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No-Fault Car Insurance and Claims, New York

Posted on: August 13, 2015

No Fault ClaimsNew York is a No Fault Insurance state.  It is important that owners and operators of vehicles be aware of the ramifications of the No Fault Law.

Consider this example:

You’re stopped at a red light and another vehicle hits you from behind, causing you to be injured.  You’ve done nothing wrong, and the other driver is 100% responsible for the accident.  There are two issues.  First, who pays your medical bills, and second, can you sue the owner and operator of the vehicle that hit you?

Part I – Paying for Medical Bills and Lost Wages.

Even though the other driver was at fault, your own insurance company pays your medical bills, and in some instances, at least some of your lost earnings.  It doesn’t matter that you were in no way responsible for the accident; your own auto insurance company still pays.  There are actually several different facets to your automobile insurance policy; your medical bills are paid under the section labeled “Personal Injury Protection” (known as “PIP”).  The law provides a very limited amount of time to apply for these benefits paid by your own company; you are required to apply within 30 days of the date of accident.  Therefore, it is crucial that you call your insurance company immediately, or at least as soon as you are physically able to do so.  While some companies may forgive a breach of the 30 day limit, there are others which will deny coverage on a late claim.

Most companies will eventually send you for what is called an “Independent” Medical Examination (known in the trade as an “IME”), with a doctor paid for by the insurance company.  The question of just how independent that “Independent Medical Examination” might be is a different issue.  Just make sure you attend that medical appointment, because if you fail to attend, the company has the right to deny the claim, not just from the date of the missed examination, but from the date of accident.  That means that your insurance company will no longer be responsible to pay for any of your bills at all.

Part II – Can You Sue the At-Fault Owner and Operator?

While the owner and operator at fault for the accident are not responsible to pay your medical bills, you can still sue that owner and operator for pain and suffering, but only if you have sustained a “Serious Injury”.  The term “Serious Injury” is defined in the New York Insurance Law, and several different types of injuries meet the definition.  As one example, any fracture, regardless of the type and treatment required, is by definition a “Serious Injury”.  While tendon and ligament tears and disc herniations do not meet the “Serious Injury” definition in and of themselves, that type of injury – known as a “soft tissue” injury – can often qualify to meet the definition.  The truth is that in many cases, a so called “soft tissue” injury is far more serious than a fracture.  Soft tissue injuries can be permanent, or at least long lasting, requiring surgical procedures, and lengthy rehabilitation periods.

There is a significant exception to what we just explained above.  No Fault Personal Injury Protection insurance coverage is not available if you are riding a motorcycle; if you are injured while riding a motorcycle, your own medical insurance will cover your medical bills; (if you are without medical insurance, your will have to sue the owner and operator of the at-fault vehicle to recover your medical bills).  At the same time however, if you are injured on a motorcycle, you do not have to prove that you have suffered a “Serious Injury” in order to sue the owner and operator of the offending vehicle.

You should also be aware that if the owner and operator are two different people that reside in different households, the driver may have his or her own insurance to cover the accident, separate and apart from the owner’s insurance.  Finally, depending upon your own policy, coverage may be available under your own policy for what is known as underinsurance.

Contact the Attorneys of Worby Groner Edelman, LLP

The law involving automobile accidents, and the insurance issues that accompany it is a complicated area, with many traps for the unwary.  The White Plains injury attorneys at Worby Groner Edelman have years of experience in representing clients involved in automobile accidents.  We’ll deal with your insurance company, and the insurance company(s) for the owner and operator that were at fault for the accident.  We’ll determine exactly how much insurance coverage is available, no matter the source.  We’ll answer all of your questions, and make sure that all filing deadlines are met.  There’s never a fee unless we recover money on your case.

 

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