Filing a No-Fault Claim

If you are hurt in a car accident, you must notify the No-Fault insurer in writing as soon as it is practical, but in no case later than 30 days after the accident—unless you can provide written documentation that demonstrates a valid reason for the delay. This notice of claim must identify the injured person or persons and include information that is reasonably obtainable about the date, time, and circumstances of the accident.

In general, if the accident happened in the state of New York, you should file your No-Fault claim with the insurance company of the car you were driving at the time of the accident or, if you were a pedestrian, with the insurance company of the car that hit you. File a claim with your own insurance company if the accident happened outside of New York State and you were driving a different car.

Your auto insurance coverage or the auto insurance of a member of your family would pay your no-fault payments if you were hurt in a car accident while riding a bus. The bus’s insurer would pay your no-fault benefits if you or a member of your household lacked vehicle insurance.

You should make your claim for No-Fault compensation with the MOTOR Car ACCIDENT INDEMNIFICATION CORPORATION if you (or a relative with whom you reside) are hurt by or while in an uninsured vehicle, by a hit-and-run driver, or while riding in a hit-and-run vehicle and do not have auto insurance (MVAIC). The appropriate authority must be notified of the accident within 24 hours.

The insurer (or MVAIC) is expected to give you an Application for Benefits (NF-2) and a letter outlining the No-Fault coverage options, as well as your rights and obligations, within five business days of receiving this notice of claim. As soon as you get the Application for Benefits form, fill it out and send it back.

In the event that you require medical attention, you have two options: (1) pay the physician or hospital directly and submit your receipts or bills to the insurance company for reimbursement; or (2) permit the physician or hospital to submit their bills to the No-Fault insurer for payment.

No-Fault benefits are paid in line with established fee schedules, which the medical practitioner must accept as full payment under the terms of the law. It is crucial that you let the medical professional know that you are receiving care for injuries sustained in an auto accident. The insurer is expected to make payment within 30 days of receiving your healthcare provider’s claim with accompanying documentation of medical necessity or your employer’s (or self-employed) notice of missed wages, unless extra verification is necessary.

If an insurer fails to pay a No-Fault claim on time, it is obligated to pay 2% interest per month on the outstanding sums as well as any reasonable legal costs you may have spent (in compliance with Insurance regulations) to recover your unpaid No-Fault benefits.

You can: (1) register a complaint with the Department of Financial Services, as described later in this Guide; (2) request No-Fault arbitration; or (3) file a lawsuit in court if all or a portion of your No-Fault benefits are delayed or refused. If the insurer rejects your claim entirely or in part, fails to pay benefits due on schedule, or fails to notify you promptly if your claim has been rejected, you may ask for no-fault arbitration.

It is the goal of the no-fault arbitration process to settle conflicts as quickly as feasible. The arbitrator’s decision is final and enforceable against all parties (unless appealed under certain strict circumstances). See Chapter XIV for a thorough explanation of how to submit a request for no-fault arbitration.

Filing a Physical Damage Claim

If your automobile is damaged or stolen and you have auto collision or comprehensive insurance coverage, your insurance company is required to give you a fast and reasonable compensation for the damages incurred or the car’s real cash value, whichever is lesser. Your insurance is responsible for covering the costs of the towing, any reasonable storage fees, and alternative transportation costs if your automobile is stolen and later found.

NY Regulation 64 aims to ensure that your insurance provider will make a fast and equitable settlement. This rule outlines the procedures and deadlines that an insurer must follow when handling your claims for vehicle collision and comprehensive coverage as well as any property damage liability claims you may have against other drivers.

In response to a claim made under your policy’s comprehensive or collision coverage, your vehicle insurer is required by these legal requirements to:

• If your car is accessible for examination, we will assess the damaged vehicle and submit a good faith offer within six business days of receiving notification of the loss. A good faith offer must be supported by the name of a DMV-registered repair facility that will carry out the requested repairs;
• Provide a thorough written estimate of the cost of the repairs to you or an authorized representative;
• Identify an easily accessible auto repair shop that will fix your car at the insurance company’s estimated cost of repair and provide you with a written guarantee of the work done, backed by your insurer; however, you retain the right, in accordance with the Insurance Law, to select the shop that will fix your damaged vehicle;
• If your car is a total loss due to theft or damage beyond repair, pay the real cash value (retail value + sales tax), which is subject to depreciation and applicable deductions, or replace it with a substantially similar car, in compliance with controlling regulatory criteria;
• Within five (5) business days after the signing of the settlement agreement.
• If your claim hasn’t been resolved within 30 days of the date you notified the insurer of the loss, provide you with a written explanation of the reasons for the delay.

Most insurance companies will cover your automobile rental costs up to the policy limit if your vehicle is stolen. When your automobile cannot be driven due to a covered collision or comprehensive loss, other than theft, some auto insurers may offer a policy with “optional rental car reimbursement coverage” that also covers these costs.

Your insurance company must get a “Certification of Automobile Repairs” form from you and your auto body repair business in order to assess the amount of your damaged car’s repairs in relation to collision and other physical damage claims. Your loss payment for a future loss can be less if you don’t turn in this form. Additionally, if an airbag was stolen or discharged as part of a loss, a replacement airbag must be installed. (The insurer has the authority to determine whether the airbag was stolen or deployed and to seize an airbag that has been deployed.)

• Report the collision, ideally there on the spot.
• Find a copy of the police report online or at the precinct.
• To all persons who may be liable, mail a notice of claim by certified mail.
• Ask the DMV for information regarding drivers (preferably immediately after the crash to meet the deadline for filing a notice of claim)

For hit-and-run and uninsured crashes:

• Within 24 hours, or as soon as feasible, report a hit-and-run collision to the police. www.cortho.org/no-fault-car-insurance/report-hit-run-crash
• Residents of NYS may submit a claim to MVAIC for medical services under the No-Fault system.
• You can submit an application to MVAIC if the insurer rejected your No-Fault claim.

For liability claims

• Although addressed here (link), liability claims (for personal injury and property damage) are outside the purview of this website. www.cortho.org/no-fault-car-insurance/accident-types

Notify all potentially responsible parties

You must give notice to anybody who might be liable in order to maintain your ability to submit an insurance claim. For a No-Fault claim and for the majority of private insurers, you must provide written notice within 30 days. (MVAIC has different deadlines; see below.)

Take this vital action to safeguard yourself in case you do require medical attention, either now or in the future, after reporting the collision. If it turns out that you didn’t require medical attention, you are not required to submit the claim (request for payment).

Giving notice typically entails writing a brief letter to the car owner’s insurance company. According to this Nolo Press page, all you need to mention in your letter to the parties is that there was an accident at a specific time and location, that you were hurt, and that you plan to make a claim. At this point, you are exempt from disclosing the amount of the damage or the scope of the harm. Give only the information that is required.

In case the insurance later claims they never received your letter, send the notice via certified mail and obtain a registered receipt. Avoid using email. According to my interviews, insurers seem to commonly misplace their correspondence.

A code that designates the driver’s insurance provider will be listed in your police accident report. The codes are listed here by the state insurance department. (link) Know the specifications and timeframes for submitting a claim. To avoid being rejected on a technicality, be aware of your rights and the norms in the insurance sector. Chapter 3 of How to Win Your Personal Injury Case by Nolo Press provides a helpful basic overview if you decide to file a lawsuit for a significant injury.

In New York City, there are an overwhelming number of both public and private entities engaged in every single auto accident. Be neither disheartened nor terrified. According to Portland-based bike attorney and author Bob Mionske, someone can be found to cover your costs somewhere in the jumble that is auto insurance.

Who might be responsible?

In any given situation, several insurers may be seen as responsible for damages. You might also need to inform your own house or auto insurance provider. To be safe, identify anyone who might be responsible and send a letter of notice to each of them.

In general, responsibility for automobile personal injury claims falls to one of the following parties, in rough order of priority:

1. Car owner’s (driver’s) personal insurance company.
2. The driver’s employer’s insurer.
3. Worker’s compensation (if a crash victim works for a covered employer).
4. State of New York Disability Insurance (if a crash victim works for a covered employer, but was off the job when struck).
5. Auto or house insurance for the accident victim; Medicare and Medicaid.
6. Corporation for Motor Vehicle Accident Indemnification (MVAIC).The MVAIC is New York’s insurer of last choice and is a nonprofit organization supported by the insurance industry. It offers payments to crash victims of uninsured or hit-and-run drivers who lack other household coverage as well as to victims whose claims have been rejected by an insurer.