Understanding New York State’s No-Fault Laws
New York is one of twelve states that have enacted no-fault laws. Each state’s no-fault laws vary. So, if you are not familiar with New York’s no-fault laws, this blog may be helpful. The purpose of New York’s no-fault laws is to ensure that car accident victims receive compensation for accident-related medical bills, lost wages and other incidentals regardless of fault. The insurance carrier of the vehicle you are occupying will pay those costs regardless of fault. If you are a pedestrian or bicyclist, those expenses will be borne by the insurance carrier of the vehicle that comes into contact with you.
How to receive no-fault benefits
To qualify for no-fault benefits, you must be a motor vehicle operator, passenger, pedestrian or bicyclist. Motorcyclists are not eligible for no-fault coverage. Also, to receive benefits, all qualified parties must complete a no-fault application with the proper insurance carrier within 30 days of the accident. Failure to do so may result in the denial of your no-fault benefits. I always advise people to complete the application and mail it certified return receipt requested. This ensures that the carrier cannot dispute it was filed promptly.
The insurance carrier will mail the application to you once the accident is reported to them. In some instances, you may not immediately know which insurance carrier is responsible for your no-fault benefits. For example, a pedestrian will likely not know the carrier of the vehicle that struck them. In such instances, the insurance information can be obtained from the police accident report.
Also, if the insurance carrier responsible for your no-fault claim is not your own company and you have no-fault insurance on one of your household vehicles, I would advise completing an application with your own carrier within the 30-day deadline. This will give you an added layer of insurance should the vehicle that is responsible turn out to be uninsured.
What does no-fault insurance cover?
No fault insurance will generally cover all of your accident-related expenses.
However, certain limits will apply. First, New York requires at least $50,000 dollars’ worth of no-fault coverage. A person may purchase additional no-fault coverage and would be wise to do so considering the cost of medical treatments. Out of that pool of money, you will receive payments for medical expenses, lost wages, household help, and transportation to and from medical appointments.
Generally, all healthcare providers accept no-fault insurance. Further, there are no deductibles or copayments. Also, you don’t need referrals. But, since a few providers do not accept no-fault insurance, as a precaution you should always confirm before receiving treatment. I advise providing the doctor’s office with your no-fault claim number at the time that you schedule your appointment. This way there is no confusion with the healthcare provider about how they are being compensated. There is nothing worse than showing up at a doctor’s office only to be turned away because of an insurance issue.
If you were taken to a hospital on the date of your accident, it is likely that you did not have a no-fault claim started before receiving treatment. I recommend that you immediately contact the hospital once you file your claim so they can bill the proper insurance carrier. If you fail to do this, the hospital will bill you directly. Also, if any bill is not submitted to the no-fault carrier within a reasonable time, it can be denied. That could mean you could be left on the hook for that bill.
Should your no-fault benefits be exhausted before you complete treatment, you must use your own personal healthcare insurance to pay for medical treatments. Unfortunately, this will mean you will incur customary deductibles and may need to obtain referrals as per your private health insurance agreement.
No-fault insurance will also cover up to 80% of your accident-related lost wages up to two thousand dollars a month. To receive this benefit, you must provide a doctor’s note from a treating physician attesting to the fact that you cannot work. Your employer must also provide a wage verification form, as well. The carrier has up to 30 days to provide wage payments once the documentation is submitted. You must submit the wage verification form to your employer. Be sure to follow up with them to make sure it is returned to your insurance carrier. You can obtain the form from your insurance carrier. I always recommend that you continue to follow up with the adjuster to make sure that they have all the documents necessary to start your payments. The adjuster will also request updated doctor notes periodically.
For some people, the no-fault maximum lost wage benefit will not adequately reimburse them for their lost wages. For example, if you earn more than two thousand dollars a month, you will be receiving less than your full paycheck. It is best to keep track of your unreimbursed lost wages. If you file a claim against the at-fault driver, it’s possible to get reimbursed for those unreimbursed lost wages.
Finally, no-fault insurance will cover up to twenty-five dollars per day of accident-related expenses for such things as travel and household help. Again, you must submit proof to your no-fault carrier of such expenses prior to reimbursement.
Independent Medical Examinations
An Independent Medical Exam (IME) is a physical examination with a doctor
hired by a no-fault insurance provider. The exam determines whether you still need medical treatment. The term “Independent” is used to describe the exam, but as you can imagine there is an incentive for the medical doctor to find you no longer need treatment since it is the insurance carrier hiring the doctor.
The independent medical doctor only has the power to terminate or reduce treatment in that doctor’s specific area of expertise. For example, an orthopedist cannot terminate or reduce your treatment with your treating neurologist. Further, the insurance carrier must provide you a claim denial accompanied by the doctor’s written report before your benefits for any particular medical discipline can be terminated.
Further, terminating your medical benefits may also result in termination of your lost wage payments. For example, if your orthopedic doctor has provided the written proof of your inability to work and an orthopedic IME doctor finds you no longer need treatment, your lost wages will stop.
If you disagree with the independent doctor’s decision following your exam, there is an appeals process. You can request an arbitration with an independent arbitrator. However, the process is complicated, time-consuming and takes several months to schedule. This may be impractical for someone undergoing active treatment. I generally recommend that once no-fault benefits are terminated by the carrier that my clients use their private health insurance to pay for medical treatments. The private carrier may want to see the no-fault denial prior to paying for medical bills.
Generally speaking, no-fault insurance can be quite complicated. Most attorneys that handle personal injury cases will also handle all of your no-fault issues. However, be aware that there may be an additional charge for such services.