No Fault is No Guarantee

Michele Mirman | Personal Injury,Truck Accidents | April 30, 2019

Victims of car accidents* will be relieved to know that under New York State No-Fault Law their medical bills and lost earnings are paid by motor vehicle insurance, regardless of who is at fault. However, a quirk in the law requires that same victim to prove with particular documentation a “serious injury,” as defined by the law, before obtaining a monetary recovery for pain, suffering and injuries. So, even if an accident was entirely the other driver’s fault, that victim can end up with nothing without the correct medical tests, treatment, and records. Equally as bad, is that an injured party has a very short time—30 days—to file for benefits, after which they will not be entitled to them without a fight.

Under NYS law, you can only be reimbursed for your medical bills and lost earnings, if you timely file your no-fault application within 30 days after an accident with the correct insurance company. And you can only sue if: a) your conditions meet the “serious injury threshold” as specifically defined, and b) you provide objective medical records and diagnostic tests to verify those “serious injuries.”

No matter how much you hurt, how much you complain about pain, no matter how many days of work you miss, if you do not file the appropriate forms within the allotted time, your bills will not be covered. Moreover, if you do not provide the proper medical documents and test results, a judge will dismiss your personal injury lawsuit because of failure to prove “serious injury.”

As if surviving a car accident isn’t enough, in New York State, you may not get a dime for pain and suffering, medical bills, and lost wages unless:

1. You file for No-Fault benefits in the 30-days time you have to protect your right to reimbursement for medical treatment and payment of lost earnings. In addition, you must file for employment benefits in the proscribed manner: a doctor must fill out the disability form, sending it directly to the insurance company; the employer must fill out the wage verification form, and likewise send it directly to the insurance company, both of which must be done at regular intervals to ensure payment for lost earnings.

Not all doctors accept No Fault Insurance, so finding a good, reputable doctor nearby is challenging. Home health care is limited to $25 per day, and must be supported by invoices and a doctor’s prescription. Travel expenses must be submitted with accompanying proof of doctor visits. Further, in order to receive benefits, accident victims must submit to physical examinations by the insurance company doctors at times and dates of their choosing and be available for a hearing at a time and place also chosen by the insurance company. Failure to go can mean benefits are denied retroactively to the date of the accident. And once the doctor who works for the insurance company says that you have received maximum benefits or have recovered, all benefits stop. Finally, in the majority of cases, the amount of benefits is limited to $50,000 for employment, medical, prescriptions, transportation, and household help.

2. You get each of your injuries timely and immediately diagnosed and treated and then fully documented by your team of medical specialists. Many people stoically abide the pain and limitations, believing that the injuries will go away on their own. Others suffer, returning to work to support families and pay bills. In both events, although injured and in pain and with limitations, victims end up without the necessary medical documentation to prove they have a serious injury. When accident victims finally succumb to their injuries and get the diagnostic tests they need, which demonstrate objective problems, insurance companies concoct arguments, no matter how wrong, that the injuries are too remote or are caused by degeneration, old age, or another accident.

New York State No Fault Law applies whether your accident is with a truck, bus, private car, Uber, taxi, limousine, or other type of vehicle, and whether you were a pedestrian, driver or passenger. It applies even if you are struck by a hit and run or an uninsured vehicle and must make a claim against a household vehicle insurance policy or the Motor Vehicle Accident Indemnification Corporation, the New York State agency that provides limited coverage to the victims of hit and run and uninsured accidents. *Only motorcyclists and their passengers are exempt from this law, but they are not entitled to No Fault benefits either, including medical and wage benefits.

If you have been involved in a motor vehicle crash in New York, call us at 212-227-4000.

We have been representing the victims of motor vehicle accidents for over 40 years, helping them get the compensation and benefits they deserve. We at Mirman, Markovits & Landau, P.C., have successfully recovered more than $1billion for our clients.