Ny's No-Fault Insurance: What's Covered?

In the state of New York, drivers are legally required to carry personal injury protection (PIP) insurance. This is because New York is a no-fault insurance state, meaning that the policyholder is the primary insurer, rather than the at-fault driver's insurance company. PIP insurance covers medical costs, lost wages, and death benefits. The minimum amount of PIP coverage available in New York is $50,000, but additional coverage can be purchased.

No-fault insurance laws in New York

New York is a "no-fault" insurance state, which means that insured individuals are reimbursed by their insurance company for damages, regardless of who was responsible for the accident. This includes medical costs and other losses that might surface after the accident.

The state of New York requires registered motor vehicles to have liability insurance with certain minimum coverage amounts:

• $25,000/$50,000 for bodily injury per person
• $50,000/$100,000 for death
• $10,000 for property damage per accident

No-fault insurance, also called Personal Injury Protection (PIP), is designed to pay promptly, regardless of who is at fault or whether there was any negligence, for economic losses (meaning medical/health expenses, lost earnings, and certain other reasonable and necessary expenses related to injuries sustained), up to $50,000 per person ("basic No-Fault coverage",), to the driver and all passengers injured in your car as well as any pedestrians injured by your car, because of its use or operation in New York State.

The purpose of No-Fault insurance is to restore individuals hurt in auto accidents to health and productivity as swiftly as possible. Because of New York's No-Fault law, lawsuits due to auto accidents can only be brought for economic losses that exceed No-Fault benefits and for non-economic damages (such as pain and suffering) only if a "serious injury" (as defined in the Insurance Law) is sustained.

No-Fault insurance does not provide coverage for vehicle repairs. It only covers personal losses that those who are covered have suffered due to their injuries.

There are benefits, and also limitations on benefits, some exclusions, and situations where a personal injury lawsuit may be filed against the party at fault for the accident. Most importantly, there is a deadline by which a car accident claim with the responsible insurance company must be filed.

Basic No-Fault auto insurance coverage includes:

• Reasonable and necessary accident-related medical and rehabilitation expenses (in accordance with established fee schedules)
• 80% of lost earnings from work, up to a maximum payment of $2,000 per month for up to three years from the date of the accident; subject to statutory offsets for New York State disability, Worker’s Compensation, and Federal Social Security disability benefits
• Up to $25 a day, for up to a year from the date of the accident, to reimburse other reasonable and necessary expenses (e.g., household help and transportation expenses to/from medical treatment) resulting from the auto accident
• A $2,000 death benefit (in addition to the $50,000 basic No-Fault limit), payable to the estate of a person eligible for No-Fault benefits who is killed in a motor vehicle accident

There are certain exclusions from receiving No-Fault benefits. Those who are not covered according to New York's no-fault statute include:

• Motorcycle passengers
• Owners driving their own uninsured vehicle
• Owner’s driving or occupying their spouse’s uninsured vehicle
• Those who are not residents of New York
• Those who may be excluded under your own policy
• Those who are covered but intentionally cause their own injury
• When the driver was intoxicated as defined by law or under the use of a controlled substance
• If, at the time the person who was injured was in the act of committing a felony, such as trying to escape from the police
• Driving or occupying a vehicle the policy owner or passenger knows to be stolen
• Racing or conducting a speed test

New York No-Fault regulations require a written claim with the insurer within 30 days of the accident. The claim is filed with the insurance company that covers the car involved. This time is extended rarely and only if a claimant can provide written proof that there is a “clear and reasonable justification for the failure to comply with the time limitation.”

What PIP covers

Personal injury protection (PIP) is a mandatory form of auto insurance for all drivers in New York. It covers medical costs, economic losses, and death benefits. The minimum amount of PIP coverage one can purchase in New York is $50,000, which is also the maximum amount one is entitled to recover with a PIP claim.

PIP covers most medical costs stemming from a car accident, including psychiatric and physical rehabilitative costs, diagnostic services like X-rays, and treatment in accordance with a recognized religion. If you are unable to work because of your injuries, PIP in New York will also pay for any lost wages up to $2,000 per month or 80% of your monthly earnings, whichever is less, for no more than three years after the accident, and up to the policy's limits. You will also be entitled to $25 per day to take care of routine activities that you can no longer do, such as laundry and home maintenance.

If an eligible insured driver is killed in an accident, the driver's estate is entitled to $2,000 to help pay for funeral and burial costs. This benefit is common in most states' no-fault insurance laws.

In addition to the above, PIP insurance in New York could also cover expenses like household costs.

Minimum PIP coverage in New York

In New York, drivers are legally required to carry personal injury protection (PIP) coverage as part of the state's no-fault insurance laws. The minimum PIP coverage amount in New York is $50,000 per person. This means that the maximum amount you are entitled to recover with a PIP claim is $50,000.

PIP insurance in New York covers three things: medical costs, economic losses, and death benefits. Most medical costs stemming from a car accident will be covered by your personal injury protection. This includes psychiatric and physical rehabilitative costs, diagnostic services like X-rays, and treatment in accordance with a recognized religion. If you are unable to work due to your injuries, PIP in New York will also pay for any lost wages up to $2,000 per month or 80% of your monthly earnings (whichever is less) for no more than three years after the accident. The insured driver, their passengers, and members of their household are entitled to PIP benefits.

You can purchase additional PIP insurance if you want to increase your coverage limits. This is a worthwhile consideration if you can afford the costs, as medical expenses after an accident can be significant. You may also increase the $50,000 limit to $75,000 by purchasing Optional Basic Economic Loss (OBEL) insurance, which provides an additional $25,000 of coverage.

It is important to note that PIP does not cover property damage or damages for "pain and suffering". Additionally, there are some situations where you cannot use PIP coverage in New York, such as if you are riding an ATV or are injured while committing a felony.

Additional PIP coverage

In New York, drivers are required to carry personal injury protection (PIP) coverage as part of the state's no-fault insurance laws. This means that the costs of all injuries drivers and passengers sustain are covered, regardless of who was at fault in the accident.

The minimum amount of PIP coverage in New York is $50,000, and this is the maximum amount you can recover with a PIP claim. However, you can purchase additional PIP insurance if you want to increase your coverage. This is a good idea if you can afford it, as medical expenses after an accident can be high.

You can also increase your coverage by purchasing optional basic economic loss insurance (OBEL) in addition to additional PIP. OBEL gives you an extra $25,000 worth of coverage, which you can allocate towards medical expenses, lost earnings, psychiatric or rehabilitative costs, or a combination of these. This is relatively cheap, costing less than $30 more per year for an extra $75,000 worth of coverage.

If you have been in an accident, you can file a PIP claim up to 30 days after the incident if injuries are involved. You will then have 45 days after the start of treatment to submit written proof to your insurance company detailing the nature and extent of your injuries and treatment.

In summary, while New York's minimum car insurance requirements are higher than in many other states, it is worth considering additional PIP coverage and OBEL to ensure you have sufficient coverage in the event of an accident.

Filing a PIP claim

Yes, New York drivers are mandated to carry personal injury protection (PIP) coverage per the state's no-fault insurance laws. PIP is a form of medical expense coverage purchased as part of an auto insurance policy. Here is a step-by-step guide on how to file a PIP claim in New York:

Step 1: Understand the Coverage

Firstly, it is important to understand what is covered by your personal injury protection in New York. PIP insurance in New York covers three things: medical costs, economic losses, and death benefits. Most medical costs stemming from a car accident will be covered, including psychiatric and physical rehabilitative costs, diagnostic services like X-rays, and treatment in accordance with a recognized religion. If you are unable to work due to your injuries, PIP will also cover lost wages up to a certain limit. Additionally, you are entitled to $25 per day to cover routine activities that you can no longer perform, such as laundry and home maintenance.

Step 2: Notify Your Insurer

Notify your insurer as soon as possible after the accident. You will be asked to complete multiple forms to initiate the claims process. The NF-2 form, or Application for No-Fault Benefits, is where you will clarify what happened, state that you are submitting a PIP claim, and describe your known injuries. If you have found a medical professional for treatment, you can use the Assignment of Benefits (AOB) form to direct your PIP insurance benefits to them. This ensures that your physician receives compensation directly from your insurer instead of billing you.

Step 3: Submit Proof of Losses

For medical costs, you will have 45 days after the start of treatment to submit written proof to your insurance company detailing the nature and extent of your injuries and the treatment received. For lost earnings, New York no-fault insurance policies allow you 90 days to submit written proof. It is recommended to submit these documents as soon as possible, as your insurance company is not required to pay out until they receive your forms. Once they receive the proof, they have 30 days to pay you.

Step 4: Independent Medical Exam (IME)

Keep in mind that your insurer may require you to undergo an IME before they approve your claim. If you refuse to take the IME, your insurer can deny your no-fault claim, and you would need to go to arbitration to overturn the ruling. An IME is more likely to be requested if you are claiming severe injuries that would result in high treatment costs.

Step 5: Follow Up

Stay in communication with your insurance company throughout the claims process. They may ask you to submit additional proof or provide more details to ensure that your claim is not fraudulent. It is important to promptly respond to any requests from your insurer to avoid delays in the processing of your claim.

Frequently asked questions