Can I get No-Fault Insurance Benefits?



What are No-Fault Insurance Benefits?

If you are hurt in a car/truck/bus/motorcycle accident, you may be entitled to certain benefits even if the accident was your fault.   The following benefits may be claimed under No-Fault:
  1. Necessary medical expenses, including ambulance, hospital, doctor, surgical, nursing, physical therapy, dental and other medical charges for injuries caused in the car accident.
  2. Loss of wages or self employment profit of 80% of your salary or profit up to $2,000.00 per month.   You may have purchased additional No-Fault coverage which can pay you up to $4,000.00 per month.   You may be required to file for disability or workers' compensation.
  3. All other reasonable and necessary expenses generally up to $25.00 a day.
  4. Most policies cap the above amounts at $50,000.00.   You may have purchased additional No-Fault coverage which can pay up to $100,000.00 in expenses.
  5. Benefits may further reduced by payments you may be entitled to under social security and workers' compensation.
  1. The accident happened in New York.
  2. You were a driver or passenger in a car/truck/bus registered in New York.
  3. You were a driver or passenger in a car/truck/bus registered outside of New York and you were injured in New York.
  4. You were a pedestrian struck by a a car/truck/bus/motorcycle.
You should get a written copy of your auto insurance policy to see what benefits you are entitled to.

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Am I eligible for No-Fault Benefits?

You might be eligivle for no-fault benefits under several insurance policies or, if there are no insurance policies, under the Motor Vehicle Indemnification Act (MVIAC).   It is always best to file claims for No Fault benefits against all insurance policies that may be applicable and let the insurance companies determine who must pay first. Generally, you would be covered for No Fault benefits if: Drivers and passengers on motorcycles are not covered although pedestrians struck by motorcycles are covered.   If you are the driver of a vehicle and found to have an alcohol level over the legal limit, you can be denied no-fault benefits.   You do not have to be arrested, charged or found guilty of DUI or DWI in order to lose no-fault benefits for drinking and driving. 3)Policy holders of NYS Auto Insurance and their household members 4)Passengers of buses

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How do I file a No Fault claim?

No Fault portions of auto insurance policies require that accidents be reported within a relatively short period of time. Insurance companies must be notified and a specific form (NF2 Application for Motor Vehicle No Fault Benefits (XXXXplace form here)) must be filed within 30 days of your accident. Insurance companies may also look to deny you coverage, in whole or in part, if you do not file within 30 days. You are always better off sending in the NF2 Application for Motor Vehicle No Fault Benefits in certified mail and keeping copies of the application sent. If you have retained an attorney many will process this paperwork for you. There are additional rights that may be jeopardized under the policy without prompt notice to the insurance company. These rights may include the loss of the right to pursue claims under the uninsured and underinsured sections of applicable policies. After the thirty days has elapse good cause must be shown for the failure to timely file a claim.

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How do I file a No Fault claim?

How long will I receive No Fault Benefits? No Fault insurance companies can require verification of the treatment you are receiving as well as require that you submit yourself to a physical examination by a Doctor of their choosing. They may also demand an oral statement regarding the facts a circumstances surrounding the accident and your medical treatment. A claimant has a duty under the insurance policy (contract) to cooperate and submit to these inquiries. Most No Fault insurance companies will choose soon after the accident (within three (3) to six (6) months to have you examined by a Doctor of there choosing at what is claimed to be an Independent Medical Examination. Should you feel that you have been unfairly denied further medical treatment based on an “Independent Medical Examination” your remedies include: 1)File a complaint with the No Fault insurance company 2)File a complaint with the New York State Insurance Department 3)File a New York No Fault arbitration with the American Arbitration Association for bills already incurred by you but remain unpaid. 4)File a lawsuit for bills incurred by you against the No Fault Insurance Note: Once you are denied No Fault Benefits or your benefits have been exhausted a number of other factors may determine who next, if anyone, is required to pay your medical bills including private health insurance, Medicare, Medicaid, union plans,