination regardless of your actual medical needs.
Proper preparation for insurance medical examinations protects your benefits from biased doctors. Document your symptoms, limitations, and pain levels before the examination. Bring a witness if permitted, and request copies of the examination report for review by your treating physicians.
How Finz & Finz Helps No-Fault Car Accident Victims in Brooklyn and Long Island
Finz & Finz has more than 40 years of experience handling complex no-fault insurance matters throughout New York’s five boroughs and Long Island. Our team includes former New York State Supreme Court Justices with a deep understanding of how no-fault benefits work alongside personal injury claims.
Over the years, we have recovered more than $1 billion for our clients by maximizing no-fault benefits and seeking additional compensation through liability claims when appropriate. Our car accident attorneys manage every part of the no-fault process, from submitting the initial application to appealing denied benefits.
We work closely with medical providers across the region, including Brooklyn Hospital Center and North Shore University Hospital, to coordinate treatment and billing while protecting your benefits. This comprehensive approach helps prevent coverage gaps and shields clients from paying out of pocket for necessary medical care.
Strategies to Maximize No-Fault Benefits in New York
Insurance companies often deny valid no-fault claims over technicalities or paperwork errors. They question medical necessity, dispute lost wage calculations, or cut off benefits too soon. Our attorneys anticipate these tactics and submit complete, accurate applications that hold up under scrutiny.
We work with medical providers who know New York’s no-fault billing rules and accept insurance assignments so you can receive treatment without upfront costs. By coordinating closely with doctors and insurers, we keep your care moving forward and protect your right to full compensation.
FAQs for Car Accident Attorneys
What happens if I was partially at fault for the accident?
No-fault benefits pay regardless of fault, so your comparative negligence doesn’t affect basic coverage. However, fault percentages matter for liability claims seeking pain and suffering damages. New York’s comparative negligence rules reduce recovery by your fault percentage but don’t eliminate rights unless you’re 100% responsible.
Do I need to use my health insurance if I have no-fault coverage?
No-fault insurance serves as primary coverage for accident-related medical treatment, paying before health insurance. Once no-fault benefits exhaust, health insurance provides secondary coverage. Providers must bill no-fault insurance first and cannot balance bill you for covered services.
What if the other driver doesn’t have insurance?
Your no-fault coverage pays regardless of the other driver’s insurance status. Uninsured motorist coverage from your policy provides additional compensation for serious injuries. The Motor Vehicle Accident Indemnification Corporation offers limited benefits when no insurance exists.
Can I choose my own doctor for treatment?
You maintain complete freedom to select treating physicians under no-fault insurance. Insurance companies cannot direct you to specific providers or limit your treatment choices. However, providers must accept no-fault assignments and follow billing requirements for coverage.
What if my no-fault claim gets denied?
Denied claims require immediate attention to preserve appeal rights and prevent benefit losses. Request written denial explanations and gather supporting documentation from treating physicians. File arbitration demands within time limits to challenge improper denials.
Contact a New York Car Accident Attorney to Protect Your Rights and Benefits
Stuart L. Finz, Brooklyn Car Accident Lawyer
No-fault insurance complexities and strict deadlines trap accident victims who try handling claims alone. Insurance companies profit by denying legitimate benefits through technical violations and biased medical opinions. Finz & Finz levels the playing field with experienced attorneys who know every insurance company tactic and how to defeat them.
Your injuries require immediate medical attention while bills mount and work becomes impossible. Call 855-TOP-FIRM now to speak with a car accident attorney who protects your no-fault benefits while pursuing maximum compensation for serious injuries. Don’t let insurance companies minimize your claim when you need benefits most.
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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.
