No-Fault Insurance After a Car Accident in New York

This article provides general information only. It should not be construed as legal advice or as specific guidance for your situation.

If you are hurt in a car accident in New York, your medical bills and lost wages are usually paid first by no-fault insurance, no matter who caused the crash. This guide explains what no-fault pays, whose insurance pays, the deadlines that matter, and when you can also bring a claim against the driver who caused the accident. For a broader overview, see our guide to auto accident claims.

What no-fault insurance pays

Under Insurance Law § 5102, basic no-fault coverage pays up to $50,000 per person for “basic economic loss,” including:

• necessary medical and rehabilitation expenses;
• 80% of lost earnings, up to $2,000 per month, for up to three years after the accident;
• up to $25 per day, for up to one year, for other reasonable and necessary expenses, such as household help.

No-fault does not pay for pain and suffering or for damage to your car. Car damage is handled through the other driver’s liability insurance or your own collision coverage.

Whose insurance pays

• Drivers and passengers: usually the no-fault insurer of the car you were in.
• Pedestrians and bicyclists hit by a car: usually the no-fault insurer of the car that hit you.
• No insurance available: the Motor Vehicle Accident Indemnification Corporation (MVAIC) may pay benefits to people who qualify.
• Motorcycles: motorcycle riders and passengers are generally not covered by no-fault.

Deadlines that matter

• 30 days: send the no-fault application to the insurer within 30 days of the accident.
• 45 days: medical bills must be submitted within 45 days of treatment. Give your doctors the insurance company’s name and the claim number right away.
• 90 days: send proof of lost earnings within 90 days.

Late papers can lead to a denial unless there is a reasonable explanation for the delay, so keep copies of everything you send and note the date you sent it.

Medical exams and examinations under oath

The insurance company may ask you to see a doctor it chooses, called an independent medical examination (IME), or to answer questions under oath, called an examination under oath (EUO). Attend every scheduled exam or reschedule it in advance; missing one can lead to a denial of benefits. Speak with a lawyer before an examination under oath.

When you can sue the driver who caused the accident

No-fault limits lawsuits for pain and suffering. Under Insurance Law § 5104, you can sue the driver who caused the accident for pain and suffering only if you have a “serious injury” as defined in § 5102(d), for example:

• a fracture, dismemberment, or significant disfigurement;
• a permanent loss of use, or a permanent consequential or significant limitation of use, of a body organ, member, function, or system;
• an injury that keeps you from performing substantially all of your usual daily activities for at least 90 of the first 180 days after the accident.

You can also sue for economic losses that no-fault does not cover, such as lost earnings above the no-fault limits. Most lawsuits must be filed within three years of the accident, and claims against New York City or another public body require a notice of claim within 90 days. Our articles on what to do after a car accident and personal injury claims in New York explain the next steps.

If no-fault denies your claim

A denial can be challenged in arbitration or in court. Keep the denial letter, the dates of your treatment, and copies of everything you sent to the insurance company, and speak with a lawyer about the options.

Talk to a lawyer about your car accident

If you were hurt in a car accident in New York City or on Long Island, call Sharifov & Associates, PLLC at 718-368-2800 or 516-505-2300, or request a consultation.