New York operates under a no-fault auto insurance system, which means that after a car accident, your own insurance company pays certain benefits regardless of who was at fault. These benefits — formally called Personal Injury Protection (PIP) or “basic economic loss” benefits — are designed to provide prompt coverage for medical treatment and lost income so that accident victims do not have to wait for a lawsuit to resolve before receiving financial assistance.

Understanding what no-fault insurance covers, what it does not cover, how to file a claim, and what to do if your claim is denied is important for every driver in New York. At Siddons Law Firm, we help accident victims across Staten Island, Brooklyn, Queens, and throughout New York City navigate both the no-fault system and, when injuries are serious enough, the personal injury lawsuit process.

What New York No-Fault Insurance Covers

Under New York Insurance Law Article 51, no-fault benefits — also referred to as “first-party benefits” — provide coverage in four main categories.

Medical expenses. No-fault covers all necessary medical treatment related to the accident, up to the $50,000 policy limit. This includes emergency room visits, hospital stays, surgery, diagnostic imaging such as MRI and CT scans, physical therapy, chiropractic care, prescription medications, and durable medical equipment like braces or crutches. Treatment must be “medically necessary,” and the insurance company has the right to challenge that determination through peer review or independent medical examinations.

Lost earnings. If your injuries prevent you from working, no-fault covers 80% of your lost gross income, up to a maximum of $2,000 per month for up to three years from the date of the accident. To claim lost earnings, you will need documentation from your employer confirming your absence and your pre-accident wage level. Self-employed individuals can submit tax returns and business records to establish lost income.

Other reasonable and necessary expenses. No-fault provides up to $25 per day for expenses that are reasonable and necessary as a result of the accident. This can include transportation to medical appointments, household help if your injuries prevent you from performing normal household tasks, and similar out-of-pocket costs directly related to your recovery.

Death benefit. In the event of a fatality, no-fault provides a $2,000 death benefit to the estate of the deceased.

What No-Fault Does Not Cover

No-fault benefits are limited to economic losses. The system specifically does not cover pain and suffering, emotional distress, loss of enjoyment of life, loss of consortium, or any other non-economic damages. These categories of compensation are only available through a personal injury lawsuit, which requires meeting the “serious injury” threshold under Insurance Law §5102(d).

No-fault also does not cover property damage to your vehicle. Vehicle repair or replacement is handled through your collision coverage, the at-fault driver’s property damage liability coverage, or an out-of-pocket payment if you lack collision coverage.

Additionally, the $50,000 cap on no-fault benefits is a combined limit for all covered categories. Once your medical bills, lost wages, and other expenses reach $50,000, no-fault benefits are exhausted. If your expenses exceed this amount and your injuries do not meet the serious injury threshold for a lawsuit, you may need to rely on your own health insurance to cover additional medical costs.

How to File a No-Fault Claim in New York

Filing a no-fault claim requires completing a no-fault application, known as the NF-2 form, and submitting it to your own auto insurance company. The critical deadline is 30 days from the date of the accident. Missing this deadline can result in the loss of your no-fault benefits entirely, so it is essential to file promptly.

After submitting the NF-2 form, your insurance company must either pay the claim or issue a denial within 30 days of receiving each bill or proof of loss. If the insurance company needs more time to investigate, it must request an examination under oath (EUO) or independent medical examination (IME) within specific timeframes.

Medical providers who treat you for accident-related injuries will typically submit their bills directly to your no-fault carrier using assignment of benefits forms (NF-3 and NF-4 forms). You should confirm with each provider that they accept no-fault assignment, as this means they bill the insurance company directly rather than billing you and requiring you to seek reimbursement.

When No-Fault Claims Are Denied

Insurance companies deny no-fault claims more often than most people expect. Common reasons for denial include late filing of the NF-2 application beyond the 30-day deadline, failure to appear for a scheduled independent medical examination or examination under oath, the insurance company’s peer review doctor determining that treatment is not medically necessary, allegations that the injuries are not causally related to the accident, policy exclusions such as injuries sustained while driving under the influence, and fraud investigations triggered by patterns in billing or treatment.

If your no-fault claim is denied, you have the right to challenge the denial through New York’s no-fault arbitration system. No-fault arbitration is handled by the American Arbitration Association (AAA) under rules specific to New York no-fault disputes. An experienced attorney can represent you in this process, which is generally faster and less expensive than full litigation.

No-Fault and Your Right to Sue

No-fault benefits and personal injury lawsuits are not mutually exclusive — they operate on separate tracks. You are entitled to collect no-fault benefits from your own insurer while simultaneously pursuing a lawsuit against the at-fault driver, provided your injuries meet the serious injury threshold under §5102(d).

If your injuries do meet the threshold and you file a successful lawsuit, the at-fault driver’s insurance pays for your non-economic damages (pain and suffering, emotional distress, etc.) and any economic damages that exceed your no-fault coverage. A lien may exist for no-fault benefits already paid, depending on the circumstances, but your attorney will address this as part of the case resolution.

If your injuries do not meet the serious injury threshold, you are limited to collecting no-fault benefits only. This makes it critically important to understand the threshold early in your case and to document your injuries thoroughly from the outset.

Frequently Asked Questions

What happens if I do not have auto insurance and I am in an accident in New York?

If you do not have your own auto insurance, you can file a no-fault claim through the Motor Vehicle Accident Indemnification Corporation (MVAIC), which provides no-fault benefits to uninsured accident victims in New York. You must apply within a specific timeframe and meet certain eligibility requirements. However, driving without insurance in New York is a violation of the law and carries separate penalties.

Can my insurance company cut off my no-fault benefits?

Yes. Your insurance company can suspend or terminate benefits if their IME doctor determines that further treatment is not medically necessary, if you fail to attend a scheduled IME or EUO, or if they believe the claim involves fraud. If your benefits are cut off, you can challenge the decision through no-fault arbitration.

Does no-fault cover me if I was a pedestrian or cyclist hit by a car?

Yes. In New York, no-fault benefits extend to pedestrians and bicyclists who are struck by a motor vehicle. If you do not have your own auto insurance, you file through the insurance policy of the vehicle that hit you. If the vehicle that hit you was uninsured or unidentified (hit-and-run), you may file through MVAIC.

What if my medical bills exceed the $50,000 no-fault limit?

Once no-fault benefits are exhausted, you may need to rely on your health insurance for additional medical coverage. If your injuries meet the serious injury threshold and you file a lawsuit, you can seek to recover medical expenses beyond the $50,000 limit from the at-fault driver as part of your personal injury damages. An attorney can advise you on coordinating coverage to minimize out-of-pocket exposure.