Up to this time in our series of articles on New York State's No-Fault Law, we have discussed the general outline of the law and its main components.  In this article we begin to discuss how no-fault claims are required to be processed.  A no-fault claim starts — like most all insurance claims — with an application.  Insurance companies may have different forms, but they all request the same type of information.  You will need to give basic information about the happening of your accident and your injuries.  It is critical that you obtain the proper form and file the application within thirty (30) days of your accident.  Late filing can lead to denial of the entire no-fault claim.  Obtaining the proper form can be more difficult than it seems.  If you are a passenger in another person's vehicle, pedestrian, or bicyclist, you may not even know who insures the automobile.  Moreover, if you are seriously injured, you may not even be in a position to discover this information.  You, or someone on your behalf, may have to contact a lawyer at this early stage for help.  An experienced law firm should be able to quickly obtain the proper information and assist you in completing your application. 

After the application is filed with the insurance company, the company will open the claim and assign a claim number.  This number will be on all further correspondence, bills, and documents pertaining to your claim.  More important, you will be required to give this claim number to any and all physicians and/or healthcare providers that treat you so that they can bill the no-fault company — not you.

The no-fault insurance company is required to pay the following benefits, which are also referred to as basic economic loss:

a.   All necessary doctor and hospital bills and other health service expenses, payable in accordance with fee schedules established by the New York State Insurance Department;

b.  Eighty percent (80%) of lost wages up to a maximum monthly payment of $2,000 for up to three (3) years following the date of the accident;

c.  Up to $25.00 per day for a period of one (1) year from the date of the accident for other reasonable and necessary expenses the injured person may have incurred because of an injury resulting from the accident, such as the cost of hiring a housekeeper or necessary transportation expenses to and from a health service provider;

d.  A $2,000 death benefit, payable to the estate of a covered person, in addition to the $50,000 coverage for basic no-fault losses.

In situations where the New York State mandatory minimum of $50,000 in no-fault benefits is available, the insurance company is only required to pay benefits up to that limit.  After the $50,000 limit is exhausted, the insurance company has no further responsibility to you and other sources — like private health or disability insurance — must take over.

According to New York Law, all insurance companies are required to treat your claim in a fair and prompt manner.  Under certain circumstances, however, all or a portion of your claim can be denied.  The insurance company must follow specific guidelines before denying your claim.  If all or any portion of your claim is denied, the insurance company is required to promptly notify you in writing of the denial and give you reasons.  You have a right to challenge that denial.  The insurance company does not have the last word.  Future articles will discuss how to challenge a no-fault denial.