The Basics of No-Fault Insurance

New York is a no-fault insurance state.

If you are involved in an accident, you are entitled to file a claim with your own insurance provider. As a general rule, causation does not factor into no-fault claims. Even if you are found at fault, your carrier must still provide benefits up to a certain limit.

The limitations on no-fault insurance claims and recoveries can make it difficult to rebuild after a serious accident. However, lawmakers know that standard no-fault policies are not always enough. If your case meets certain standards, you could be entitled to file a personal injury lawsuit against the person or party who caused your accident.

New York No-Fault Insurance: The Basics of Coverage

If you have a no-fault policy issued in New York state, your policy should protect you and your passengers in the event of an accident. Basic policies usually provide the following benefits:

1. The cost of medical care;
2. Lost income from work; and
3. Other accident-related expenses, including the cost of parking at the hospital, mileage reimbursement for travel to and from the doctor’s office, and certain aiding services.

Every basic no-fault benefit is subject to a range of special caveats and stipulations.

Your insurance carrier, for instance, has to pay for medically necessary care and treatment. However, your insurance company may not always see eye to eye with you and your doctor on best practices. If an adjuster thinks that you are exaggerating your injuries or that a particular procedure is not likely to work, they could refuse to pay for treatment.

Aside from medical costs, income replacement is not unlimited. Your policy is supposed to pay 80% of your pre-accident gross wages, but benefits are capped at a maximum of $2,000 per month. In today’s economy, that might not be enough money to cover rent, a mortgage, groceries, and other expenses. After three years, these benefits come to an end, even if your injuries are so severe that you do not think you will ever be able to return to work.

Insurance Exclusions and Exceptions

Your no-fault insurance would not pay for certain types of claims.

Excluded claims usually include claims for:

1. Property damage;
2. Motor vehicle theft;
3. Medical care and income replacement that exceeds your policy limits; and
4. Any additional expenses that cannot be traced back to your accident and accident-related injuries.

Most other no-fault claims must be paid by your provider, but exceptions do exist. One of the most notable exceptions relates to driving under the influence. If the police say that you were drunk or abusing drugs at the time of the accident, your carrier may not have to pay for anything beyond an ambulance ride and the care you receive in the emergency room.

Your Right to File a Personal Injury Lawsuit

No-fault insurance is supposed to eliminate the need for litigation, but that does not mean you cannot file a personal injury lawsuit to recover additional damages. In New York, anyone who sustains a “serious injury” in an accident that was not their fault could be entitled to sue.

However, the term “serious injury” is not just a vague phrase; it has a precise legal definition.

Under state law, a serious injury is an injury that causes any one or more of the following:

1. A fractured or broken bone;
2. Permanent loss of a bodily organ, member, function, or system;
3. Permanent consequential loss of use of a bodily organ or member;
4. Significant limitation of the use of a bodily function or system;
5. Non-permanent injuries that prevent you from resuming your daily routine for at least 90 days out of the 180 days following the accident;
6. Dismemberment;
7. Significant disfigurement; and
8. Death.

If you think that you could have a case, please contact the Dietrich Law Firm P.C. today at 1-866-529-5334 to speak to an attorney and schedule your 100% free, no-obligation consultation as soon as possible.