New York No-Fault FAQ's

New York's Insurance Law provides for mandatory no fault coverage for persons injured in automobile accidents. No-Fault is a form of insurance benefit that pays where applicable, lost earnings, medical expenses and other reasonable and necessary expenses; such as prescriptions, travel expenses and household help.

1. Who is eligible to receive No-Fault benefits?
   Anyone who is injured in a motor vehicle accident or hit by a car or injured in some way by the use or operation of a motor vehicle. It does NOT apply to people on a motorcycle but does apply to pedestrians struck by a motorcycle or motor vehicle.
   
   
2. How do I file for my No-Fault benefits?
   A No-Fault application must be filed with the No-Fault Insurance Company 30 days of the date of occurrence. After the No-Fault application is filed, the insurance company is responsible for medical bills, lost earnings and other reasonable and necessary expenses. The No-Fault carrier is responsible to send the appropriate forms to the doctors, hospitals and your employer as listed on the application.
   
   
3. How do I get my (NEW) doctors, therapists or hospitals paid?
   You are required to provide the No-Fault Insurance information to them and they are required to submit their own bills to the No-Fault Insurance Company on their own.
   
   
4. How do I get reimbursed for: a. Travel Expenses? b. Household Help? c. Prescriptions? d. Lost Earnings?
   You must keep copies of all mailings to the carrier. Failure to so do could lead to non-payment by the health insurance carrier for failure to submit as soon as possible.
   
   NOTE: Every single piece of paper that you send to the insurance company MUST have the insurance company claim number written on it!!
   
   The following is what you must do to collect these benefits. To simplify this for you we have included the actual forms you may use.
   
   
   • Travel Expenses: The insurance company will reimburse you for travel expenses to and from your doctor or healthcare provider; cab, car service, bus or train. If you drive, the insurance company will reimburse you for the number of miles traveled to and from the doctor, physical therapy and hospitals. You must indicate the name of the doctor, hospital, etc..., the date of the office visit and the number of round trip miles. You may use the enclosed 'MILEAGE FORM' to mail this information to the insurance company.
     
     
   • Household Help: The No-Fault carrier will pay for someone to assist with the household chores you are unable to do as a result of your injuries. YOUR doctor MUST give you a letter stating this Household Help is necessary. You MUST send the letter from your doctor to the No-Fault carrier along with a form signed by you and the person providing the Household Help listing the dates this person has assisted you. You may use the enclosed form to mail to the insurance company. The No-Fault Insurance carrier, in most cases, will not pay for Household Help if it has been rendered by a spouse, parent or family member.
     
     THE NO-FAULT INSURANCE COMPANY IS ONLY REQUIRED TO PAY A TOTAL OF $25.00 (TWENTY-FIVE DOLLARS) PER DAY FOR TRAVEL EXPENSES AND HOUSEHOLD HELP COMBINED FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE ACCIDENT, PROVIDING THAT THE PROPER DOCUMENTATION HAS BEEN MAILED TO THE NO-FAULT CARRIER.
     
     BILLS AND/OR RECEIPTS FOR TRAVEL EXPENSES AND/OR HOUSEHOLD HELP MUST BE TIMELY SUBMITTED TO THE NO-FAULT CARRIER TO RECEIVE REIMBURSEMENT.
     
     
   • Prescriptions: BEFORE you mail the copies of your prescription receipts to the No-Fault carrier ALWAYS write the name of the doctor who prescribed the medicine and the name of the medication on the receipt. Prescription receipts must be timely submitted to No-Fault carrier to receive reimbursement.
     
     
   • Lost Earnings: There is a form that must be filled out by your employer called 'EMPLOYER'S WAGE VERIFICATION REPORT'. There is a form that must be filled out by your doctor called 'VERIFICATION OF ATTENDING PHYSICIAN FORM' stating you are unable to work because of your injury from this accident. These 2 forms must both be timely mailed to the No-Fault Insurance carrier. The No-Fault carrier has 30 days from receipt of both forms to issue payment.
     
     IF YOU ARE SELF-EMPLOYED, there is a form that must be filled out called 'VERIFICATION OF SELF-EMPLOYMENT INCOME' and you will have to mail this completed form to the No-Fault Insurance company along with copies of your previous two (2) years income tax returns.
     
     
5. How long can the insurance company take before they pay me the money they owe me?
   The No-Fault carrier can take up to thirty (30) days from the date they receive all appropriate documentation. The No-Fault carrier is required to pay 80% of your lost earnings, up to a maximum amount of $2000 per month. The No-Fault Insurance carrier is entitled to deduct the amount of New York State Disability paid or what would have paid. New York State Disability benefits are payable the second week of your disability for 26 weeks. In the event you failed to timely file New York State Disability, the No-Fault Insurance carrier is not penalized and may still properly deduct the amount NYS Disability would have paid. The No-Fault Insurance carrier is responsible to pay lost earnings up to 3 years from date of accident (subject to restrictions) or until $50,000 in combined benefits (medical and/or wage, etc.) have been paid which ever occurs first.
   
   
6. How long will New York State Disability pay me if I am unable to work?
   Disability will pay you for twenty-six (26) weeks assuming of course you are actually disabled and your disability is verified by your doctor and employer (not including the 1st week you are disabled).
   
   
7. Who will pay me for the first week I am unable to work?
   The No-Fault Insurance carrier will pay you for the first week you are disabled from working.
   
   
8. Who will pay me if I am not able to work after the disability payments run out (after 26 weeks)?
   The No-Fault Insurance company will continue to pay lost earnings up to three (3) years from the date of the accident as long as your doctor has said that you are unable to work because of your injury from this accident or until you have exhausted $50,000 in combined lost earnings and medical payments. The No-Fault Insurance carrier can request verification of your disability every 30 days. The No-Fault Insurance carrier may stop paying your lost earnings if their doctor examines you and finds that you are no longer disabled.
   
   
9. What will the No-Fault Insurance company pay if the injuries should result in death?
   The No-Fault Insurance company is required to pay what is called a Death Benefit in the amount of $2,000.00.
   
   
10. What do I have to do to get the $2,000.00 from the No-Fault Insurance company?
    You must provide the No-Fault Insurance Company with a copy of the death certificate and advise them of the name of the person who has been appointed for the deceased person's estate.
    
    
11. What do I do with medical bills for treatment rendered to my child or other family members as a result of the accident who are not pursuing a personal injury claim?
    You, on behalf of your child as well as other family members on their own behalf, are still required to file for no-fault benefits 30 days from the date of the accident, even if he/she is not pursuing a personal injury claim.
    
    The parents or guardian of a child under eighteen (18) remains legally responsible for any medical bills incurred for treatment rendered to the child as a result of the accident. The general rule in New York is that a child, under the age of eighteen (18), is not responsible for his or her own medical treatment. If, at the time of settlement, there are outstanding medical bills, it is possible that this might delay the final settlement of the lawsuit. It is therefore always best that the parent submit the medical bills to any insurance which is available as those medical bills come due so that the child can continue to receive medical treatment. The bills should be submitted to any available insurance. For example, if this is an auto accident, no-fault is responsible for the medical bills and it is the parents' obligation to forward the bills directly to no-fault. If this is not an auto accident, for example a dog bite or a fall, then any insurance which the parent has through his or her job is normally responsible for paying the medical bills and it is the parents' obligation to see that these medical bills are forwarded to the appropriate insurance.
    
    MEDICAL BILLS MUST BE SUBMITTED AS SOON AS RECEIVED. FAILURE TO DO SO COULD LEAD TO NON-PAYMENT BY THE HEALTH INSURANCE CARRIER FOR FAILURE TO MEET TIME LIMITS. A NO-FAULT CARRIER SHALL NOT PAY ANY BILL SUBMITTED AFTER 45 DAYS FROM DATE OF TREATMENT.

If you or a loved one have been injured in a car accident and you are researching legal options, please call us at 1.800.966.4999 or fill out the form to the right of the page for a free case evaluation.