Auto Accidents

Frequently Asked No-Fault Questions

Q.What is No-Fault?

A. No-fault is an insurance benefit that pays where applicable, lost earnings, medical bills, prescriptions, travel expenses, and household help up to $50,000.00.

Q.Who is eligible to receive no-fault benefits?

A. Anyone who is injured in a car accident or hit by a car as a pedestrian or hurt or injured in some way by the use, operation, or maintenance of a motor vehicle. It does not apply to people on a motorcycle, but it does apply to a pedestrian struck by a motorcycle.

Q. How do I apply for no-fault benefits?

A.You or your attorney can fill out the no-fault application provided by the insurance company.

Q. How do I get my medical bills paid?

A.The no-fault insurance company will send the forms to the doctors, and hospital etc.. Most doctors will submit the bills directly to the insurance company.

Q. How do I get my lost earnings?

A. A form will be sent from the no-fault insurance company to your employer.

Q.How do I get reimbursed for: Travel Expenses? Household Care? Prescriptions? Lost Earnings?

A.You should keep copies of all receipts and a record of all travel expenses and forward them to the no-fault carrier. Important: You should put the claim number on all pieces of paper that you send the insurance company. There is a maximum of how much the insurance company will pay for household help and travel expenses.

• Travel Expenses: You will be reimbursed for the number of miles you travel to and from the doctor, physical therapists and hospitals. You should keep track of who you visited, the date, and the round trip mileage.
• Household Care: If you obtain a letter from your doctor the insurance company will pay for someone to come to clean your home and assist you. You must send the doctor's letter, and an insurance form signed by you and the person helping you to the insurance company. Insurance companies are very reluctant to pay for household help if it has been performed by a family member or spouse, parent or family member. Please discuss this with your Legal Assistant prior to making this claim with the insurance company for the exact rules surrounding this situation. Please Note: The No-fault Insurance company is only required to pay $25.00 per day for Travel Expenses and Household care combined. The No-Fault Carrier is required to make payment of Travel Expenses and/or Household care for a period of one (1) year from the date of the accident, providing of course, that the proper documentation has been mailed to the No-Fault carrier
• Prescriptions: Before you mail the copies of your prescription receipts to the no-fault carrier always write the name of the doctor who prescribed the medicine and the name of the medication on the receipt.
• Lost Earnings: There is a form that must be filled out by your employer called "Employer's Wage Verification Report". Once this has been completed you will also need a note from your doctor stating you are unable to work because of your injury from this accident. These must both be mailed to the No-fault insurance carrier. If you are receiving money from New York State Disability you should also mail a copy of one of the checks to the No-fault Insurance company as they will deduct that amount before sending you money. If your are self employed, there is a form that must be filled out called "Verification of Self-Employment Income" and you will have to mail this completed form to the No-Fault Insurance company along with copies of your previous two (2) years income tax returns. Please ask this office for assistance, if needed.

Q. How long can the insurance company take before they pay me the money they owe me?

A. The No-Fault carrier can take up to thirty (30) days from the date they receive your bill to consider payment of everything you mail to them.

Q. How long will New York State Disability pay me if I am unable to work?

A. Disability will pay you for twenty six (26) weeks (not including the 1st week you are disabled).

Q. Who will pay me for the first week I am unable to work?

A. The no-fault carrier will pay you for the first week you are disabled from working.

Q. Who will pay me if I am not able to work after the disability payments run out (after 26 weeks)?

A. The No-Fault insurance company will continue to pay lost earnings up to three (3) years from the date of the accident as long as your doctor has said that you are unable to work because of your injury from this accident.

Q. What will the No-fault insurance company pay if the injuries would result in death?

A. The No-Fault insurance company is required to pay what is called a death benefit in the amount of $2,000.00.

A. What do I have to do to get the $2,000.00 from the No-fault company?

A. You must provide the No-fault Insurance Company with a copy of the death certificate and advise them of the name of the person who has been appointed for the deceased person's estate. Your legal assistant will help you to expedite this claim.

Q. What do I do with medical bills for treatment rendered to my child as a result of this accident?

A. The parents or guardian of a child under eighteen (18) remains legally responsible for any medical bills incurred for treatment rendered to the child as a result of the accident. The bills should first be submitted to any available insurance. For example, if this is an auto accident, no-fault is responsible for the medical bills and it is the parents' obligation to forward the bills directly to no-fault. If this is not an auto accident, for example a dog bite or a fall-down, then any insurance which the parent has through his or her job is normally responsible for paying the medical bills and it is the parents' obligation to see that these medical bills are forwarded to the appropriate insurance company. Of course, if the parent is unsure where bills should be submitted, or if there is a question or problem about the payment of bills, this office remains ready to discuss the matter and to offer suggestions. It should not be assumed that the medical bills will be paid out of any funds that the child receives, whether by settlement of the claim or by verdict after trial. The general rule in New York is that a child, under the age of eighteen (18), is not responsible for his or her own medical treatment and the court is very reluctant to take money that is views as belonging to the child and use that money to pay medical bills. If, at the time of settlement, there are outstanding medical bills, it is possible that this might delay the final settlement of the lawsuit. It is therefore always best that the parent submit the medical bills to any insurance which is available as those medical bills come due so that the child can continue to receive medical treatment. MEDICAL BILLS SHOULD BE SUBMITTED AS SOON AS RECEIVED. FAILURE TO DO SO COULD LEAD TO NON-PAYMENT BY THE HEALTH INSURANCE CARRIER FOR FAILURE TO MEET TIME LIMITS. For your knowledge: * No-Fault will pay eighty (80%) percent of your gross wages in conjunction with any disability payment. * Most no-fault policies only pay up to a maximum of $2,000.00 per month, you must again deduct any money paid to you by disability. * No-fault is required to pay your lost wages up to three (3) years form the date of the accident. There are certain restrictions that apply. * If your earnings are higher than what no-fault allows please advise this office.

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Do's and Don'ts of No Fault Cases

Do's

• You must file a New York State Disability form with your employer's disability carrier within twenty (20) days of the date of your accident or the date you become disabled as a result of the accident. If you do NOT do this, you may LOSE a portion or all of your disability benefits. If you were in the course of your employment when this accident happened, you must apply for Workmen's Compensation Benefits through your employer. The Workmen's Compensation carrier will pay you a portion of your earnings and the No-Fault carrier will pay you a portion totaling eighty percent (80%) of your gross earnings.
• When you receive papers from Workmen's Compensation you must give a copy to your lawyer.
• Always forward copies of all correspondence, letters, bills, etc. to your lawyer for your file records.
• Always keep copies of the bills, lost wages forms, mileage statements, etc., that you mail to the No-Fault Insurance company.
• Always write the date you mail the bills to the No-Fault carrier on your cover letter.
• Keep your attorney up-to-date on any new doctor or hospital visits or if you have any type of testing done.
• Always make copies of all checks received from the No-Fault carrier or any other source prior to cashing them.
• Obtain a disability note from your doctor as soon as he/she tells you that you cannot work or if you need Household Care/Help.

Don'ts

• Don't discuss your case or injury with anyone. You should refer them to your attorney to discuss your case or injury.
• Don't sign anything for anyone without first showing it to your lawyers.
• Don't leave the New York State Disability form with your doctor or your employer as you only have twenty (20) days from the date of your accident or the date you become unable to work to send the form to your employer's insurance company.