What is No-Fault and How Does It Work in my Motor Vehicle Accident Case?

No-Fault is so named because it is a mandatory insurance coverage in every vehicle registered in the State of New York.  It provides certain insurance coverage to the occupants of a motor vehicle involved in an accident, regardless of who was at fault in the accident.   So, the occupants of the vehicle who caused the accident are entitled to no-fault benefits to be paid by the insurance company who insure the at-fault vehicle; and the occupants of the so-called “innocent vehicle” will receive their no-fault benefits from the insurance company who insures the innocent vehicle.

 

WHO IS ELIGIBLE TO RECEIVE NO-FAULT BENEFITS?

No-fault is a mandatory portion of every automobile policy issued in the State of New York and provides medical and disability insurance.  Both drivers and passengers involved in motor vehicle accidents, as well as pedestrians and bicyclists struck by a motor vehicle, are entitled to no-fault insurance coverage, regardless of who is at fault in the accident.

 

WHAT IS NO-FAULT AND WHO IS ELIGIBLE TO RECEIVE NO-FAULT BENEFITS?

QUESTION:  What is no-fault?

 ANSWER:     No-fault is a form of a health and disability insurance that pays, where applicable, lost earnings, medical bills, prescriptions, travel expenses and household help.

 

QUESTION:  Who is eligible to receive no-fault benefits?

 ANSWER:     Anyone who is hurt in an auto accident, hit by a car as a pedestrian or bicyclist, or injured in some way by the operation, use or maintenance of a motor vehicle.  Unfortunately, insurance companies are not required to provide coverage if you own a motorcycle, but does apply to pedestrians struck by a motorcycle.

 

HOW DO I OBTAIN MY NO-FAULT BENEFITS?

 QUESTION:  Do I need a lawyer to obtain no-fault benefits?

 ANSWER:     No-fault was initially enacted in the 1970’s.  The fact of the matter is that, over the years since then, the insurance industry has complicated the process significantly and prejudiced the right of their own insureds in many, many cases.  An injured party is well advised to speak to a lawyer as soon as possible, after their accident.  Lawyers such as Spiegel Brown & Fichera, LLP, charge no fees for providing advise to people on no-fault matters or anything else arising out of a motor vehicle accident.  You would be wise to take advantage of that and, at least, get some advice to be sure that you are not waiving your legal rights without knowing that you are doing so.  We will never charge you a fee for anything on a motor vehicle accident case, except as may be clearly disclosed to you, in advance and in writing.  Any agreed upon fees will only be repayable if and when we make a financial recovery for you.

 

QUESTION:  How do I obtain my no-fault Benefits?

 ANSWER:     A no-fault application must first be filed with the insurance company who insured the vehicle that you were an occupant of at the time of the accident or the vehicle which struck you, in the event that you are an injured pedestrian within 30 days of the date of the accident. In the event you do not retain a lawyer promptly after your motor vehicle accident to assists you with applying for no-fault benefits you should contact the insurance company yourself and tell them that you were involved in the accident and that you have incurred or expect to incur medical bills. Request that they send you a no-fault application.

 

BESIDES THE NO-FAULT APPLICATION, WHAT DOCUMENTS DO I NEED TO FILE?

You MUST file a NEW YORK STATE DISABILITY form with YOUR employer’s disability car­rier within 20 days from the date of your accident or the date you became disabled as a result of this accident.  If you don’t do this, you may lose a portion or all of your disability benefits.

If you were in the course of your employment when this accident happened, you MUST file for WORKERS’ COMPENSATION BENEFITS through your employer.  The Workers’ Com­pensation carrier will pay you a portion of your earnings and the No-fault carrier (if applicable) will pay you a portion, totaling 80% of your gross earnings.  When you receive papers from Workers’ Compensation, you MUST give a copy to this office.

If the property damage is more than $1,001 for any person, ALL drivers involved are required by the NYS Vehicle and Traffic Law to file a MV-104 with the New York State Department of Motor Vehicles (DMV) within 10 days of the accident. Failure to do so can result in the suspension of your driver’s license. This form is available on the DMV website (www.dmv.ny.gov).

 

WHAT BENEFITS DOES NO-FAULT PROVIDE?

QUESTION:  Am I entitled to be reimbursed for anything besides doctor bills?  How about:

A.  Travel expenses?

B.  Household Care?

C.  Prescriptions?

D.  Lost Earnings?

ANSWER:     Yes.  With respect to all of these categories it is important to note the following:  You have to mail this information to the no-fault carrier.  You should keep copies of all mailings to the carrier and also provide us with a copy.  If you live nearby, we will photocopy this information for you.
Also note, that, every single piece of paper that you send to the insurance company MUST have the insurance company claim number written on it.

The insurance company will reimburse you for the number of miles traveled to and from doctors, physical therapists and hospitals.  You must indicate the name of the doctor, hospital, etc., the date of the office visit and the number of roundtrip miles.  Requests for mileage reimbursement should be submitted to your insurance company monthly.

Any prescriptions that your doctor has issued to you for the treatment of conditions caused by the accident, will be reimbursed.  It is important that you mail copies of your prescription receipts to the no-fault insurance company.  ALWAYS write the name of the doctor that prescribed the medicine and the name of the medication on the receipt.  Prescription receipts must be submitted within 45 days of the date of purchase (N.B. In more recent years, most of the major pharmacy chains will accept your no-fault claim number and issue the prescription without your having to seek reimbursement).

The no-fault carrier will pay for someone to take care of you because you were hurt in this accident.  Your doctor must give you a letter saying this household care is needed.  You MUST send the letter from your doctor to the No-fault Insurance Company along with a form signed by you and the person doing the household care listing the dates this person has taken care of you.  In most cases, your No-fault Insurance Company will not pay for household care if it has been rendered by a spouse, parent or family member.

 

QUESTION:  How do I make sure my treating doctors, therapists and/or hospitals are paid?

ANSWER:     After the no-fault application has been sent to you, filled out by you and returned to the insurance company, they will obtain a list of your treating health care providers and will send them a form advising them that they should send the bills directly to the no-fault insurance company.  Once you get a no-fault claim number (generally over the phone from the insurance company that insures your vehicle), you should simply give the name of the insurance company and the no-fault claim number to your doctors/hospital’s business office and they will bill no-fault directly.

 

QUESTION: How long do I have to submit medical bills to the no-fault insurance carrier?

ANSWER:     Your medical bills, in order to be covered by no-fault, must be submitted by you or the provider of healthcare services to the no-fault insurance company within 45 days of service. Failure to submit them within the 45 days gives the insurance company the right to reject payment.

 

QUESTION:  Is there a limit to the amount of my no-fault coverage?

Answer:     There is a minimum of $50,000 combined medical and disability benefits available on every no-fault claim; however, there may be additional no-fault coverage on the vehicle that was involved in your accident because the owner of said vehicle paid an additional premium for extended or additional no-fault coverage.  There may be circumstances also where, if you were a passenger or pedestrian, you may be entitled to “stack” the no-fault coverage of the vehicle with which you were in involved in the accident together with any motor vehicle policy you may have had on a vehicle of your own.

 

QUESTION:  How long will the no-fault carrier pay for travel expenses and/or household care?

ANSWER:     The no-fault carrier is required to make payment of travel expenses and/or household care for a period of one year from the date of the accident, providing the proper documentation has been mailed to the no-fault carrier.

 

QUESTION:  How does lost wages/earning work?

ANSWER:     You are entitled to be paid no-fault benefits for time lost from work, provided that you were actually employed on the date of the accident.  The procedure is a portion on the no-fault application for you to set forth the name and address of your employer and other information relating to your wages.  Once that application has been returned to the no-fault insurer, they will send a New York No-fault Employer Wage Verification Form to your place of employment.  Once this has been completed, you will also need a note from your doctor stating you are not able to work because of your injury from this accident.  These must both be mailed into the insurance company. Documentation from your doctor stating that you are unable to work must be submitted to the insurance company within 45 days of the date of the lost time from work.

If you are receiving money from New York State Disability, you should also mail a copy of one of the disability checks to the no-fault insurance company, as they will deduct that amount before sending you money.

If you are self-employed, there is a form that must be filled out.  You will have to mail this completed form to the no-fault insurance company along with copies of your previous two years’ income tax returns.  Please ask this office for assistance, if needed.

 

IF YOU HAVE ANY QUESTIONS, PLEASE CALL YOUR CLAIMS REPRESENTATIVE OR ATTORNEY

 QUESTION:  How much will no-fault pay me for my lost earnings?

ANSWER:     All New York automobile polices require that No-fault pay 80% of your gross wages in conjunction with any disability payment up to a maximum of $2,000.00 per month in lost wages (you must again deduct any money paid to you by disability). You or the owner of the vehicle you are occupying may have purchased coverage that provides a highter wage loss benefit. No-fault is required to pay your lost wages up to three years from the date of the acci­dent.  (There are certain restrictions that apply, including exhaustion of the available no-fault coverage, usually $50,000 before 3 years has passed). If your earnings are higher than what No-fault allows, please advise your lawyer. You should check with your lawyer to make sure you are receiving the benefits to which you are entitled.

 

QUESTION:  How long can the insurance company take before they pay me?

ANSWER:     The no-fault carrier can take up to 30 days from the date they receive your bills to consider payment of your bills.  Reminder: make sure you keep copies of everything you mail to the no-fault carrier.

 

QUESTION:  How long will New York Disability pay me if I am not able to work?

ANSWER:     Disability will pay you for 26 weeks (not including the first week you are disabled).

 

QUESTION:  Who will pay me for the first week I am not able to work?

ANSWER:     The no-fault carrier will pay you for the first week you are disabled from working.

 

QUESTION:  Who will pay me if I am not able to work after the Disability payments run out? (after 26 weeks)

ANSWER:     The No-fault Insurance Company will continue to pay you up to three years from the date of the accident as long as your doctor and the insurance company does not say that you are not able to work because of your injury from this accident and you have not exhausted the no-fault coverage limit, which is a minimum of $50,000.

 

QUESTION:  What will the No-fault Insurance Company pay if the injuries should result in death?

ANSWER:     The No-fault Insurance Company is required to pay what’s called a Death Benefit in the amount of $2,000.00.

 

QUESTION:  What do I have to do to get the $2,000.00 from the No-fault Insurance Company?

ANSWER:     You must provide the No-fault Insurance Company with a copy of the Death Certificate and advise them of the name of the person who has been appointed for the deceased person’s estate.

 

WHAT SHOULD YOU DO IF NO-FAULT SENDS A “DENIAL OF BENEFITS?”

Sometimes the No-Fault Insurance Company will deny a payment to you and will tell you how to fight or arbitrate the denial.  For technical reasons, you MUST NOT do this without first speaking to your attorney.  BY DOING THIS, YOU COULD DESTROY YOUR LAWSUIT.  There are very few times we will suggest you fight this, but we will offer alternatives to you.

 

QUESTION:  What should I do if I receive a letter from the insurance company telling me I have to be examined by a doctor?

ANSWER:     You must first contact this office to advise us of this appointment.  You MUST keep this appointment.  Failure to do so would allow the insurance company to stop payment of your benefits.

 

IMPORTANT CONSIDERATION IF YOU ARE INJURED WHILE A PEDESTRIAN OR A PASSENGER IN SOMEONE ELSE’S VEHICLE

If your no-fault coverage of the car in which you are a passenger or which struck you while you were a pedestrian is allowed to cover all of your medical bills and lost earnings – -  and – - – if you own your own motor vehicle  – - – the no fault coverage under your own motor vehicle will provide a second and additional level of no-fault benefits which may increase the amount of benefits available to you.  In such a case, it is important that you promptly notify your own insurance company, as well as the insurance company for the car in which you were involved in the accident of the fact that you were involved in the accident and that you have sustained medical treatment and/or loss of time from work.    You should do so immediately and request a no-fault application.

 

KEEP IN MIND THAT YOU SHOULD…

– NEVER discuss your case or injury with anyone, except your no-fault insurance company.  You should get the contact information on anyone else and ask them to send it to you in writing.  You will then be well advised to at least speak with a lawyer.

– NEVER sign anything for anyone without showing to your attorney.

– ALWAYS keep copies of any correspondence, letters, medical bills or any other documents related to your case so that they will be available.

– ALWAYS keep copies of anything that you have sent to or received from the No-fault Insurance Company.

ALWAYS forward copies of all correspondence, letters, bills, etc. to this office for your file records.

ALWAYS keep copies of the bills, lost wage forms, mileage statement, etc., that you mail to the No-fault Insurance Company.

ALWAYS write the date you mail the bills to the no-fault carrier on your cover letter, as well as the claim number.

ALWAYS make copies of ALL checks received from the no-fault carrier or any other source PRIOR to cashing them.

TRY to obtain a disability note from your doctor as soon as he tells you that you cannot work or if you need household assistance.

DO NOT leave the New York State Disability form with your doctor or your employer as you only have 20 days from the date of the accident or the date you became unable to work to send this form in to your employer’s insurance company.

 

WHAT SHOULD YOU DO IF THE INSURANCE COMPANY TRIES TO SPEAK WITH YOU ABOUT THE ACCIDENT?

 QUESTION:  Should I speak to an insurance company about my accident?

 Answer:  While you are required to discuss your case and your injuries with YOUR no-fault insurance company, you should not discuss your injury or the facts of the accident with the insurance company who insures any other person until you have consulted a lawyer.  In this connection, it is important that you understand that the insurance adjustors who insure the drivers involved in a motor vehicle accident are trained to convey the impression to you, the potential injured claimant that they are there to be of assistance to you.  This is a false impression that they are trained to try and create.  They are there to attempt to get as much information as they can to use against you in the event that you may bring a claim later on.  You don’t know what may hurt you.  If you think that you may have been injured in an accident, you should consult a lawyer with significant experience in handling serious motor vehicle accident cases, such as the lawyers at Spiegel, Brown & Fichera, LLP

 

REMEMBER: THERE IS NEVER A FEE CHARGED BY SPIEGEL BROWN & FICHERA, LLP FOR A NO-FAULT OR ACCIDENT CONSULTATION.  IF WE DETERMINE THAT YOU HAVE A CASE AND YOU WISH US TO REPRESENT YOU, THE EXACT TERMS OF OUR FEES WILL BE PROVIDED IN WRITING TO YOU AND EXPLAINED TO YOU.