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.


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About Jim Reed

I am an attorney from Elmira, N.Y. representing people who have been injured by the negligence of others. For more than 20 years, I have practiced in the state and federal courts of both New York and Pennsylvania in the areas of Personal Injury, Medical Malpractice, and Legal Malpractice. Circle Jim on Google+! I am proud to be a member of the prestigious Million Dollar Advocates Forum. Forum membership is limited to trial lawyers who have demonstrated exceptional skill, experience and excellence in advocacy by achieving a trial verdict, award or settlement of One Million Dollars or more. I have been fortunate to recover many multi-million dollar recoveries for my clients. I am also proud of the fact that WETM-TV selected me as their local legal expert. I am featured on the Noon News on Wednesdays when I respond to listeners' legal questions. If you have a legal question, feel free to E-mail it to me at [email protected] and I will be happy to address your question either via E-mail or on WETM. I am a lifelong resident of Elmira where I live with my wife and three children. When I am not working, I can often be found on my bicycle as I am an avid bicycle racer having competed in races all over the country including a 508 mile team race through Death Valley (The Furnace Creek 508) and a 540 mile race through the Cascade Mountains of Oregon (The Race Across Oregon). I have lectured frequently on many law-related topics and I have been published in the New York State Bar Journal, which is the largest and most prestigious legal publication in New York State. I am happy to speak to local civic groups so please feel free to E-mail me at [email protected] or call me at 1-800-Zifflaw (943-3529) .

24 thoughts on “NY Insurance Department FAQ’s About NY No-Fault Insurance

  1. I have a question. I was a pedestrian struck by a vehicle and have sustained serious injuries. Is my attorney permitted to take any fee money out of the 50,000. NO Fault medical award?
    He states he is eligible for a portion of that money (even though I filed and have handled all correspondence with the insurance company involving the No Fault payments.)

  2. Karen:

    The answer depends upon the fee agreement you have with your attorney. An attorney should have a written retainer agreement spelling out the details of his or her representation of you. The retainer agreement should define the scope of the representation as well as how any attorney’s fees or costs should be calculated. You need to look at the written agreement between you and your attorney.

    As to how I generally handle this issue in my office when I am representing NY and PA auto accident victims, I do NOT charge any fee on the no-fault medical award. The only exception to this general rule is when the NF carrier has wrongfully denied payment and I have to pursue NF arbitration to compel the carrier to pay the bill. The reason for this charge is that I am now performing additional legal services that do not fall under the terms of my written retainer agreement on the personal injury case. This is kind of like the plumber you have hired to fix your faucet charging you more if you now ask him to fix your furnace too.

    I believe the best way to avoid any fee disputes with clients is to put everything in writing and to freely discuss any questions they may have about the fees. I would urge you to discuss the fee issue with your attorney ASAP.

    Good luck.

    Thanks for your great question,

    Jim
    _________________________________
    James B. Reed
    NY & PA Injury & Malpractice Lawyer
    Ziff Law Firm, LLP
    Mailto: [email protected]
    Office: (607)733-8866
    Toll-Free: 800-ZIFFLAW (943-3529)
    Web: http://www.zifflaw.com
    Blogs: NYInjuryLawBlog.com and
    NYBikeAccidentBlog.com

  3. I was in an accident where an 84 yr old lady ran a red light. I was just back to work after stress caused a small herniation in my neck so her hitting me caused me to loose 3 more weeks of work. I am still waiting after 2 months for my auto to be fixed. I got a demerit at work and never had one in 16 years. I have stress issues, neck pain, right arm pain, lower back pain and right ankel pain(never had the last 2 b4). This ladies negligence has taken a lot of time and running out of my life, i am unable to get to work union meetings as i am driving a substandard vehical. i had auto rental but Allstate called me 2 times a day and my mechanic constantly to get me to turn it in so i had it for 2 weeks and gave up the fight to keep it. I am so tired of dealing with this and what do i get? Is there anything i can sue for? I want to sue, i am angry she took all this from my life and my health is back to borderline and im in pain all the time again. Please write me back at my email not sure if i can find this one again. thanks so much. Julie.

  4. IN NY, there is an order of priority as to what no-fault insurance carrier is required to pay in the event of a bus accident. If the bus passenger has their own no-fault coverage, that coverage is primary. If the bus passenger does not have their own coverage but someone within their household has coverage, then that coverage applies. If the bus passenger does not have their own NF policy and there is no NF coverage within their own household, then the insurance company for the bus must provide NF coverage. These rules of priority are set forth in Insurance Law §5103. Hope this helps!

    Jim Reed

  5. Jim, I have a client who while attempting to enter his parked vehicle, he slipped and fell on ice located beneath the vehicle. His driver’s door was open, he was putting his right foot into the vehicle and then when he stepped on the ice patch with his left foot, he went down. Covered under no fault? I say yes under the entering and alighting from the vehicle portion of the policy but carrier is denying…any help?

  6. Yes, I agree with you but just because we are right doesn’t mean that the carriers will roll over. Looks like you are going to have to file for NF arbitration to compel them to do the right thing. Good luck!

    Thanks, Jim
    _________________________________
    James B. Reed
    NY & PA Injury & Malpractice Lawyer
    Ziff Law Firm, LLP
    Mailto: [email protected]
    Office: (607)733-8866
    Toll-Free: 800-ZIFFLAW (943-3529)
    Web: http://www.zifflaw.com
    Blogs: NYInjuryLawBlog.com and
    NYBikeAccidentBlog.com

  7. hi, my car was parked in front of my house got hit by another car that is insurance,i would like to know who will fix my car the owner or their insurance company . Thank you

  8. The insurance carrier for the car that hit your car should pay for your car damage under the property damage coverage for that car. However, just to be safe, you should report this accident to your insurance carrier too because in the event that the other car is not insured or the car’s insurance carrier jerks you around, you may seek coverage under your own policy. Your policy requires that you promptly notify the carrier of any accident if you wish to seek coverage. Sorry to hear about your car but good luck!

    Jim Reed
    NY & PA Car Accident Lawyer
    [email protected]

  9. I was rear ended & currently out of work due to injuries. I’m waiting on wage payments from my insurance company now. My question: hopefully at some point, I can try returning to work. But what if, due to my injuries, I end up in too much pain & need to leave work again. Will my insurance then pay my wages (the 80%) again?

  10. Mary:

    This is a tough question to answer because frankly every person’s injuries and every insurance company is different. Long story short, so long as a Dr. will certify the fact that you are unable to work due to injuries suffered in the accident, the no-fault insurance carrier “should” resume your lost wage payments.

    The reason I put “should” in italics is because some no-fault carrier’s unfortunately deny lost wage claims even though you have presented medical evidence of disability. Your remedy if your lost wages are denied is to file for NF arbitration but often that isn’t a great solution because arbitration takes a long time and while the arbitration is pending, you are not receiving lost wage checks. Needless to say, not a great situation.

    Because this all gets complicated and because it is important to devise a good strategy based on the unique facts of your situation, I would strongly urge you to contact an experienced injury attorney who can assist you. Best of luck!

    Thanks, Jim
    _________________________________
    James B. Reed
    NY & PA Injury & Malpractice Lawyer
    Ziff Law Firm, LLP
    Mailto: [email protected]
    Office: (607)733-8866
    Toll-Free: 800-ZIFFLAW (943-3529)
    Web: http://www.zifflaw.com
    Blogs: NYInjuryLawBlog.com and
    NYBikeAccidentBlog.com

  11. Camille:

    My apologies for my delay in responding but I had never seen a case approving yoga for NF coverage so it took me some time to research the issue and reach out to my fellow car accident lawyers. Long story short, I came up with absolutely no authority finding yoga covered under NY no-fualt. The best suggestion I have is to see if you can find a physical therapist who uses yoga as part of their PT program because PT is covered under NF. Sorry I couldn’t find more but good luck in seeing if you can get it covered through PT.

    Thanks, Jim
    _________________________________
    James B. Reed
    NY & PA Injury & Malpractice Lawyer
    Ziff Law Firm, LLP
    Mailto: [email protected]
    Office: (607)733-8866
    Toll-Free: 800-ZIFFLAW (943-3529)
    Web: http://www.zifflaw.com
    Blogs: NYInjuryLawBlog.com and
    NYBikeAccidentBlog.com

  12. My lawyer recommended a PT but now that Winter is coming, I would like to switch to a PT near my area, how do I make the switch?
    Thanks

  13. I was in horsehead ny on 8/31/12 with my wife on a motorcycle a car on rt. 14 turned in front of us. I sustained a dislocated elbow torn tin dun and knock unconscious and a lot of bruises. My wife some scraps my problem is we are from Ohio. I don’t understand no fault my motorcycle insurance is paying on medical to its limit . And it looks like I have to pay the rest that seems dumb . I guess then I sue for pain and suffering and out of pocket cost . Also should I get attorney from ohio or ny or what other options do I have. Thanks

  14. Sorry to hear about your motorcycle accident. Because you are insured in Ohio but the accident happened in NY there will be an interplay between Ohio law and NY law. Unfortunately this can be a somewhat complex question and it is tough to accurately answer your question without more info regarding your OH insurance policy and your injuries. My suggestion is that you call my paralegal Karen Wheadon at 800-ZIFFLAW (943-3529) and she will get some more info from you so I can give you a better answer to your question.

    Thanks for visiting our website.

    Jim Reed
    NY & PA Injury and Malpractice Lawyer
    [email protected]

  15. Hello,

    In August I was hit by a car while riding my bike. The driver was insured, and provided me with paperwork to fill out and a claim number, and handled the property damage claim quickly. As for the medical claim, that’s another story: For the paperwork they asked me to fill out, I filled out as well as possible. I went to the emergency room, but after that no doctor would touch me if I said it was a no fault claim. Luckily it was only some strained tendons/ligaments and with some anti-inflamatories, and a sling, and some rest, I recovered. So the only medical claim I sent to them were the bills for the ambulance ride and the emergency room services, and they offered to pay me for my days off. But at this point nothing has been paid, I keep getting calls from collections agencies. They claimed to have sent forms to the hospital, but the hospital has no records of that, nor has anything come to me. I finally got them to send me the papers they wanted the hospital to fill out and spent a day getting those filled out and mailed back to them, only to have them “lose” the papers (luckily I kept copies) but the loss of papers is commonplace, and nothing arrives to them despite tracking numbers and delivery confirmations and clear labeling of the papers with the claim number. Is there any recourse? Do I have options? No lawyer wanted to be involved with the case because the money was so minor, and I was not “legally injured”. But now I’m stuck with no idea about what to do.
    Thank you.

  16. Chad:

    Now you know why I hate insurance companies. It makes me nuts that they jerk folks around in refusing to properly handle what should be a very small and straight-forward claim. Although I normally don’t handle NF claims unless I am representing the injured party on a personal injury claim, I feel bad for the position you are in so I am happy to see if we can help you. Please email my paralegal Karen ([email protected]) with the information above as well as your contact information and additional details (date of accident, insurance carrier adjuster’s address, name of the driver, etc.) and we will see what we can do to help you out.

    Jim
    ___________________________
    Jim Reed
    NY & PA Bike Accident Lawyer

  17. my son was at a party at a friends house they were all drinking and he jump or fell or slipped off the top of a 7 foot slide and landed on the concrete causing major damage to both heels is this some thing covered by the home owners insurance

  18. Sorry to hear about your son. It is difficult to answer your question without a lot more information so please call my ace paralegal Karen at 899-943-3529 and she will get the necessary information from you so I can respond to your question.

    Jim Reed
    NY & PA Injury and Malpractice Attorney

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