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If you are injured in a
crash in New York, the No-Fault coverage you receive
comes from the vehicle you drove, rode in, were hit by,
or came into contact with.
No-Fault is separate and distinct claim from a bodily
injury claim. Many people get this confused. If injured
in a crash, a cyclist, pedestrian, driver or passenger
may have the right to sue for their injury as well as
their pain and suffering. This is what we call a bodily
injury or BI claim. When you are a cyclist, pedestrian
or passenger, it will be this same insurance company
that provides and pays your No-Fault claim that will
also be defending and paying a judgment or settlement
for your BI claim. Although payment is made by the same
insurance company, these are completely separate claims.
Each has their own laws and rules and is usually handled
by different adjusters and departments at the insurance
company. The two claims also have different standards of
proof, available compensation, and coverage.
No-Fault in New York was designed to ensure that
regardless of fault; an insurance company will pay
cyclists, pedestrians, drivers, and passengers up to
$50,000.00 for the legitimate economic losses. This
includes ambulance and hospital expenses, doctor bills,
prescription drugs and diagnostic tests, such as x-rays
and MRI’s as well as therapeutic services such as
physical therapy. It also includes your lost wages. It
does not include compensation for pain and suffering.
Any additional claims can be pursued (if you qualify) by
a separate lawsuit against the driver(s) and vehicle
owner, or any other party who is responsible for causing
the crash and your injury.
Who gets No-Fault?
New York No-Fault Law applies to any cyclist,
pedestrian, passengers, or driver injured by a motor
vehicle in New York. The conditions that must be met to
qualify for No-Fault coverage:
■ The accident occurred in New York.
■ The injured party was the driver or passenger of the
insured vehicle or a cyclist or pedestrian struck by or
in contact with the motor vehicle.
■ The vehicle must be a car, truck, bus, taxi (not a
motorcycle) or other vehicle covered by New York
No-Fault law.
■ The vehicle is registered in New York.
■ The vehicle has an insurance policy sold in New York
or issued by a company licensed to do business in the
State of New York.
Who doesn’t get No –Fault?
■ Motorcyclists
■ Vespa or Scooter Riders ( depending on the engine size
of the scooter)
■ Someone injured as a result of operating a motor
vehicle while intoxicated
■ And under other certain circumstances, out –of- state
policies, etc…
How to file for No-Fault?
There are important steps to follow in order to make a
no-fault claim. Although the intent of the legislation
was to ease the process, this is simply not the case.
Under the false premises that they are combating
insurance fraud, the insurance companies have turned
this process into an adversarial proceeding taking
advantage of any mistake a claimant may make to deny you
coverage. Whether failing to miss a filing date, a
medical appointment, or by an incorrect entry on a form,
a carrier can deny you your medical benefits and lost
wages. Even when everything is done properly, you still
may face a denial after one of THEIR doctors says you
don’t need treatment. In order to protect your coverage
and your benefits these are the steps needed to properly
file a claim.
The No-Fault Application (form NF-2): The no-fault
application is normally provided form the insurance
carrier of the car that struck you, you came into
contact with, that you were driving or in which you were
a passenger. If you were a cyclists or a pedestrian AND
own your own car, you should request or send the
application to your insurance company as well. You may
have benefits under your policy such as excess PIP
(additional no-fault coverage above $50,000). The
application can be requested by phone but it is
recommended to also request it by mail, certified return
receipt requested.
Time Constraints- You have thirty (30) days from the
date of the crash to file the application. Don’t put it
off thinking that your injuries may get better or that
your health insurance will cover injuries you suffered
in the crash. Simply filing the application does not
obligate you to commence a claim. Second, most health
insurance do not cover a personal injury resulting from
a car crash. Filing the form simply protects your
rights.
Additionally, make sure that you send the form to the
correct insurance company. Even if you believe the crash
was not the fault of the driver, the No-Fault
Application still gets sent to the insurance carrier for
the car that you were struck by or was a passenger in,
or was driving.
There are occasions where you may not be able to
ascertain the insurance company of the car that struck
you, especially if a driver of a car is particularly
uncooperative and will not provide the information.
Always call the police. The police will obtain the
information for you and place it on the Police Report.
The police report will have a three digit code that will
indentify the insurance carrier.
If you still cannot find the insurance company, the new
regulations do allow you to provide written proof of a
“clear or reasonable” reason for missing the 30
deadline. But, the insurance companies are largely
responsible for determining what is “clear or
reasonable” so don’t count on this provision to save you
from the late filing.
MVAIC - If you cannot determine the insurance company on
time, you should, at a minimum, send a notice right away
to the New York State Motor Vehicle Accident
Indemnification Corporation (MVAIC). MVAIC is a state
run agency which steps into the shoes of the insurance
company where there is no insurance. If you find out the
identity of the insurance company after you file with
MVAIC, you can withdraw your claim. Hopefully you will
not need it. MVAIC is a state agency and is full of
bureaucratic paperwork and is difficult to navigate even
for a seasoned attorney.
Lost Wages- Under No-Fault you can claim lost earnings
and out of pocket expenses. Lost earnings require your
employer sends proof of your wages on a form provided by
the insurance company called a No-Fault Wage
Verification Report. You may need to be on top of your
boss or H.R. department to get this filled out. Under
No-Fault you are entitled to receive 80% of your crash
related lost earnings up to $2000 a month. You will also
require a note from your doctor that you are disabled
from performing your normal job duties. Your doctor must
specify the length of your disability and that it is
related to the crash.
Out-of-Pocket Expenses- Save all your receipts for taxis
and transportation costs, pharmacy bills and other crash
related expenses. No-fault will reimburse you for travel
expenses to and from your doctors or medical treatment.
They will also reimburse you for medications, brace and
bandages as well as up to $25 dollars a day for other
related incidentals for one year post accident.
WHAT TO EXPECT AFTER YOUR CLAIM IS FILED
After your claim is filed you should be provided with a
no-fault claim number. This number, together with the
name of the insurance company, the adjuster assigned,
and contact information should be provided to your
doctor and other health care providers for all
treatment, both past and future. If you left the
hospital without providing insurance information, call
the hospital billing department right away and give them
the information. You may have also been provided with a
no-fault facility form to mail to the hospital. Fill
this out with the no-fault information and your patient
number and mail in right away. In the next several weeks
you may receive a bill for the ambulance, x-rays, labs,
or other treatment related to the crash. The no-fault
information should be provided to these facilities as
well. Once you provide the information you have
fulfilled your obligation and it is incumbent upon the
service providers to timely submit the claims and
respond the insurance companies demand for additional
information.
Don’t expect No-Fault to last forever. The insurance
company wants you off their coverage as soon as
possible. In order to do so, they are allowed to have
you examined by a physician or medical specialists to
determine in his or her opinion whether you need
additional treatment or your treatment and no-fault
benefits should be terminated. This doctor hired by the
insurance company will also decide whether you are still
disabled or can return to work. If you fail to appear
for an exam, they can use this as grounds to terminate
your benefits.
You may also be required to appear for an E.U.O.
(examination under oath). This is a hearing ordered by
the company where an attorney hired by the insurance
company will ask you questions about the crash and your
treatment. If you fail to appear they can use this as
grounds to terminate your benefits.
WHAT IF YOUR CLAIM IS DENIED?
If your claim is denied and you have private health
insurance, you can submit the bills to your private
carrier and also direct your doctors to bill them as
well. Obtain a copy of the denial as most insurance
companies want proof that you have been denied by
No-Fault before they assume the bills.
If you do not have any insurance and cannot afford to
continue treatment, speak to your doctor concerning your
continued treatment on a lien basis. These additional
medical lien expenses would become part of the damages
being claimed in your underlying case against the
defendant.
The No-Fault carrier’s denial includes instructions on
how to fight or arbitrate the denial. DO NOT ARBITRATE
THE NO-FAULT DENIAL OR ALLOW YOUR DOCTOR TO DO IT FOR
YOU UNTIL YOUR LAWSUIT IS RESOLVED. An adverse finding
at the arbitration can destroy your claims in the
underlying lawsuit for damages.
WHY CONTACT A LAWYER?
No-Fault, although original designed to be
non-adversarial has turned out to be just the opposite.
The rules change regularly and the failure to comply
with one element may destroy your rights to collect
these benefits. Most lawyers (at least the ones you want
to retain) do not charge for handling the no-fault
aspect of the case while handling the underlying
personal injury litigation. The right attorney also is
familiar with all of the No-Fault regulations, knows all
the individual nuances of the insurance companies and
can easily navigate their attempts to deny your
benefits. |
