No-Fault Car Insurance Claims in New York
car accident paperwork no fault claims NY insurance

New York requires that every driver maintains proper insurance coverage for their vehicles if they wish to drive them legally. This is a requirement in every state, and normally, the insurance policies that a driver might purchase would allow them to sue after an accident for compensation to cover medical expenses, lost wages, and non-economic losses. However, this is not the case in New York, as the state has a no-fault law.

No-fault laws limit the right of a victim to sue after an auto accident in order to prevent the courts from being overwhelmed by personal injury cases. In exchange, victims are entitled to compensation through personal injury protection (PIP) benefits, also known as first-party benefits. This coverage is required in all New York auto policies and are payable regardless of fault in an accident. However, PIP benefits may not cover all of the expenses that result from an accident. For this reason, victims may file lawsuits in New York under certain conditions.

What Do PIP Benefits Cover?

PIP benefits can be used to cover a wide-range of costs in many different forms of auto accidents.

PIP benefits will provide a minimum of $50,000 to cover what is known as basic economic loss incurred after an accident.

Basic economic loss can include the costs for any of the following services and treatments that you must undergo as a result of an accident:

  • Medical expenses, such as hospital and surgery services
  • Rehabilitation services
  • Lost wages

PIP benefits provide coverage when the victim is a driver of their own vehicle, a passenger in someone else’s personal vehicle, a passenger on a bus, a pedestrian hit by a driver, or a cyclist hit by a driver. However, under the law, PIP benefits will not cover accidents in which the insured was operating a motorcycle or a passenger of one, even if it collides with a motor vehicle. 

The case of Boyson v. Kwasowsky establishes this application of the law, as Boyson was riding as a passenger on her husband’s motorcycle when he had to swerve to avoid a truck. This caused the couple to fall off, the bike was launched airborne by the truck, and landed atop Boyson. Because Boyson was an occupant of a motorcycle, it was held that she could not receive PIP benefits from any of the auto policies involved in the dispute.

What Laws Cover Auto Insurance Policies?

New York’s laws on auto insurance are spread across both the Vehicle and Traffic Law and the Insurance Law of the state. The Insurance Law covers the no-fault law in Article 51, providing the definitions and regulations of PIP benefits and lawsuits in the state. Primarily, the statutes from Article 51 that will concern you as a victim are the following ones:

  • NY Ins Law § 5102 – This statute states what basic economic loss and first party/PIP benefits are, along with naming an option to purchase an additional $25,000 of optional basic economic loss. It also details what is a serious injury under the law, which is used to determine when you can sue after an accident.
  • NY Ins Law § 5103 – This statutes creates the requirement that all auto insurance policies include PIP benefits for victims in the event of an accident regardless of fault.
  • NY Ins Law § 5104 – This statute states the requirements in order to be able to sue a liable party after an accident. It forbids suing a liable party unless you suffer a serious injury or economic losses in excess of the $50,000 covered by PIP benefits.
  • NY Ins Law § 5106 – This statute states that first-party benefits shall be paid as losses are incurred, and if an insurer fails to pay first-party benefits within 30 days of proof of losses being incurred, then their required payment will incur interest of 2% per 30 days overdue.

In general, the law requires you to file a claim with your insurance company within 30 days of the accident and provide proof with your claim. It will then have 30 days to pay your benefits or deny your coverage.

If your coverage is denied, then you can bring a lawsuit against the insurance company. Otherwise, you cannot sue any party unless you suffer a serious injury or your expenses exceed $50,000.

What Happens if I’m in an Auto Accident?

There are obvious steps you need to take after a car accident. Obviously, you need to file a police report as soon as possible and undergo a medical examination. These will be key for documentation during your no-fault claim, serving as proof of your accident and injuries as a result of it. Additionally, if necessary, be prepared to speak with an attorney. Hiring an experienced legal professional will prepare you in case your insurer denies your claim or you decide to pursue a lawsuit.

Am I Allowed to Sue?

No-fault laws typically limit the right of victims to sue after an accident. However, there are legal exceptions provided to this policy, allowing a victim to pursue a liable party for non-economic losses and economic losses in excess of $50,000. Non-economic losses are intangible concerns such as pain and suffering, loss of enjoyment of life, and similar conditions.

In order to sue for non-economic damages after an accident in New York, you must suffer what is considered a serious injury. This will satisfy the serious injury threshold found in all auto insurance policies, allowing you or a loved one to sue. These injuries can include any of the following:

  • Death
  • Dismemberment
  • Significant disfigurement/scarring
  • Bone fracture
  • Loss of a fetus
  • Permanent loss of use of a body organ, member, function or system
  • Permanent consequential limitation of use of a body organ or member
  • Significant limitation of use of a body function or system
  • A medically-verified, non-permanent injury or impairment which limits the injured from performing the material acts of their usual and customary daily activities for 90 days of the first 180 days after an accident.

Be aware that if you choose to sue, you are not guaranteed to receive the full compensation you seek or even a partial amount. New York uses a pure comparative model to compare liability between parties involved in an accident. If you are found partially at fault for an accident, then your compensation will be reduced in proportion to your liability.

Always contact an experienced legal professional who is experienced in personal injury suits if you plan to sue. Unlike filing a no-fault claim, which may be simple enough to handle on your own, preparing for a lawsuit and presenting your case requires an expert’s knowledge of the legal system. An attorney will be able to collect evidence such as police reports, medical records, and eyewitness testimony for your benefit during the process of negotiations and discovery. They will also be able to create the best arguments for your case during negotiations and, if necessary, litigation, ensuring that a court will have the best impression of you and your case.


Frequently Asked Questions

Will my insurance rates increase if I file a no-fault claim?

Possibly. Your insurer may factor the claim and the resulting expenses into their considerations when you renew your policy, which is generally when insurance premiums change in value. However, if you have a good driving record besides the accident, your insurer may simply allow a rate to stay the same. If you are not partially responsible for the accident, the insurer will factor that fact into their consideration.

Can I sue for my insurer for PIP benefits?

Yes; if your insurer denies your PIP benefits, you may bring a suit against them. Be aware, however, that you may be expected to pay for certain legal fees even if you win.

Is my health insurance or the PIP benefits I receive the primary payer of medical expenses for my injury?

It depends on what provisions you have selected for each policy. Typically, PIP benefits will be the primary payer in the event of an accident. However, if you are uncertain, you can speak with an attorney who is willing to walk through your policies’ provisions with you to help you understand them.


What Should I Do if I Need Help Filing a No-fault Claim?

If you or a loved one have been injured in an accident and you need help filing your claim, contact Rosenblum Law for a free, no-obligation consultation today. Our experienced personal injury attorneys can analyze the situation and negotiate the best possible settlement for you. Call 888-815-3649 or email us today.

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