The ambulance ride from Elmwood Avenue to Buffalo General. The ER visit. The follow-ups, the physical therapy, the two weeks you couldn’t work. In most states, you’d be fighting the other driver’s insurer over all of it. In New York, your own policy usually pays first, no matter who caused the crash. The catch is a set of short deadlines that trip up a lot of people.
What does no-fault pay?
New York calls the benefits “basic economic loss.” Under Insurance Law 5102, they cover up to $50,000 per person for the following.
- Necessary medical, hospital, surgical, dental, ambulance, prescription and therapy expenses.
- Lost earnings, at 80 percent of what you would have earned, up to $2,000 a month for up to three years.
- Other reasonable expenses, like help around the house, up to $25 a day for up to a year.
Some people buy an optional extra $25,000 that kicks in after the first $50,000 for lost earnings and therapy. Check your declarations page.
Who pays?
Usually, the insurer of the vehicle you were in pays. If you were a pedestrian or on a bicycle, the insurer of the car that hit you usually pays, though your own household policy can come into play in some situations. If no policy applies, the Motor Vehicle Accident Indemnification Corporation may step in. See our guide on uninsured drivers and MVAIC.
What are the deadlines?
This is where claims die. The state’s Department of Financial Services says you need to give the no-fault insurer written notice of your claim within 30 days of the accident. Medical providers have 45 days from treatment to submit their bills, and lost wage claims have their own paperwork. Missing the 30 days doesn’t always end a claim if there’s a reasonable excuse, but it hands the insurer an easy reason to deny.
In practice, call the insurer of the car you were in within a day or two, ask for the no-fault application, often called an NF-2, and send it back promptly. Keep a copy and proof of mailing.
What will the insurer ask for?
- The completed application with details of the crash and your injuries.
- Names of every doctor, clinic and hospital that treated you.
- Wage verification from your employer if you’re claiming lost earnings.
- Sometimes an examination under oath or an independent medical exam with a doctor the insurer picks.
Go to every scheduled exam. Skipping one can let the insurer cut off benefits.
Why do no-fault benefits get cut off?
The most common reason is an insurer’s medical exam concluding that you don’t need more treatment. You’ll get a denial form, often called an NF-10. You can challenge it, either through arbitration or in court. Many Buffalo injury lawyers handle no-fault disputes, and some providers will pursue unpaid bills themselves.
What about health insurance?
No-fault is primary for crash injuries, so providers generally bill it first. Once no-fault is exhausted or denied, your health insurance may pick up the rest. Medicaid and Medicare have their own rules. Keep the explanations of benefits from every payer.
Does no-fault cover motorcyclists?
No. Motorcycle operators and passengers are excluded from New York no-fault benefits, per the DFS no-fault FAQ. Riders rely on health insurance and their own coverage, and they can sue the at-fault driver without meeting the serious injury threshold. A pedestrian hit by a motorcycle, on the other hand, can claim no-fault from the motorcycle’s insurer. Read our motorcycle guide.
Where does no-fault end and a lawsuit begin?
No-fault covers economic loss up to $50,000. A pain and suffering claim against the other driver generally needs a “serious injury” as defined in Insurance Law 5102(d). Losses above the $50,000, like a large wage loss, can be pursued against the other driver without proving a serious injury. See our threshold guide.
Is there a DMV report too?
Yes, and it’s separate. If anyone was injured, or damage to any one person’s property tops $1,000, every driver has to file an MV-104 with the DMV within 10 days. Our crash report guide covers it.
The short version
- No-fault pays up to $50,000 for medical bills, 80 percent of lost wages and some other costs.
- Give written notice to the insurer within 30 days of the crash.
- Providers must submit bills within 45 days.
- Go to every exam the insurer schedules.
- Motorcyclists don’t get no-fault benefits.
The 30-day and 45-day filing windows
The Department of Financial Services tells consumers to file a no-fault claim within 30 days and to submit medical bills within 45 days. Those are not the same as the three-year lawsuit deadline. A late notice can be excused only in limited situations, so it is safer to get the application in than to wait until every bill has arrived. Keep the proof of mailing or the electronic confirmation.
Motorcyclists are generally outside this system, which the DFS no-fault FAQ explains, and a pedestrian or cyclist usually makes the no-fault claim against the insurer of the vehicle that struck them. If that vehicle cannot be identified, the MVAIC qualification page describes a different path, including a police report generally within 24 hours and a notice of intention within 90 days for a hit-and-run.
This page explains how the system generally works. Your policy controls the details, so read it and ask questions early, including whether you bought additional no-fault coverage above the basic $50,000 limit. You can browse attorneys around Buffalo.