NY Insurance Department FAQ’s About NY No-Fault Insurance

My clients frequently ask me questions regarding NY No-Fault Insurance Law. Although I am happy to answer their questions, a large number of the basic questions are answered on the FAQ page of the New York State Insurance Department website that you can access by clicking here. Below I have pasted some of the FAQ’s for your convenience but I must issue a WARNING– This stuff is very dry as it was undoubtedly written by a bureaucrat deep in the bowels of the Insurance Department:What is No-Fault coverage and what am I entitled to under it?Ans: See our 2006 Consumers Guide on Automobile Insurance – No-Fault Benefits.When and where should I file my No-Fault claim?Ans: Regulation 68 requires that “in the event of an accident, written notice setting forth details sufficient to identify the eligible injured person, along with reasonably obtainable information regarding the time, place and circumstances of the accident, shall be given by, or on behalf of, each eligible injured person, to the applicable No-Fault insurer, or any of their authorized agents, as soon as reasonably practicable, but in no event more than 30 days after the date of the accident, unless the eligible injured person submits written proof providing clear and reasonable justification for the failure to comply with such time limitation.”You should file your claim with the insurance company which covers the car in which you were an occupant (either as passenger or driver) or, if you were a pedestrian, with the car that struck you. If you do not know the vehicle that struck you or if the vehicle was uninsured, you may file a claim with the insurer of a household family relative who had an auto policy at the time of the accident. If there was no auto policy in the household, you should file a claim with the Motor Vehicle Accident Indemnification Corporation (MVAIC). Additional information on MVAIC can be obtained on their web site www.mvaic.com or you can contact them by telephone at (646) 205-7800.What do I do if my expenses exceed the $50,000 available under No-Fault?Ans: When the basic No-Fault benefits are consumed, you may apply for Additional No-Fault (Additional PIP) benefits either from the vehicle you occupied or any auto policy of a related member of your household. Additional PIP is an optional coverage which is usually not expensive. If no Additional PIP benefits are available, you may make a claim to your standard health insurance to pay for your medical expenses. You may also be eligible for Federal Social Security Disability benefits. In addition to the above, you can also sue the party responsible for the accident, in order to recover the costs that you paid which exceed your policy limit.What if the vehicle involved was a motorcycle?Ans: If you are the operator or passenger of a motorcycle involved in an accident, you are excluded from No-Fault benefits (you may sue from first dollar loss). If you were a pedestrian struck by a motorcycle, you should file a claim with the insurer of the motorcycle. If it is not insured, then you may file the claim with the insurer of a household family relative who had an auto policy at the time of the accident. If there was no auto policy in the household, you should file a claim with the Motor Vehicle Accident Indemnification Corporation (MVAIC).Can I sue for “serious injury” against another driver’s liability coverage?Ans: You may sue another driver if he or she caused the accident that injured you and you sustain a “serious injury”. Section 5102(d) of the New York Insurance Law describes various conditions that meet the definition of “serious injury” [I WILL BE POSTING SHORTLY ON WHAT CONSTITUTES A "SERIOUS INJURY" UNDER NY LAW SO STAY TUNED...].What are some of the more significant regulatory changes in automobile No-Fault insurance that have occurred as a result of the Department’s promulgation of the revised Regulation 68 in September of 2001?Ans: Insurance Department Regulation 68, as revised effective April 5, 2002, effected numerous changes to the processing of No-Fault claims. The revised Regulation modified the timeframes in which to submit written notice of claim from 90 to 30 days and to submit medical bills from 180 to 45 days, respectively, and mandated that lost wage claims must be submitted within 90 days. The new regulation also included provisions for the electronic data transmittal of claim information, and revised rules concerning the wording and acceptance of No-Fault assignments. In addition, the revised regulation modified many of the administrative procedures in connection with No-Fault arbitration and conciliation.When do the new provisions establishing time frames of 30 days for written Notice of Claim, 45 days for submission of health care bills and 90 days for submission of loss of earnings claims take effect?Ans: Insurers are required after April 5, 2002, to issue new prescribed endorsements for all new and renewal policies which contain the new requirements. These requirements can be applied only to claims that arise under policies issued which include the new endorsement.Is there a prescribed form which must be used by a No-Fault insurer or self-insurer in order to request additional verification of claim?Ans: No such requirement exists within Regulation 68.Where may I obtain a copy of Form AR, the New York Motor Vehicle No-Fault Insurance Law Arbitration Request Form?Ans: Form AR may be obtained from http://nysinsurance.adr.org/public/AR1.pdf or visit the web site of the American Arbitration Association for further information on how to file for No-Fault arbitration.The revised Regulation 68 specifically provides the arbitrator with the discretion to resolve disputes involving amounts of less than $2,000 by written submissions only. When does this rule take effect?Ans: This rule takes effect for all arbitration requests filed on or after April 5, 2002.I have received a No-Fault Arbitration award over a month ago but I have not received payment from the insurer. What should I do?Ans: If a conciliation agreement or settlement letter issued by the American Arbitration Association (AAA) or arbitration award is not paid within 30 days of the date the agreement was mailed to the parties, an applicant or applicant’s attorney may submit a written enforcement request to the Insurance Department’s Property Bureau. With every request for enforcement, the Department requires insurers and self-insurers to either provide proof to the Department that full payment was made or an explanation why payment was not made.If payment is not made by the insurer in accordance with the terms specified in the conciliation letter or arbitration award within 45 days following such resolution, an additional attorney’s fee shall be paid by the insurer when the attorney writes to the insurer in order to receive such overdue payment. The additional attorney’s fee shall be $60 and shall become payable only after written request from the attorney to the insurer, received by the insurer more than 45 days after mailing of the conciliation letter or arbitration award. Such fee shall not be payable if payment was made by the insurer prior to the attorney’s request for such payment or if an arbitration award is appealed.When insurers do not make timely payments, you are encouraged to request enforcement of such dispute resolutions with the Department. The enforcement request should include (1) a full and complete copy of the conciliation agreement, settlement letter or arbitration award and (2) a copy of your follow-up correspondence addressed to the insurer requesting that they issue payment for the unpaid conciliation agreement or arbitration award. Your enforcement request should be directed to:Hyman Silberstein, Senior Insurance ExaminerNew York State Insurance Department25 Beaver StreetNew York, NY 10004No-Fault provides coverage for my lost wages subject to a 20% statutory offset. My lost wage payment is subject to additional statutory offsets for amounts recovered or recoverable on account of personal injury to an eligible injured person under State or Federal laws providing disability benefits. Are these other statutory offsets deducted from my gross wages before application of the 20% offset, or are they deducted after application of the 20% offset?Ans: The determination of whether the offsets for New York State Disability benefits are deducted before or after the 20% offset is dependent upon the taxability of the disability benefit. If the benefit is taxable, it is deducted prior to application of the 20% offset. If the benefit is not taxable, it is deducted after application of the 20% offset factor. In order to expedite the processing of your wage claim, you should provide evidence of taxability of your New York State Disability benefit to your No-Fault insurer at the time you make a No-Fault lost wage claim.