What You Need To Know About No-Fault Insurance

IMC Bone Doc can help you after a car accident

New York is a “no-fault” state for car insurance. That means if you’re injured in a crash, in most circumstances you can get coverage for your treatment and lost wages if you can’t work, regardless of who was at fault for the accident.

At Island Musculoskeletal Care (IMC Bone Doc), we are happy to accept no-fault insurance to pay for treatment related to car accidents, and we can help with verification of disability for no-fault wage loss benefits. Contact us today to make an appointment. Same-day appointments are available with many of our doctors. Learn more by visiting our patient resources page.

Here’s what you need to know about no-fault insurance:

What is no-fault insurance?

No-fault insurance provides coverage for certain accident-related expenses for people injured in a car accident (with some exceptions, see below) regardless of fault. This is a required type of insurance coverage for every vehicle garaged in New York state. The state minimum no-fault coverage is $50,000, with the option to purchase more.

Who is covered by no-fault insurance?

If you were inside an enclosed vehicle (as a driver or passenger) and were injured in an accident, you’re covered by no-fault benefits. If you were hit by a car as a pedestrian or cyclist, you’re covered as well. No-fault benefits do not apply to anyone who was injured as a motorcycle rider or passenger (but they do cover pedestrians who are hit by motorcycles).

What are the exceptions to no-fault insurance?

Again, if you’re on a motorcycle, you’re ineligible for no-fault coverage (your policy may include MedPay coverage with more narrow benefits). There are a few other reasons why your no-fault claim could be denied:

  • You were driving under the influence
  • You were driving in commission of an act that would constitute a felony, such as evading arrest
  • You were driving in a drag race or speed test
  • You were knowingly driving a stolen vehicle
  • You were injured while repairing or servicing a vehicle on the premises of a business that provides vehicle repair services

What does no-fault insurance cover?

No-fault benefits cover medical, hospital, surgical, nursing, and dental services related to the accident, as well as prescription drugs, prosthetics, therapy, rehabilitation, and any other professional health services. Essentially, if you were in a car accident and need medical treatment, it’s covered by no-fault, up to the policy limit. No-fault also covers 80 percent of your lost wages up to $2,000 per month if you’re unable to work due to your injuries, again up to the policy limit.

What do I need to do to get my treatment paid for by no-fault insurance?

First, notify the no-fault insurance carrier in writing within 30 days of the accident. The carrier will assign a claim number to your case. When you come to our office for treatment, just provide us with the claim number along with the name of the carrier, the date of the accident, and your date of birth. We’ll give you an “Assignment of Benefits” form to sign. From there, we’ll bill the no-fault carrier directly for any treatment related to the accident; if there is a dispute regarding payment, we’ll handle that with the insurance carrier.

How long do no-fault benefits last?

There is no end date to no-fault coverage for your medical expenses as long as it’s medically ascertainable within one year of the accident that further medical treatment will be needed. For instance, if you sustained a knee injury and we can ascertain within a year of the accident that you may need a future knee replacement because of the injury, the no-fault insurance should apply to that future knee replacement surgery, even if it’s many years after the accident. The wage loss portion of no-fault insurance ends after three years from the date of the accident.

How can I get paid if I’m unable to work?

Under New York law, no-fault insurance will pay you for 26 weeks of disability due to the accident, not including the first week of disability. We can examine you and verify whether you are disabled so that you can collect the benefits you’re entitled to receive.

What if I was on the job when the car accident happened?

You need to report the accident to both your employer and the no-fault insurance carrier for the vehicle involved. Usually, your medical expenses in this situation will be paid by workers’ compensation, not no-fault car insurance. We can help you sort out the insurance situation and get your treatment paid for.