No Fault Insurance
What is no-fault and what does it cover?
No-fault is coverage under the automobile insurance policy of the New York vehicle you occupy at the time of an accident. You may also be eligible for this coverage if you are a pedestrian hit by a vehicle. This coverage is designed to pay for your lost wages, medical bills, and other medically-necessary expenses. This means that your doctor must put everything in writing. It is called no-fault insurance because it is available regardless of who caused the accident.
The applicable no-fault carrier must be placed on written notice within 30 days of an accident. In most cases, there are no exceptions. This means that you must submit an Application for No-Fault benefits within 30 days of an accident, in order to be able to make a claim for past and future lost wages, medical bills, and other medically-necessary expenses. In limited instances, this time frame may be extended. Please contact us to discuss the specifics of your case to determine if you may qualify for an extension of time.
Amount of Coverage
Each insured automobile carries a minimum of $50,000.00 in no-fault coverage for each occupant of the vehicle. Monthly wage loss is paid at 80% of your gross wages, up to a maximum of $2,000.00 per month – from all sources – unless you elect a special rider on your policy to extend to a higher monthly lost wage. Wages are reduced by 20% to simulate taxes – this means that no-fault payments are not taxable. Medical supplies such as a wheelchair or crutch rental, mileage to and from your doctors, as well as payment for any household chores your doctor writes that you cannot perform, may be reimbursed as well. The $50,000.00 includes payments from all sources, including New York State Disability.
Who is not covered?
In most cases, the following people would not be eligible for no-fault coverage:
- Motorcycle drivers.
- Motorcycle passengers.
- If you are in your own uninsured vehicle, there is no coverage for you.
- If you occupy your spouse’s uninsured vehicle, there is no coverage for you.
- Non-New York residents may not be eligible for coverage. Ask us to help you determine if you qualify.
What if you occupy someone else’s uninsured vehicle?
If the vehicle you are in is uninsured, and you do not reside in the same household as that person, you may be eligible to make a claim for no-fault benefits from your own automobile insurance policy, or the automobile policy of a relative you live with. If you do not have your own automobile insurance in your household, you could be eligible to make a claim for no-fault benefits from the Motor Vehicle Accident Indemnification Corporation. Proof of no insurance and proof that you do not live with someone who has automobile insurance is required. The same or similar deadlines apply to these types of alternate coverage. Ask us to assist you with the application and proof process.
Do I need a referral to see a doctor?
In most cases, no. Under no-fault, you do not need a referral to see a specialist such as a neurologist, orthopedist, acupuncturist or chiropractor. Therefore, if you do not have a primary care physician, you can usually still see a specialist without a referral. You do need a referral for diagnostic tests such as x-rays, MRI and CAT scans, as well as physical therapy.
Am I covered if I am in a rental vehicle?
In most cases, yes. You would be eligible for no-fault coverage available through the rented vehicle and still have the ability to use any “extra” coverage you may have paid for on your own automobile insurance policy. We can assist you in determining what coverage applies to your specific situation.
Am I covered for accidents outside of New York State?
If you are a New York State resident, and you own an automobile covered by insurance, then you are most likely covered by no-fault for accidents occurring in the continental U.S. and Canada.
What types of “extra” no-fault coverage is there?
Ask your insurance agent for information concerning Optional Basic Economic Loss (OBEL) coverage, Additional Personal Injury Protection (APIP) coverage, and medical payments coverage. Oftentimes these types of additional coverage are available for a very small cost. They would extend your coverage beyond the basic $50,000.00. If you want to know what those types of coverage can do for you, ask us for more information.
Is there a deadline for submitting medical bills for payment?
Yes. Medical bills must be submitted to the no-fault carrier within 45 days of the date of treatment. Therefore, it is imperative that you give your medical providers the no-fault information as soon as possible. Any treatment that is denied payment because of the 45-day rule, could result in your becoming personally responsible for the payment of that bill. Never assume that the bill is being taken care of. Be certain to submit all bills, including duplicates, immediately upon receipt.
Is there an expiration date for medical treatment?
Essentially, no. There is no law that says your benefits expire after “x” days/weeks/years. As long as your medical providers have indicated you will need treatment beyond the first year from the date of the accident, then No-fault will continue to pay for your medical treatment and prescriptions until the dollar amount is completely used up. However, no-fault could send you to an “independent” medical doctor to have your medical status and treatment verified. If a no-fault doctor examines you and determines you do not need that type of treatment, you could be denied benefits based on a lack of medical necessity. It is your treating medical provider’s obligation to justify the need for the treatment you are receiving, and that it is directly connected to your automobile accident.
What if no-fault denies payment?
There are various options available to you and/or your medical providers if no-fault denies payment for a specific treatment, medical testing, or even for a particular specialist. There are various avenues available to contest or refute a denial. Some options should not be taken right away, as they could put you “on the hook” for payment of the bill yourself. Contact us to discuss your no-fault denial options.
If you have questions concerning your state’s auto insurance laws, visit here for information.