In the United States, two different auto insurance types exist. The first is a traditional insurance model, which is based on fault. The other model is no-fault insurance. New York is one of a small number of states that follows the no-fault insurance system. 

With no-fault insurance, you seek compensation from your own insurance company in the event of an accident. However, it can be difficult to understand just how the no-fault model and how personal injury protection (PIP) coverage actually works. PIP coverage is already required in New York as part of your required auto insurance, regardless of whether you have health insurance. Under the state's no-fault insurance system, all auto insurance policies must include personal injury protection (PIP) coverage, which compensates the policyholder for accident-related injuries regardless of who is at fault.

At Brandon J. Broderick, Attorney at Law, our NY car accident lawyers can assist you in understanding just how the PIP claims process in New York works and how our personal injury attorneys can assist you in recovering compensation for your injuries.

Read on to learn more about the PIP claims process below.

New York's No-Fault Insurance System Explained

In a traditional fault-based insurance model, when a person is injured in a car accident, they submit a claim with the car insurance company of the at-fault driver in order to recover compensation for their losses. New York, however, has a no-fault auto insurance system. In a no-fault system, following an accident, you file a claim from your car insurance provider, regardless of who caused the collision.

In addition to liability and uninsured motorist coverage, personal injury protection (PIP) coverage is required for vehicle registration in New York. PIP coverage compensates you for your accident-related financial losses, regardless of fault. Most fundamental no-fault auto insurance policies include:

• Death benefits
• Medical costs
• Reasonable expenses such as assistance for help at home and transportation to medical appointments
• Up to 80 percent of lost income

Personal injury protection typically pays for your medical costs until you reach the policy's limit.

Steps When Filing a New York PIP Claim

Notifying the appropriate parties, such as your insurance company and law enforcement, is the initial step in filing a claim. Regardless of the situation, it is always recommended to contact the police immediately. However, you must also remember that anyone involved in a car accident in New York is required to report the incident to the New York Department of Motor Vehicles within ten days if the damage caused exceeds $1,000 or if there were injuries or fatalities.

The sooner you report the accident to your insurance company, the better. Depending on the terms of your policy, there may be a deadline for submitting your claim. The majority of insurance providers require individuals to file a claim within thirty days of an accident. The longer you delay, the more likely it is that your claim will be scrutinized. Also, evidence could be lost if you delay.

Typically, your insurance company requires written notification of the claim. This notice typically includes the identity of the injured person and details about the accident. Remain as specific and factual as you can. Include the accident date, time, location, and circumstances surrounding the accident. Call the police, because a police report can help provide the necessary details to your insurance company.

Within five business days of receiving your notice of claim, your insurance company typically sends you an Application for Benefits and a letter. Utilize the Application for Benefits to submit your official claim. Please complete and return as soon as possible. This letter explains your rights, responsibilities, and what to do next.

Continue receiving the necessary medical care in the interim. You should seek medical attention promptly after an accident, but it is equally important to adhere to your doctor's treatment plan in the days and weeks that follow. Always inform your medical provider that your injuries were sustained in a car accident in New York. Benefits are paid according to specific fee schedules. By law, healthcare providers must take full payment according to this fee schedule.

Within 30 days of receiving a claim from a healthcare provider, insurance companies must make payment. In addition, they must provide supporting evidence of medical necessity. Failure to make required payments can result in monthly interest charges of 2% on the outstanding balance.

Denied Claims

If your no-fault claim is denied, you may have other resolution options. The initial step is to submit a complaint with the New York Department of Financial Services. Also, you can request arbitration. Arbitration is a method for resolving disputes outside of the court system. Arbitration is faster than going to court, but the results are enforceable by law. Arbitration is applicable when a portion or the entirety of your claim is denied, the insurer fails to make payments, or the insurer fails to promptly notify you of the claim's denial.

You may also be able to file a lawsuit in court to pursue the compensation you are entitled to. The best choice for you is wholly dependent on the specifics of your accident and claim.

Serious Injury Threshold

Filing a third-party liability claim against the at-fault driver to seek additional compensation beyond those covered by your no-fault benefits could also be an option. To receive compensation for non-economic losses, such as pain and suffering, you must meet New York's threshold for serious injury.

You may be eligible to file a lawsuit against a negligent or at-fault driver if you have sustained the following injuries:

• Fractures
• Significant disfigurement
• Full disability lasting at least 90 days
• Permanent disability
• Significant limitation of the use of a bodily system of body functions

Consult a Lawyer If You Were Injured in a Car Accident

If you or a loved one has been injured or killed in a car accident, you should consult with the experienced car accident attorneys from Brandon J. Broderick.

We can assess your accident, assist you in filing a PIP claim, and determine if you have any other available options.

To schedule an appointment for a free consultation, contact us today.