What Are NY No-Fault Claims (Insurance Law § 5103 / PIP)?

New York No-Fault insurance, also known as Personal Injury Protection (PIP), provides benefits for certain accident-related medical expenses, lost earnings, and other covered costs regardless of who caused the crash. However, strict filing deadlines and coverage limits apply, and No-Fault does not compensate injured people for pain and suffering. In some cases, an injured person can pursue additional compensation from an at-fault driver.

At K L Sanchez Law Office, P.C., Queens car accident attorney Keetick L. Sanchez helps injured people understand their No-Fault benefits and address issues involving delayed or denied claims. She also helps clients determine whether they have a separate personal injury claim against an at-fault driver.

This guide explains what New York No-Fault insurance covers, how to file a claim, the deadlines you need to know, and what options you have if your benefits are denied or your losses extend beyond No-Fault coverage.

If you have questions about a No-Fault claim after a Queens car accident, contact K L Sanchez Law Office, P.C. at (646) 701-7990 for a free consultation. Keetick L. Sanchez can review your situation, explain your available benefits, and discuss your options for pursuing compensation.

What Is New York No-Fault Insurance (PIP)?

No-Fault insurance, also called Personal Injury Protection (PIP), covers basic economic loss after a motor vehicle accident regardless of who caused the crash. New York requires this coverage on qualifying motor vehicle policies under Insurance Law § 5103.

Benefits are not based on fault, so an injured person does not have to wait for a court to determine who caused the accident before seeking coverage. No-Fault pays for covered medical expenses, lost earnings, and certain other necessary expenses, up to $50,000 per eligible injured person. However, PIP does not pay for pain and suffering.

Who Is Covered Under New York’s No-Fault Law?

New York’s No-Fault law covers more than just the policyholder. Coverage extends to eligible drivers and passengers, as well as pedestrians struck by a covered motor vehicle.

Household members can also receive No-Fault protection in certain circumstances, including some accidents involving uninsured vehicles or accidents outside New York. Coverage depends on the vehicle involved and the circumstances of the accident.

Motorcycle operators and passengers are excluded from standard No-Fault benefits. However, pedestrians struck by a motorcycle or an all-terrain vehicle can qualify for first-party benefits under the applicable policy.

What Does No-Fault Insurance Pay For in New York?

New York No-Fault insurance covers basic economic losses resulting from a motor vehicle accident. These benefits include medical expenses, lost earnings, and certain reasonable and necessary expenses, subject to a $50,000 basic No-Fault limit. A separate $2,000 death benefit is available when a covered person dies from accident-related injuries.

How Are Medical Expenses Covered?

No-Fault covers reasonable and necessary medical treatment related to injuries from the accident. Covered care can include hospital treatment, surgery, physical therapy, diagnostic testing, doctor visits, and prescription medication.

Medical expenses share the $50,000 basic economic loss limit with lost earnings and other covered expenses. After those combined benefits reach the limit, basic No-Fault coverage is exhausted unless additional PIP coverage applies.

How Are Lost Wages Reimbursed?

If accident-related injuries prevent you from working, No-Fault covers 80% of lost earnings, up to $2,000 per month for up to three years from the accident date, subject to applicable statutory offsets and policy terms.

Proof of the wage loss and your inability to work is required. This can include documentation from your employer and treating physician.

Are Death Benefits Included?

Yes. If a covered person dies from accident-related injuries, No-Fault provides a $2,000 death benefit to the estate. This benefit is separate from the $50,000 basic No-Fault limit.

Key Takeaway: Basic No-Fault coverage provides up to $50,000 per eligible person for covered economic losses. A $2,000 death benefit is paid separately, while pain and suffering is not covered by No-Fault.

How Do I File a No-Fault Claim in New York?

Start by identifying the insurer responsible for the No-Fault claim and providing written notice of the accident. If you were driving or riding in a vehicle, file the claim with that vehicle’s insurer. If you were a pedestrian, file with the insurer of the vehicle that struck you. Special filing rules apply to accidents involving buses, uninsured vehicles, and hit-and-run drivers.

The next step is completing the NF-2, or “Application for Motor Vehicle No-Fault Benefits.” The form asks for information about the accident, your injuries, and any lost earnings. After receiving notice of the accident, the insurer must send the prescribed NF-2 form within five business days.

Once the claim is opened, medical providers can submit bills directly to the insurer when benefits are properly assigned. Keep copies of all forms, medical bills, and correspondence related to your claim.

What Forms and Supporting Documents Are Needed?

The documents required depend on the benefits you are claiming. Common forms and supporting records include:

• NF-2 application: Your completed application for No-Fault benefits
• Medical records and bills: Records from providers treating your accident-related injuries
• Proof of lost income: An NF-6 wage verification form completed by your employer
• Physician’s disability statement: Documentation showing that your injuries prevent you from working
• Police or accident report: A report documenting the crash, if available

What Are New York’s No-Fault Filing Deadlines?

New York’s No-Fault system has strict deadlines for reporting the accident and submitting claims for benefits. Written notice of the accident must be provided to the insurer within 30 days of the accident. This notice starts the No-Fault claim process and gives the insurer information about the crash and the people seeking benefits.

Different deadlines apply after the claim is opened. Medical bills must be submitted within 45 days after the treatment or health service is provided. Proof of lost earnings and other necessary expenses, such as transportation costs related to medical treatment, must be submitted within 90 days after the loss or expense is incurred.

Missing a deadline does not automatically end every claim. A late submission can be accepted when the claimant provides clear and reasonable justification for the delay, such as hospitalization or incapacity. However, the insurer can deny an untimely claim when sufficient justification is not provided, so keeping track of each deadline is important.

Queens Car Accident Attorney – K L Sanchez Law Office, P.C.

What If My No-Fault Claim Is Denied or Delayed?

A No-Fault insurer can deny benefits for several reasons, including missed filing deadlines, failure to attend a required Independent Medical Examination (IME), or a determination that treatment was not medically necessary. A denial does not always mean the dispute is over, and you have options to challenge the insurer’s decision.

An IME is an examination requested by the insurer to evaluate your injuries and treatment. Failing to attend a properly scheduled IME without a valid excuse can result in a denial of benefits, so it is important to respond to an IME notice and attend as required.

If your benefits are denied, you can challenge the decision through No-Fault arbitration administered by the American Arbitration Association or by filing a lawsuit against the insurer. The appropriate option depends on the reason for the denial and the circumstances of the dispute.

A delayed claim is handled differently. Benefits become overdue if the insurer does not pay them within 30 days after receiving proof of the fact and amount of the loss, although a timely request for additional verification can affect when that 30-day period begins or resumes.

Key Takeaway: A denied No-Fault claim can be challenged through arbitration or a lawsuit, while delayed benefits are subject to New York’s payment and verification rules.

When Can I Sue Beyond No-Fault?

New York’s No-Fault system limits when an injured person can pursue additional damages from an at-fault driver. Under Insurance Law § 5104, basic economic loss is covered through No-Fault rather than recovered in a lawsuit. Economic losses exceeding the basic No-Fault limit can be pursued against an at-fault driver if liability is established.

A different rule applies to non-economic damages, such as pain and suffering. To recover these damages from another covered person, your injury must meet New York’s serious-injury threshold.

What Qualifies as a “Serious Injury” Under NY Law?

Insurance Law § 5102(d) defines serious injury through specific categories, including:

• Death
• Dismemberment
• Significant disfigurement
• A fracture
• Loss of a fetus
• Permanent loss of use of a body organ, member, function, or system
• Permanent consequential limitation of use of a body organ or member
• Significant limitation of use of a body function or system

For actions and proceedings commenced on or after May 26, 2026, New York no longer includes the former 90/180-day category in the statutory definition of “serious injury.” Cases commenced before that date can be subject to the prior version of the law.

Can I Sue the At-Fault Driver Separately?

Yes. A third-party personal injury claim against an at-fault driver is separate from your No-Fault claim. You can continue receiving applicable No-Fault benefits while pursuing economic losses beyond the No-Fault limit and, if your injuries meet the serious-injury threshold, compensation for pain and suffering.

Key Takeaway: No-Fault does not prevent every lawsuit against an at-fault driver. The damages you can pursue depend on the type of loss, and pain and suffering requires a serious injury under Insurance Law § 5102(d).

Get Help With Your No-Fault Claim in Queens

A denied or delayed No-Fault claim can create added stress when medical bills and lost income are already affecting your daily life. Understanding why benefits were denied and what options you have can help you decide what to do next.

Queens car accident attorney Keetick L. Sanchez handles No-Fault disputes and serious injury claims for injured clients. At K L Sanchez Law Office, P.C., our Queens personal injury team helps with No-Fault claims, challenges wrongful denials, and pursues additional compensation when appropriate.

Call K L Sanchez Law Office, P.C. at (646) 701-7990 for a free consultation. Our Jackson Heights office at 37-06 82nd St., Suite 304 serves injured clients throughout Queens.

Frequently Asked Questions

Does No-Fault cover pain and suffering in New York?

No. No-Fault pays only basic economic loss, medical bills, lost wages, and certain expenses. To recover pain and suffering, your injury must meet the serious injury threshold under Insurance Law § 5102(d), which lets you sue the at-fault driver separately.

What is the deadline to submit medical bills under NY No-Fault?

Medical bills generally must be submitted to the insurer within 45 days of the date of treatment. Written notice of the claim itself is due within 30 days of the accident.

Can I still get No-Fault benefits if I was partially at fault?

Yes. No-Fault pays regardless of who caused the crash, which is the point of the system. Your degree of fault does not reduce your basic economic loss benefits, though an insurer may deny coverage if your own intoxication caused the accident.

What happens if my insurer denies my No-Fault claim?

You can challenge the denial through No-Fault arbitration with the American Arbitration Association or by filing a lawsuit against the insurer. An attorney can present your medical records and argue that the treatment was reasonable and necessary.

Can passengers file a No-Fault claim separately from the driver?

Yes. Passengers are covered persons and can claim benefits through the vehicle’s No-Fault policy, independent of the driver. Pedestrians struck by a covered vehicle can also file.