New York State No-Fault Law

The No-Fault Law was implemented in 1973. The purpose of the law was to make sure that drivers, passengers, pedestrians and bicyclists who are injured in motor vehicle accidents are compensated for the medical and hospital expenses and lost earnings in a prompt fashion.

The law, also known as the “threshold law” as will be described below, applies to what is known as “first party benefits” for medical/hospital expenses, lost earnings and incidental expenses due to the car accident. However, the No-Fault law does not cover damages for pain and suffering, which can be recovered by the injured person in a “third party action” against the negligent owner and driver of the automobile that caused the injuries. Thus, there are often two separate claims proceeding at the same time—a first party claim for no-fault benefits including hospital and medical expenses and lost earnings, and a third party action for pain and suffering against the wrongdoing driver (for example, who rear ended the car in which the injured people were passengers) who caused the injuries.

At the Law Office of Mark A. Siesel in White Plains, New York, we have over 26 years of experience, knowledge and dedication in assisting in our clients to obtain the maximum possible benefits under the No-Fault law, which is often confusing and has many deadlines which must be followed to ensure eligibility for benefits. For example, after an accident, the injured driver, passenger, pedestrian or bicyclist must submit a form (known as an NF-2) to the No-Fault insurance company within 30 days of the accident, or run the risk of being ineligible for no-fault benefits! This is a bigger issue when the injured person is a pedestrian and likely does not the owner of the car that caused the injuries, with the possibility that due to his or her injuries, he or she was not able to obtain the no-fault insurance information to follow up for the forms.

First party benefits are paid by the insurance company for the owner of the vehicle in which the injured driver and passenger were occupants, not by the driver of the car that struck the car causing injuries. An exception to this rule is that in occurrences in which a pedestrian or bicyclist is struck by a car, both the no-fault first party claim and a third party action for pain and suffering would proceed against the negligent driver’s insurance company. Another important exception to the No-fault law is that motorcyclists are not eligible for any no-fault benefits and must submit expenses for hospital or medical bills to their health insurance or self pay.

Under the No-Fault law, drivers, passengers, pedestrians and bicyclists are eligible for up to $50,000 in “basic economic loss” for medical and hospital bills, lost earnings, and incidental expenses. Frequently, there will be an additional $25,000 in benefits (if purchased by the owner of the vehicle) for what is known as “optional basic economic loss”. Further, some people obtain full no-fault protection by purchasing a rider that allows for an additional $100,000 in PIP (personal injury protection) known as “APIP” or “additional personal injury protection.”

When the injured person incurs lost earnings, the No-Fault law provides a maximum of $2,000 per month for up to three years. To be eligible for these first party benefits, the person must submit an additional form to the insurance company, which has three parts, including sections to be completed by the treating physician and employer.

If an injured person in pursuing a pain and suffering claim in a third party action against the owner and/or driver of the car that caused injuries, the No-Fault Law requires that the injured person meet the “threshold” and have suffered a “serious injury.” Under Section 5102 of the Insurance Law of the State of New York (The No-Fault Law), a serious injury is defined as:

  1. Death;
  2. Dismemberment;
  3. Significant Disfigurement;
  4. Fracture;
  5. Loss of Fetus;
  6. Permanent Loss of Use of a Body Organ or Member;
  7. Permanent Consequential Limitation of Use of a Body Organ or Member;
  8. Significant Limitation of Use of a Body Organ Function or System;
  9. A Medically Determined Injury or Impairment of a Non-Permanent Nature Which Prevents the Inured Person From Performing Substantially All of the Material Acts Which Constitute Such Person’s Usual and Customary Activities For Not Less Than Ninety Days During the One Hundred Eighty Days Immediately Following the Occurrence of the Injury or Impairment.

It should be clear from the wording of paragraphs “g”, “h” and “I” that they are so vaguely worded and subject to interpretation that injuries which fall under these categories often result in contested claims and litigation. Due to these and many other complexities in automobile accident cases under the No-Fault Law, you require the services of seasoned, experienced and knowledgeable litigators at the Law Office of Mark A. Siesel. Contact us for your free consultation today.