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NY No-Fault

If you were hurt in a car accident, no-fault insurance might just give you the help you need. If you live in a handful of states including New York, you might have filed for no-fault benefits and have some questions. What happens next? What kind of treatment is paid for? Where do you go for medical care? Will I have my medical expenses taken care of without risking my home and my property? And perhaps the biggest question is, what does the law say about who pays for your medical bills?

If you reside in New York State, you’re in luck. New York is one of only about a dozen no-fault states that have in place “personal injury protection,” (PIP coverage) in the form of No-Fault insurance as part of everyone’s regular automobile insurance. No-Fault insurance ensures that you will be able to cover the cost of your medical treatment bills without having to pay out-of-pocket. It also ensures that your doctor is not going to be left without your paying your medical bills after your car accident is a distant memory. No fault also provides wage protection, with coverage up to $2,000.00 per month in lost wages.

Some of the medical expenses that are included under No-Fault include:

  • Hospital

  • Medical bills (examples: primary care doctor, orthopedic surgeon)

  • Surgical

  • Dental

  • Ambulance

  • X-ray

  • Prescriptions

  • Prosthetic services

  • Psychiatric

  • Physical therapy (must have a referral)

  • Occupational therapy

  • In-patient rehabilitation

  • Acupuncture

When you’re in an auto accident, your own car insurance coverage pays for the medical expenses and other financial losses such as lost wages suffered by anyone covered under your policy. The section of your coverage that takes care of this is usually outlined under the “personal injury protection,” or, “medical benefits,” section of your policy. Your insurance will cover your costs up to the coverage limits outlined by your insurer. If you are a pedestrian or bicyclist, no-fault coverage will be provided by the vehicle that struck you. Passengers receive no-fault coverage from the vehicle in which they were riding.

Not all physicians or medical offices accept No-Fault insurance. It’s a good idea to consult your doctor’s office to find out if they accept No-Fault coverage. Knowing that your physician will take No-Fault insurance will save you from having to search around for one who does.

Because New York state is one of the “No-Fault” states, the procedure for submitting insurance claims is fairly straightforward. You will be submitting your claim to your own insurance company for lost wages and other accident related expenses. Your physicians will bill your no-fault carrier directly. Your insurance company then covers certain financial losses related to your auto accident, regardless of who caused the accident up to the limit of the coverage and the nature of the claims.

In a no-fault automobile insurance accident claim, you don’t have to prove to the insurance company who was at fault for the car accident.

In contrast, in a third-party accident insurance claim or lawsuit against an at-fault driver, you can recover compensation for pain and suffering, in addition to reimbursement for medical bills and other expenses like lost income. “Pain and suffering” and certain other damages are typically claims that no-fault car insurance doesn’t cover. In order to recover on a liability claim, fault must be established.

It’s in the insurance company’s best interest to deny as many accident payouts as possible. After you’ve begun getting care from your physician, the no-fault insurance company will start the process of verifying your injuries. The no-fault insurance company will attempt to show that you are not injured so they can stop paying for medical costs, lost earnings, and other expenses. Remember, the no-fault auto insurance company must provide up to $50,000 in protection. However, this requirement does not mean they must pay out $50,000 worth of coverage.

If you have been in an accident and the No-Fault insurance company with whom you have filed a claim is refusing to pay for your medical treatments, give us a call today. We have dealt with cases concerning these types of insurance companies for years. Do not let your injuries go untreated because you cannot pay for medical care. Contact us and let us help you get the coverage that you seek.


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