One of the most important parts of any New York motor vehicle insurance policy is coverage that is known as “No Fault”. No Fault coverage is critically important because it is the portion of the car insurance policy that steps in to pay for medical and hospital bills incurred as a result of injuries sustained and lost wage reimbursement for time missed from work as a result of a motor vehicle accident. The term “no fault” was given to this coverage because the insurance company that is responsible for providing the benefits is not determined by who is at fault for the happening of the accident. Rather, the insurer that is responsible for providing the No Fault benefits is determined by a number of longstanding New York rules of law.
Primarily, the insurer of the vehicle that you are an occupant of at the time of the accident (whether you are a driver of that vehicle or a passenger in the vehicle) is the one that must provide the No Fault benefits even if the other vehicle is the one at fault for the accident. If you are a pedestrian that has been struck by a motor vehicle, the insurer of the vehicle that came into contact with you must provide the No Fault coverage.
While there is an opportunity in many cases for individuals to purchase additional No Fault coverage (also referred to as Personal Injury Protection or PIP) that goes beyond what is required in New York, the law in New York State requires insurers to provide up to $50,000 in No Fault coverage to covered persons who have been injured in a motor vehicle accident. The coverage is provided to pay for a combination of hospital, medical, therapy and radiological testing bills related to the accident and lost wage reimbursement for time missed from work.
In order to be eligible for this all important coverage however, an injured party is required to file a completed No Fault Application seeking benefits with the applicable insurer within 30 days of the date of the accident. The failure of the injured party to take this step can result in the insurer denying the No Fault claim altogether. Because of this strict time limitation and the harsh penalty that can result in a party’s failure to file the application in time (essentially, the injured party getting stuck with all of the medical bills), it is extremely important for the injured person to speak with an experienced personal injury attorney in the early stages of the process. An experienced motor vehicle accident attorney will not only ensure that your No Fault claim is timely filed with the right insurer, but also that the forms are filled out correctly and that you receive all of the benefits to which you are entitled.
Perhaps the most challenging aspect of a No Fault claim, however, is what is often referred to as the “cut off”. Simply put, under New York’s No Fault law, insurance carriers are required to pay for the medical and hospital bills for the injuries sustained in an accident until such time as an “independent” doctor determines that no further medical treatment is needed. Unfortunately, these “independent” medical experts are doctors that are hired by the insurance company and are being paid by that company. It is not surprising, therefore, that these doctors often deem the claimant to have reached “maximum medical improvement” during these examinations, determining that no further treatment is needed. Under the law, with this medical determination in hand, the insurer can “cut off” future no fault benefits and deny all further medical bills in connection with the claim. Often, this leaves injured persons who continue to require medical care for their injuries, in a desperate situation.
An experienced motor vehicle accident attorney will fight for you against the “cut off” of your rightful No Fault benefits by the insurance carrier. For example, your attorney can file an arbitration on your behalf in order to have a truly impartial arbitrator determine whether the denial of future benefits was proper, looking at medical evidence from both sides in making his or her decision. Because medical care can be astronomically expensive, No Fault coverage is often critically important to an injured person and keeping that coverage active until the injured party has legitimately healed from their injuries is a must.