After a car accident, the laws of the state in which the accident occurred determine which party pays for the damages. Generally, in a “no-fault” insurance coverage state, a declaration of fault is not put on either party, and each driver files a claim with his or her own insurance provider.
New York is one of many U.S. states that have some type of no-fault insurance law. In the State of New York, any person injured in a motor vehicle accident is entitled to make a claim for the insurance company of the vehicle they were in to receive compensation. This coverage is known as Personal Injury Protection (PIP), and it must pay for certain medical expenses and lost wages. Pedestrians and cyclists who are hit by a motor vehicle are also entitled to bring a claim for no-fault benefits against the insurance carrier of the driver who hit them.
At The Law Office of Carl Maltese, we focus only on personal injury, negligence, and accident cases, and we’ve helped countless Long Islanders successfully file Suffolk County no-fault claims after being injured in car accidents. If you think you may be eligible for a Suffolk County no-fault claim, contact us today to schedule a free consultation.
Understanding No-Fault Insurance Claims
The individual results vary by circumstances, but a few basic facts about the process apply to all no-fault insurance claims in the State of New York:
The no-fault insurance company will pay drivers, passengers, pedestrians, and cyclists up to $50,000 for medical treatment, lost wages, and other expenses.
The application for no-fault insurance benefits needs to be filed with the insurance company within 30 days after the accident.
No-fault insurance does not cover property damage, such as damage to a vehicle, nor does it cover non-economic damages like pain and suffering.
While no-fault benefits are generally available to all individuals injured in a car, bus, or truck accident, there are some exceptions to keep in mind. In New York, no-fault protection will not apply in the following circumstances:
If the injuries occurred due to a deliberate act
If the accident was the outcome of the injured individual’s use of alcohol or drugs
If the injured individual was committing a felony while the accident happened
If the hurt individual was operating or riding on a motorcycle
If the hurt individual or his/her spouse was behind the wheel of an uninsured automobile
No-fault law is often misunderstood, but The Law Office of Carl Maltese makes it simple. If you have been injured in a car accident, you should get in touch with a skilled Long Island car accident attorney from our firm to identify how New York’s no-fault laws might impact your right to recuperate damages.
Benefits Provided by the Carrier in No-Fault Accident Claims
After an accident, certain financial benefits may be afforded to you by the no-fault insurance carrier, depending on the extent of your injuries and the assistance you require to make a full recovery.
While speaking to a lawyer is the best way to accurately calculate your damages and estimate the benefits you may receive, some potential benefits of no-fault accident claims include the following:
The no-fault insurance carrier will pay for all of your accident-related medical treatments, including hospital and doctor’s visits, diagnostic testing, therapy, rehabilitation, and other healthcare costs up to statutory limits.
If you are unable to work as a result of injuries sustained in the accident, the no-fault insurance carrier will reimburse you for lost wages. If you are entitled to short-term disability coverage from your employer, your employer’s short-term disability insurance carrier will pay you after the first week at a rate of half your gross salary to a maximum of $175.00 per week for 26 weeks. After that, the no-fault insurance carrier will pay 80% of your salary up to $2,000 per month with a set-off for what you are entitled to receive from the short-term disability carrier.
No-fault coverage allows you to receive reimbursement of your transportation expenses to and from medical providers with a maximum of $25.00 per day for a period of up to one year from the date of the accident. If you are driving yourself to medical providers, the no-fault carrier will reimburse you based upon the number of miles you travel.
If you are unable to perform your usual household duties and must hire someone to help you, the no-fault insurance carrier will reimburse you a maximum of $25.00 per day for a period of up to one year from the date of the accident.
How are no-fault benefits applied, though? Since New York is a no-fault coverage state, you are required to carry personal injury protection (PIP) on your policy. If you are involved in a motor vehicle accident, you’ll submit a claim through your own insurance company. PIP will then cover your damages according to your policy’s limits.
Subrogation of No-Fault Claims
After the PIP benefits have been paid, a car insurance company has the right to pursue repayment of any additional benefits by taking legal action on behalf of the insured against the person who caused injury. Known as subrogation, this is the insurance provider’s right to seek compensation for paying the insured’s losses, and the insured signs this right over to the insurer when they purchase a policy.
If you get a subrogation letter from the insurance provider of the other involved party, a personal injury lawyer can help you explore your options. Insurance providers are quick to take advantage of those in need, but consulting with an accident lawyer can help ensure that you do not sabotage your claim or lose on the payment you need to gain closure and begin your recovery.
Subrogation does not occur until the settlement has already been paid. Drivers generally do not need to handle subrogation; instead, it’s handled between the insurance providers. However, when deciding to pursue subrogation, the insurance provider needs to notify you of the decision to continue.
It’s important to keep in mind that if the insured takes legal action against the other party themselves and wins additional compensation, he or she will more than likely owe their insurer back what was paid in benefits through the PIP given that the settlement or decision indicates that the insurance provider lost the right of subrogation. Because of this, it’s always wise to discuss your situation with a Suffolk County car accident lawyer prior to making any decisions.
Filing a Lawsuit Outside of the No-Fault Benefits
Keep in mind that a no-fault claim is separate and distinct from your personal injury claim. Even if they make a no-fault claim, an injured person can still seek compensation for their pain and suffering and additional economic damages from the at-fault party.
However, in order to take legal action against and gather payment beyond the no-fault advantages, an injured individual must have sustained a “serious injury” under New York State Insurance Law. This limit is referred to as the threshold law.
New York State Insurance Law specifies 7 defining requirements for a serious injury. These include:
Personal injury which results in wrongful death.
Dismemberment; significant disfigurement.
Loss of a fetus.
Permanent loss of use of a body organ, member, function or system.
Permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system.
A medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.
What does this mean for you? If you sustained an injury in an accident and wish to gather damages beyond the no-fault limit, you should be able to show that your injuries satisfy the threshold law and establish that the other driver was at fault for the mishap. An attorney like those at The Law Office of Carl Maltese can help build a strong case in your favor so you can obtain the compensation and closure you deserve. At this law firm, you can also seek the legal assistance of a nursing home abuse lawyer in Smithtown if you or a loved one is suffering from elderly abuse.
Working With a Long Island No-Fault Lawyer
Handling a no-fault claim is a complex process to take on alone. The no-fault insurance carrier often takes an adversarial position when it comes to paying medical bills and lost wages, and many deadlines must be observed and forms completed. Failing to comply with even a single requirement may invalidate your rights to collect benefits. It’s essential to have a Smithtown auto accident law firm that routinely handles these matters on your side to help you ensure that your medical bills are paid and your lost wages are reimbursed.
The Law Office of Carl Maltese has been assisting clients with their no-fault claims since New York enacted the no-fault law in 1974, so we know how to navigate the process on your behalf and help you receive full and fair compensation. We’re also prepared to file a separate claim on your behalf if your damages extend beyond the limits of New York’s no-fault law.
Our law firm offers free, no-obligation consultations to help you explore your options and determine the best course of action. If we identify that your case satisfies the requirements to seek additional payment, our experts will help prove who was at fault for the mishap, and we will work hard to make certain that you have the appropriate medical tests and that your treatment is documented in detail to hold up in court.
Remember, a no-fault claim must be filed within thirty days of the accident. If you need legal assistance with a Suffolk County no-fault claim or even a Smithtown defective products lawyer, contact us online or by phone at (631) 496-1714 today to schedule a free consultation.