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What is No-Fault Insurance?

No fault insurance in new york

No-Fault insurance is available to New York residents involved in an automobile accident.  These benefits are part of the insurance policy of the vehicle occupied by the injured person at the time of a car accident.  No-Fault insurance covers drivers and passengers.

A pedestrian struck by a vehicle may also be eligible for No-Fault benefits. In such a case, the pedestrian would receive no-fault coverage under the insurance policy of the vehicle that struck them.  Importantly, the New York No-Fault insurance laws govern these benefits. The coverage includes reimbursement of lost wages and medical bills/expenses.  A person can be entitled to No-Fault benefits even if his or her vehicle is the cause of the accident.

However, a person does not qualify for No-Fault benefits if hurt while operating their own uninsured vehicle. Also, if they are operating their spouse’s uninsured vehicle.  Similarly, riders do not qualify for no-fault insurance coverage while operating a motorcycle.

How Much Coverage Do You Receive Under No-Fault Insurance?

In New York, every insured automobile carries at least $50,000 in No-Fault coverage for each occupant of the vehicle.  An injured person must file a claim for No-Fault benefits within 30 days of the accident. Doing so ensures the maximum benefits available.  Generally, an injured party can receive payments for lost wages at a rate of 80% of gross wages. Lost wages payable under No-Fault are capped at $2,000 per month.  You can also receive payment for medical treatment received. 

Treating physicians must submit medical bills to the No-Fault insurance carrier within 45 days of each visit. If not, the carrier may deny payment. Unfortunately, if doctors do not comply with the 45-day rule, the injured claimant may become personally liable for the bills. 

No-Fault IME’s

In addition, No-Fault insurance carriers will send claimants to independent medical examinations. No-Fault carriers hire IME doctors to confirm a claimant’s injuries. These doctors are not treating physicians – their examinations are solely for the insurance company’s benefit.  An insurance carrier can deny future benefits based on an IME report.  If the IME doctor determines that no further treatment is necessary, the No-Fault provider will issue a denial of benefits. A claimant’s failure to appear for a No-Fault IME will also lead to a denial of further benefits.

IME doctors are under pressure from their employers (No-Fault insurance companies) to deny benefits.  Thus, it is important to immediately consult with an attorney regarding a No-Fault claim. It is also important to ensure all medical providers have up-to-date no-fault info. Otherwise, a claimant can be stuck with the bills.

As experienced New York City automobile accident attorneys, The Platta Law Firm will gladly handle your No-Fault claim and personal injury case. 

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