NEW YORK'S MOTOR VEHICLE NO-FAULT LAW: WHAT IS “NO-FAULT”?

Well, in New York, this applies to Motor Vehicle Accidents only. It does not apply to trip and Fall, Slip and Fall, and generally does not apply to motorcycle accidents. It doesn’t matter whether you are a driver, passenger, pedestrian or bicyclist. All are covered by New York’s No-Fault law. But what is it?

Also known as the Personal Injury Protection law (PIP), the applicable New York Statute is:

11 CRR-NY 65-1.1The “MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT”

Why is it important?

After an accident, an injury is likely in some form. Whether you are just shaken up, banged up, have bruises, or broken bones, a back injury, a neck injury, headaches or injuries to your limbs, you should get medical attention as soon as possible. The No-Fault law in New York assures that you can get free medical attention, owing nothing for any treatment you get costing up to $50,000.00 in total, no co-pays, no bills, with the only possible exception being a $200.00 deductible which is present in some, but not all policies. So don’t be afraid to go the hospital, Urgent Care, a physician or for physical therapy to get better. You don’t need to have, and cannot use your own private health insurance. Your medical bills following a motor vehicle accident MUST be paid by the No-Fault Insurance Company and most importantly, you are not obligated to repay the medical bills paid by the basic no-fault coverage.

How does it work?

  1. If you are the driver of the car:
    If you are the driver of a motor vehicle involved in the accident, no matter whose fault the accident was--- yours, or the other drivers, it would be your own motor vehicle insurance company which would pay for all of your medical bills related to the accident, up to $50,000.00 in total (more on that later);
  2. If you are a passenger in a motor vehicle:
    If you are a passenger in a motor vehicle involved in an accident, no matter whose fault the accident was--- your drivers, or the other driver, it would the insurer for the motor vehicle in which you were the passenger which would pay for all of your medical bills related to the accident, up to $50,000.00 in total (more on that later);
  3. If you were a pedestrian or bicyclist struck by a motor vehicle:
    If you were a pedestrian or bicyclist struck by a motor vehicle no matter who’s fault the accident was--- yours, or the other drivers, it would be the motor vehicle’s insurance company which would pay for all of your medical bills related to the accident, up to $50,000.00 in total (more on that later);

What is covered?

While its best to call our office, THE LAW OFFICE OF STEVEN R. SMITH at 516-741-5454 for all of the details, in general, you should know that your medical bills will be paid for a ‘reasonable’ period of time, up to three years; you can receive 80% of your lost earnings up to $2,000.00 per month (and possibly more depending upon the cars insurance policy) and up to $25 per day for transportation to medical treatment or other necessary expenses.

How long does the coverage last?

Well this is a really good question. In theory, the insurer would pay for treatment you receive for your injuries for up to three years from the date of the motor vehicle accident. However, they are only obligated to pay for as long as the treatment is reasonable and necessary. How is that determined? Well the insurance company, which is of course a business interested in making a profit, gets to select and hire their own doctors, to examine the injured person- on their behalf-- ‘as often as necessary’ to determine if the injured person still needs medical treatment—which is being paid for by the insurance company – which hired the doctor. So one might question why the insurance company gets to select and hire their own doctors and not an independent entity assigning the doctors—Good Point. Contact your legislator and raise that point !!

Can you still get medical treatment even after the No-Fault Insurance company terminates your benefits?

You can use your own personal health Insurance, Medicaid benefits and/or Medicare benefits once your No-Fault benefits are terminated to continue to receive medical treatment. You can also ‘appeal’ by way of arbitration the No-Fault termination of benefits, although there are some ‘pros’ and ‘cons’ to this which are better to discuss with our firm, THE LAW OFFICE OF STEVEN R. SMITH at 516-741-5454. Some doctors will continue to treat you on a ‘lien’ basis, meaning that their bills would be paid at the end of your case out of your settlement or judgment proceeds, and finally, some doctors with arbitrate the bills directly with the insurance company, saving you the obligation to pay off their unpaid medical bills.

What about the $50,000.00 limit on medical bills?

Well $50,000.00 goes a long way in the land of No-Fault. There is a No-Fault ‘billing rate’ which greatly reduces the amount of the bill to a lower scheduled rate. So while a doctor may charge $300 for a visit, the No-Fault payment rate might be only $58.00 (for example) and the best part is that the doctor is NOT allowed to charge you the difference. Surgeries charged at $25,000 are often reduced to $6,500 (for example) and so $50,000.00 in ‘paid’ bills could be thousands more in charges, and you do not need to pay back any. There are other, somewhat complicated ‘additions’, called “endorsements” which could provide even more medical payment coverage if needed, called APIP, OBEL and med pay, although some of these coverages also give the No-Fault insurer rights to go after the other cars (if there is another car) insurance policy. As your attorneys, THE LAW OFFICE OF STEVEN R. SMITH will make sure that you are afforded all of the possible medical coverage that you are entitled to.

How do I get the No-Fault benefits?

One final thought on No-Fault benefits. You are required to file an application for No-Fault benefits within thirty (30) days of the accident. Late applications may be accepted with a valid explanation but it should never be left to that. It is therefore so important to call our office as soon as you are involved in an accident so that we can make sure that all of your rights are protected and of course that includes the proper and timely filing of your application for No-Fault benefits. While many firms charge a separate fee to complete the No-Fault application, monitor your benefits, schedule and reschedule the No-Fault examinations, we DO NOT charge any fee for this service. We consider this to be a vital part of your case and we want to assist you so that you can get the best medical attention possible, treat your injuries properly, get paid medical treatment for as long as necessary and put your case in a position to obtain maximum compensation for your injuries.

Our office, The Law Office of Steven R. Smith has been representing injured people in New York State for over 30 years. We take every case personally and give our fullest attention to every detail of the claim and every need of our client. Whether its medical treatment cost, lost earnings, vehicle damage, transportation costs to the doctor or prescription medication, we assist our clients in getting every benefit that they deserve. And of course, we have a track record of getting maximum results for our clients. If you have a case for us to handle for you now, or if you would like to discuss or get more information about the subject of this article, please feel free to call us at 516-741-5454, to email us at steven@srsnylaw.com, or to get more information at our website, www.newyorkattorneyatlaw.com. We hope this article was informative and useful.

*Please note that this article was meant to be informative and should not be taken and is not intended to constitute legal advice. All cases are different, laws in other states differ, and unless our firm is specifically retained in writing and you are given specific legal advice about your case by an attorney in our firm, you should not rely on any informational content, which is provided herein for general knowledge only.


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