How Do I Pay For Medical Care And Treatment And Other Expenses Immediately Following An Accident (No-Fault Coverage)?

Regardless of your right to sue all responsible parties who caused or contributed to a motor vehicle accident in a court of law, there have been laws enacted in the State of New York, commonly referred to as “No-Fault” that provide separate benefits for accident victims, which allow for immediate coverage relating to medical, remedial and certain health care expenses, including lost earnings as defined by the State of New York insurance law.

Basically “No-Fault” also known as personal injury protection (PIP), is designed to promptly pay “Basic Economic Loss” coverage to the driver and all passengers injured in a vehicle because of its use or operation in the State of New York. In most cases, this coverage will be available to you from the motor vehicle you are either driving, a passenger in, or struck by, regardless of whose fault the accident is.

The purpose of No-Fault insurance is to restore individuals hurt in motor vehicle accidents to health and productivity as swiftly as possible. Once again, it is important to realize that these immediately available benefits relating to “Basic Economic Loss” coverage are separate and apart from any right or ability you have to bring a lawsuit in Court seeking money damages for your injuries. 

This No-Fault/PIP coverage, also known as “Basic Economic Loss” is available for up to $50,000 per person for the following combined items:

1. All necessary expenses incurred for:
(i) Medical, hospital, surgical, nursing, dental, ambulance, x-ray, prescription drug and prosthetic services
(ii) Psychiatric, physical therapy (provided that treatment is rendered pursuant to a referral) and occupational therapy and rehabilitation
(iii) Any nonmedical remedial care and treatment rendered in accordance with a religious method of healing recognized by the laws of this state
(iv) Any other professional health services; all without limitation as to time, provided that within one year after the date of the accident causing the injury it is ascertainable that further expenses may be incurred as a result of the injury.

2. 80% of lost wages from work, up to a maximum payment of $2,000 per month for up to three years from the date of the accident; subject to statutory offsets for New York State Disability, Workers’ Compensation and Federal Social Security Disability benefits

3. All other reasonable and necessary expenses incurred, up to $25 per day for no more than one year from the date of the accident (e.g., household help and transportation expenses to/from medical treatment resulting from the auto accident)

4. A $2,000 death benefit (in addition to the $50,000 basic No-Fault limit), payable to the estate of a person eligible for No-Fault benefits who was killed in a motor vehicle accident

However, under most insurance policies, a person will be ineligible for No-Fault benefits if:

• Driving while intoxicated or impaired by the use of a drug that contributes to the accident
• Intentionally causing his or her own injuries
• Riding an all-terrain vehicle (ATV) or a motorcycle as operator or passenger (a pedestrian struck by a motorcycle or ATV is covered)
• Injured while committing a felony
• Injured while in a vehicle known to be stolen
• An owner of an uninsured vehicle

In order to qualify for No-Fault benefit coverage, certain documentation relating to No-Fault must be submitted to the appropriate insurance carrier responsible for the No-Fault coverage within 30 days of the motor vehicle accident. This documentation, once it is properly executed, will trigger the No-Fault coverage you are entitled to. Eventually, the insurance company furnishing you with No-Fault benefits will send you for what is referred to as an “Independent Medical Examination” (IME) to determine whether you still need medical treatment. Of course, this IME is often anything but independent or objective, and the examining physician chosen by the insurance company will often indicate that you are no longer in need of further treatment, thereby enabling the insurance carrier to cut you off from further benefits. Once you have been cut off or denied further No-Fault benefits, you are then free to utilize any private health insurance you may have, if available.

Of course, there are many nuances and other variables that come into play under the No-Fault law and all of the different coverage available, including the limitations and exceptions associated therewith. Only an experienced attorney practicing in this area of the law can guide you and provide you with an appropriate opinion. We urge you to either contact our office or any other competent counsel for this purpose. Call the Law Offices of Ira M. Perlman, P.C. & Robert D. Rosen, P.C., at 212-668-0100 to schedule your free consultation today.