Medical Coverage for Injuries from a Motor Vehicle Accident

If you are injured in a motor vehicle accident, your treatment and related expenses will usually be covered under an auto insurance policy. All auto insurance policies in New York State include “Personal Injury Protection” (also known as PIP or No-Fault Insurance). Fortunately, those who are injured in a motor vehicle accident do not need to have their own health insurance to have their medical expenses covered.  It does not matter who your insurance carrier is, or how much coverage you pay for, all policies include No-Fault coverage. This component of NYS issued auto insurance helps pay for medical bills for injuries sustained involving your vehicle. No-Fault covers medical treatment for injuries involving an automobile, for example, injuries sustained in a car accident or by shutting your finger in the car door. In most cases, if your injury was caused in or by an automobile, No-Fault insurance is the primary payor of medical bills. 

The best thing about No-Fault is that it provides coverage regardless of who is at fault. Those who are 100% at fault for a car accident are still covered by this part of their auto insurance policy. Coverage, no matter who is at fault, does not extend to cases where a driver intentionally or criminally caused an accident, the auto insurance carrier can decline coverage for the alleged wrong doer. However, the passengers or pedestrians affected by the accident would still be covered regardless.

You are entitled to receive health service benefits without any time limit if it is possible to determine during the first year after the accident that further health services may be required after the first year. However, a No-Fault application MUST submitted to the insurance company within thirty (30) days of the accident date. Coverage may be denied without proper notice in writing to the insurance company.

What Coverage is Available for Medical Expenses?

No-Fault covers all necessary doctor and hospital bills and other health service expenses for injuries sustained in a motor vehicle accident.

The minimum No-Fault insurance coverage required on a vehicle driven in New York State is $50,000. This pays for medical bills, lost earnings, death benefits, among other expenses. The $50,000 includes all expenses paid out under No-Fault for each person injured. Additional coverage is available but must be purchased; it is not automatically included. Purchasing additional No-Fault coverage is advantageous because treatment for serious injuries requiring hospitalization and/or surgery can exhaust No-Fault coverage quickly, leaving no health coverage or lost wage benefits for the remainder of treatment.

What else does No-Fault cover?

Lost Wages:         

No-Fault coverage may reimburse you for a portion of your lost wages if you are medically unable to work because of injuries sustained in a motor vehicle accident. You may collect 80% of your lost wages while you are out of work. There is a maximum amount of $2,000 that you may collect each month. Lost wages may only be collected for up to three (3) years, even if you are unable to work for longer. In certain situations, you may sue the at-fault drive (or vehicle owner) for your lost wages without having to repay No-Fault.

Out-of-Pocket Expenses:

No-Fault benefits include reimbursement for out-of-pocket expenses for up to $25 per day for up to one-year from the date of the accident for “other reasonable and necessary expenses.” Most frequently this includes transportation expenses. No-Fault coverage may include reimbursement for miles or taxi/rideshare expenses. This is especially handy in the case where the injured party is unable to driver as a result of their injuries and must rely upon transportation services to travel to doctor’s offices.

Death Benefit:

In the event someone passes away from a motor vehicle crash, there is a $2,000 “death benefit” that is payable to the estate of the deceased person. Additionally, under the standard No-Fault coverage, medical expenses prior to death will be satisfied up to $50,000.

Who is Entitled to No-Fault Benefits?

No-Fault coverage extends to all occupants of a motor vehicle at the time of an accident and any pedestrians or bicyclist. Since No-Fault provides benefits regardless of who is at-fault, injuries to individuals in the other involved vehicle are covered under that vehicle’s auto insurance.

There is no payment of No-Fault benefits to the driver or passengers of a motorcycle. There is separate coverage that may be purchased for injuries sustained on a motorcycle, but it is not automatically included or mandatory.

Is there a deductible?

Depending on the policy covering the vehicle involved in the accident, there could be a No-Fault deductible. This must be paid out-of-pocket before benefits are applied.

Is there a Statute of Limitations?

With respect to recovery of No-Fault benefits, there could be between a three (3) year statute of limitations and a six (6) year statute of limitations. It is best to consult with us on your individual case before relying upon any self-calculated time bars.

Does No-Fault Need to be Paid Back?

There are normally no No-Fault liens under the standard Basic Economic Loss policy. However, this is not always the case. Determining whether a lien could be asserted by the No-Fault coverage provider from the outset can make the difference in recovery in a personal injury lawsuit. If you have any questions about your individual situation, please feel free to contact us.

Ensuring you receive all No-Fault benefits to which you are entitled is only a small fraction of the representation we provide when you are injured in an accident. We would be happy to discuss your circumstances with you during a confidential consultation. Call or email us.