New York No-Fault Insurance: What You Need to Know

Understanding New York No-Fault Insurance (PIP)
New York No-Fault Insurance, formally known as Personal Injury Protection (PIP), requires drivers to carry coverage that pays for their own medical bills and related expenses after a car accident—regardless of fault. The system aims to reduce lawsuits by ensuring prompt payment for injuries while limiting the ability to sue unless injuries meet a specific “serious injury” threshold under state law.

Mandatory Coverage Requirements
New York law mandates all registered vehicles carry minimum PIP coverage:

• $50,000 per person for medical expenses, lost wages, and essential services.
• $2,000 death benefit (in addition to the $50,000) for funeral expenses.
• $25,000 for wrongful death if the accident results in fatality.
  PIP covers the policyholder, household relatives, passengers, and pedestrians struck by the insured vehicle. Uninsured drivers or motorcyclists (who are exempt from PIP) may still claim benefits through another involved vehicle’s policy or New York’s Motor Vehicle Accident Indemnification Corporation (MVAIC).

Expenses Covered by PIP
PIP pays for “reasonable and necessary” accident-related costs, including:

• Medical bills: Hospital visits, surgeries, rehabilitation, diagnostics, and prescriptions.
• Lost wages: Up to 80% of gross income, capped at $2,000/month for up to three years.
• Essential services: Reimbursement for household help (e.g., childcare, cleaning) if injuries prevent daily tasks.
• Travel expenses: Costs for medical appointments (e.g., mileage, public transit).
  Benefits apply even if the policyholder caused the accident.

Filing a No-Fault Claim: Deadlines and Process

1. Notify Your Insurer: Report the accident to your insurance company within 30 days. Delays risk denial.
2. Submit Medical Proof: Provide documentation (bills, doctor reports, wage statements) via Form NF-2. Insurers have 30 days to approve or deny claims after receipt.
3. Follow Treatment Guidelines: Treatments must align with New York’s “Preparing for Your Independent Medical Examination” rules. Insurers may require independent medical exams (IMEs) to verify injury severity.
4. Dispute Denials: If denied, request arbitration via the insurer or New York Department of Financial Services (DFS).

Serious Injury Threshold: When You Can Sue
PIP restricts lawsuits unless injuries meet the “serious injury” definition under NY Insurance Law § 5102(d), which includes:

• Death
• Dismemberment or significant disfigurement
• Fractures
• Permanent loss of a body organ/function
• Significant limitation of a body system or function
• Disability lasting 90+ of the 180 days post-accident
  If qualified, injured parties can sue for non-economic damages (e.g., pain and suffering) and excess economic losses beyond PIP limits.

Benefits of the No-Fault System

• Faster payouts: Avoids lengthy fault disputes.
• Reduced court burden: Only ~3% of NY auto injury cases reach litigation.
• Broad coverage: Protects passengers and pedestrians irrespective of insurance status.

Limitations and Exclusions
PIP does not cover:

• Property damage (handled under liability or collision coverage).
• Injuries from intentional acts (e.g., staged accidents), drunk driving (if the driver was intoxicated), or during commission of a felony.
• Out-of-state accidents (unless the policy includes optional “extended PIP”).
  Lost income claims exclude the first 14 days post-accident.

Steps to Protect Your Rights After an Accident

1. Seek Medical Care Immediately: Delayed treatment undermines claims.
2. Document Everything: Collect photos, witness contacts, police reports, and medical records.
3. Track Expenses: Save receipts for all accident-related costs.
4. Consult an Attorney: Critical if injuries appear serious or claims are disputed.

Disputing Denied or Underpaid Claims
Insurers may deny claims for missed deadlines, incomplete documentation, or disputes over medical necessity. Solutions include:

• Internal Appeals: Submit additional evidence (e.g., peer-reviewed medical studies).
• Arbitration: File through DFS or the American Arbitration Association.
• Litigation: Sue if the insurer breaches its duty of good faith.

Special Considerations

• Pedestrians/Bicyclists: PIP from the striking vehicle covers their injuries. If the vehicle is uninsured, file through MVAIC.
• Rideshare Drivers: Uber/Lyft drivers in NY must carry PIP through their personal policy or rideshare insurer.
• Out-of-State Accidents: PIP generally applies only in NY. Consider supplemental coverage like MedPay if traveling frequently.

Enhancing PIP Coverage
Optional add-ons increase protection:

• Extended PIP: Raises medical/lost wage limits beyond $50,000.
• Additional PIP: Adds coverage for non-family passengers.
• Supplemental Spousal Liability: Covers a spouse’s economic losses if injured by the policyholder.

Coordination with Health Insurance
Health insurance may cover accident-related medical bills, but PIP is primary. Reimbursement from health insurers may apply if PIP pays first.

Final Policy Considerations
Review PIP limits annually, especially after major life changes (e.g., income increases). Compare insurers for optimal rates—NY’s average annual premium is ~$1,400, but prices vary by region (e.g., higher in NYC).