No-Fault Insurance

In New York, regardless of fault, every automobile insurance policy provides for the payment of first-party benefits of up to $50,000 for “basic economic loss” for covered persons injured in car accidents, but bars the filing of lawsuits against the at-fault party to recover non-economic loss (i.e. pain and suffering) except for those who have suffered “serious injury” as defined by the statute.

The No-Fault statute defines “covered persons” to include any pedestrian injured through the use of operation of a motor vehicle, any owner, occupant or operator of a motor vehicle, or any other person entitled to first party benefits. Generally, for accidents occurring in New York State or for vehicles insured in New York State, this includes the named insured under the insurance policy and members of the named insured’s household. Bicyclists are also covered persons.

The No-Fault law permits insurance companies to exclude coverage for persons who intentionally injure themselves, who are operating under the influence of alcohol or drugs, who are committing a felony, who are knowingly passengers in a stolen car, who are injured while fleeing the police or while racing. Generally, for these to apply, the insurance company must provide an express exclusion in the policy, which carriers do not always do. In the absence of an express exclusion, there may be no-fault coverage even in some of the circumstances listed above. Motorcyclists and their passengers are excluded from no-fault coverage, as are non-pedestrians injured by motorcycles. Pedestrian victims of motorcycles are covered by no-fault.

Generally, drivers and occupants of uninsured vehicles are excluded from coverage, as are people who are injured repairing, servicing or maintaining motor vehicles in a repair facility, as opposed to on a roadway.

The fundamental coverage under the New York No-Fault law that provides up to $50,000 for “basic economic loss” to persons injured in or by an insured vehicle. This coverage, which is on the vehicle and is mandated by law, is often called “Personal Injury Protection” or “PIP”. It is available regardless of fault to cover medical expenses, lost wages and certain other expenses caused by a motor vehicle accident. Although $50,000 is mandatory on all motor vehicle policies in New York, car owners can buy additional protection above the mandatory $50,000. This is often referred to as “Additional Personal Injury Protection” or APIP. To obtain benefits, an injured party must give the carrier notice of the accident. This will require to injured party to submit a written application to the insurance carrier on a standard form that can be obtained by calling the carrier to report the accident. This form must be properly filled out and filed within 30 days of the accident. Failure to timely file this form will permit the insurance carrier to disclaim coverage for first party benefits. Once the application is timely filed, the insurance carrier is responsible for paying medical expenses related to the accident, lost wages caused by the accident, and other “reasonable and necessary expenses.”

Medical, loss of earnings and other related and reasonable expenses may be recouped and this to find out more you should contact our office for a consultation.

For more information about No-Fault insurance and Benefits in New York State, visit: New York State Consumer Financial Services, No-Fault FAQ