Personal Injury Protection is the no-fault insurance coverage that every auto policy in New York is required to carry. It pays for your medical expenses and lost wages after a car accident regardless of who caused the collision. PIP is not optional. It is mandated by Insurance Law Section 5103, and it is the first source of compensation in every motor vehicle accident in the state. Understanding how PIP works, what it covers, and what its limits are is essential for anyone involved in a car accident in New York.
What PIP covers
PIP provides up to $50,000 per person for reasonable and necessary expenses resulting from a motor vehicle accident. This includes medical treatment (emergency care, surgery, diagnostic imaging, physical therapy, prescription medication, and other treatment related to the injuries), lost earnings up to $2,000 per month for up to three years, and other reasonable and necessary expenses such as transportation to medical appointments and essential services the injured person can no longer perform.
PIP benefits are paid by your own insurance company, not the at-fault driver’s insurer. This is the fundamental principle of New York’s no-fault system: each driver’s own insurance covers their own losses up to the PIP limits, regardless of fault.
Who is covered by PIP
PIP covers the named insured, resident relatives, passengers in the insured vehicle, and pedestrians or cyclists struck by the insured vehicle. If you are a passenger in someone else’s car and you are injured in an accident, the vehicle’s PIP coverage applies to you. If you are a pedestrian struck by a car, the striking vehicle’s PIP covers your expenses.
Filing a PIP claim
You must file a no-fault application (NF-2) with the insurance company within 30 days of the accident. This deadline is strict. Missing it can result in denial of your PIP benefits. The insurance company then has 30 days from receipt of the completed application and supporting documentation to pay or deny the claim.
Medical providers who treat you for accident-related injuries can bill the no-fault carrier directly using NF-3 verification forms. Most providers in the New York area are familiar with the no-fault billing process and will submit claims on your behalf.
PIP limitations and the serious injury threshold
PIP covers economic losses only — medical expenses and lost wages. It does not cover pain and suffering. To recover non-economic damages, you must pursue a personal injury lawsuit against the at-fault driver, and your injuries must meet the serious injury threshold under Insurance Law Section 5102(d).
The $50,000 PIP limit can be exhausted quickly in a serious accident. A single surgery can consume the entire PIP benefit. When PIP is exhausted, your health insurance becomes the primary payer for continued treatment, and the costs become part of the damages in the personal injury lawsuit.
Disputes with the no-fault carrier
The no-fault carrier may deny treatment or cut off benefits by arguing that the treatment is not related to the accident, is not medically necessary, or that you have reached maximum medical improvement. These denials can be challenged through no-fault arbitration — a streamlined dispute resolution process administered by the American Arbitration Association. Medical providers frequently pursue no-fault arbitration on their own behalf when the carrier denies payment for treatment.
How Schwartzapfel Holbrook handles PIP and no-fault issues
At Schwartzapfel Holbrook, we ensure every car accident client files their no-fault application within the 30-day deadline and receives the PIP benefits they are entitled to. When the carrier disputes treatment or cuts off benefits, we pursue the appropriate remedies. PIP is the foundation of every car accident case in New York — the personal injury lawsuit builds on top of it, but the no-fault benefits must be secured first.
Schwartzapfel Holbrook / Fighting For You