Originally published September 27, 2021. Updated July 25, 2023.
What Does PIP Insurance Cover in New York?
In New York, it doesn’t matter who is at fault for an accident; if you were injured as a driver, your own auto insurance company is supposed to pay any medical expenses through your PIP coverage. On the other hand, if you were injured as a passenger in someone else’s vehicle, their auto insurance company should cover your medical bills.
Additionally, if a car hits you while you were walking or biking, the driver’s insurance company pays your medical bills. Other non-motorized modes of transportation, like rollerblading and skateboarding, are also covered under this category.
The minimum no-fault PIP limit for medical bills, lost wages, and other accident-related costs is $50,000 in all circumstances. Under New York’s no-fault auto insurance laws, the minimum no-fault benefits also include:
- 80% of lost earnings that can be paid up to $2,000 per month, for a maximum of three years, subject to New York State disability, workers’ compensation, and Federal Social Security offsets.
- $25 per day, up to a year after the date of the accident, to reimburse other reasonable and necessary expenses incurred because of the car crash, such as household assistance.
- A death benefit of $2,000 payable to a deceased no-fault beneficiary’s estate upon their death in a car accident.
When you have suffered major injuries that require lengthy medical treatments and time off work, your insurance provider may cap your reimbursement at $50,000. At that point, you can look at other options to help pay your medical bills.
What if My Medical Bills Are More Than PIP Covers?
Your minimum no-fault PIP benefits are not the only option for paying medical bills after your car accident. Insurance providers in the state of New York offer two additional coverage options: Additional Personal Injury Protection (APIP) and Optional Basic Economic Loss (OBEL).
- Additional PIP (APIP): Additional PIP coverage can help you boost the overall limit of no-fault compensation available in an accident to $100,000 or more, as well as covering lost wages payments. APIP can help cover more of your medical bills, lost wages, and out-of-pocket expenses.
- Optional Basic Economic Loss (OBEL): OBEL provides you with an extra $25,000 in no-fault insurance benefits that can be used for lost wages or medical bills. You can choose to have your OBEL coverage reimburse medical bills, lost wages, or a combination of both. OBEL coverage can also help with rehabilitation costs. You can only use this policy once you reach your $50,000 no-fault minimum limit.
- Other Options to Help Cover Your Bills: When you do not have APIP or OBEL coverage, you can file a claim with your regular health insurance company for coverage of your medical bills. If you are unable to work or your ability to work is impaired because of your injury, you may qualify for Federal Social Security benefits.
How to Prove Serious Injuries from a Car Accident
If you’ve suffered serious injuries in New York, you can seek compensation beyond your no-fault coverage by filing a personal injury lawsuit against the at-fault driver. However, before you can do so, you need to meet the legal threshold of a serious injury. According to New York State law, the conditions for a serious injury include:
- Significant disfigurement
- Losing a fetus
- Loss of complete use of an organ, member, function, or system
- Permanent limitation of a body part or organ’s functionality
- A significant limitation of a body system or function
- Any non-permanent medically diagnosed injury that would prevent the individual from doing their normal functions for 90 of the 180 days after suffering an injury
If you believe your injuries are serious and want to file a lawsuit against the other driver in the state of New York, contact a car accident attorney immediately. They can help you determine if your injury meets the conditions under state law and get your case in motion.
Deadlines for Filing a No-Fault Claim After a Car Accident
If you want to have your medical bills and lost wages paid by no-fault insurance, you must file a no-fault claim within 30 days of the accident. Otherwise, any benefits are denied, and the costs are your responsibility.
The New York State statute of limitations for filing a lawsuit against a negligent driver is three years in most car accident cases. If the accident involved any municipal, state, or federal entity, you have 90 days to file.
Work With a New York State Car Accident Attorney
Facing uncovered medical bills can be overwhelming, but it’s essential to take proactive steps to address the situation. Seeking legal assistance can significantly improve your chances of securing the compensation you deserve after an accident. Remember, you don’t have to face this challenge alone. At Catalano Law we are here to answer questions during this time of uncertainty and stress. Reach out today for a free consultation so our team can help you get your life back on track.