No-Fault Benefits-Personal Injury Protection (PIP)

No-Fault, also called Personal Injury Protection (PIP), is designed to pay promptly, regardless of who is at fault or whether there was any negligence, for economic losses (meaning medical/health expenses, lost earnings, and certain other reasonable and necessary expenses related to injuries sustained), up to $50,000 per person ("basic No-Fault coverage"), to the driver and all passengers injured in your car as well as any pedestrians injured by your car, because of its use or operation in New York State.

The purpose of No-Fault insurance is to restore individuals hurt in auto accidents to health and productivity as swiftly as possible. Because of New York's No-Fault law, lawsuits due to auto accidents can be brought only for economic losses that exceed No-Fault benefits and for non-economic damages (such as pain and suffering) only if a "serious injury" (as defined in the Insurance Law) is sustained.

No-Fault is a personal injury coverage and does not pay for auto body repair of your car or damage to any other party's motor vehicle or other personal property. No-Fault is also primary to health insurance, which means it pays first in the event injury is due to an auto accident.

Under this coverage, your insurer provides you and all relatives who reside in your household with protection against economic losses arising from injuries sustained in motor vehicle accidents anywhere within the United States, its territories and possessions, or Canada. It also provides coverage for any passengers injured in accidents in New York State while in your vehicle, as well as any guest passengers who are New York State residents injured in your vehicle anywhere in the United States, its territories and possessions, or Canada, if they are not covered under another auto insurance policy in New York State.

All pedestrians injured by motor vehicles in New York State are also protected by No-Fault.

Basic No-Fault auto insurance coverage includes:

• reasonable and necessary accident related medical and rehabilitation expenses (in accordance with established fee schedules);
• 80% of lost earnings from work, up to a maximum payment of $2,000 per month for up to three years from the date of the accident; subject to statutory offsets for New York State disability, Worker's Compensation and Federal Social Security disability benefits.
• up to $25 a day, for up to a year from the date of the accident, to reimburse other reasonable and necessary expenses, (e.g., household help, and transportation expenses to/from medical treatment) resulting from the auto accident; and
• a $2,000 death benefit (in addition to the $50,000 basic No-Fault limit), payable to the estate of a person eligible for No-Fault benefits who is killed in a motor vehicle accident.

However, under most insurance policies, a person will be ineligible for No-Fault benefits, if:

• driving while intoxicated or impaired by use of a drug that contributes to the accident, except for emergency health related services performed in a general hospital or by an ambulance worker outside of a general hospital. However, the No-Fault insurer has the right to recover from the intoxicated or impaired driver the full amount of those No-Fault payments made by the automobile insurer for the emergency services provided to the driver if the driver is convicted of driving while intoxicated or impaired through the use of alcohol or drugs.
• intentionally causing his or her own injuries;
• riding an all terrain vehicle (ATV) or a motorcycle as operator or passenger (a pedestrian struck by a motorcycle or ATV is covered);
• injured while committing a felony;
• injured while in a vehicle known to be stolen; or
• an owner of an uninsured vehicle.

Liability Insurance-Bodily Injury & Property Damage

This liability coverage protects you (and anyone driving your car with your permission), if a claim is made against you by another person (“third-party”), alleging that you were negligent or otherwise at fault. Thus this coverage will make payments on your behalf to that injured third-party, in the event your car is involved in an accident that results in serious injury or death to others or damage to their property.

In addition, your insurance company must provide you with a legal defense against such claims, without reducing your policy's liability limits.

The minimum limits of third-party bodily injury liability coverage mandated by New York's Vehicle and Traffic Law are:

• $25,000 for bodily injury (not resulting in death), or $50,000 for any injury resulting in death, sustained by any one person in any one accident;
• $50,000 for bodily injury (not resulting in death) sustained by two or more persons in any one accident, or $100,000 for any injuries resulting in death sustained by two or more persons in any one accident (subject to the above per person limits).

Since the minimum limit of coverage required by law for property damage liability protection, for damage to another party's car or property, is $10,000 per accident, these minimum liability limits in New York are sometimes together referred to as “$25,000/$50,000/$10,000” or “25/50/10”.

If, however, your vehicle is used or operated in another state or Canadian province that requires higher liability limits than the above New York mandated limits or what is purchased, your policy will provide coverage for those limits required by such other jurisdiction.

If you are injured in an auto accident, or your car is damaged, due to someone else's negligence, you may be able to make a claim against that other person's auto insurance policy for bodily injury and property damage liability. You must establish that the other party was at fault. You have a right to sue another party involved in the auto accident for pain and suffering, only if you sustained a “serious injury” as defined in the Insurance Law. You can also go to court against a third party for property damage and, when bodily injury has been sustained, for other economic loss not covered by, or exceeding the limits of, your No-Fault coverage.

Suing another party would be your own personal action, and does not involve your insurance company under the provisions of your policy. If you decide to sue someone else, your insurer under your own policy is not required to provide or pay for a lawyer you might want or need to handle your claim against another party.

While your automobile liability insurance policy provides coverage for every passenger in your vehicle injured in an accident caused by the driver's negligence, it will most likely not provide any liability coverage when the injured passenger is your spouse unless you purchase Supplemental Spousal Liability Insurance. However, your spouse would still be eligible for basic No-Fault coverage as discussed earlier. When shopping for insurance, please check with your insurance company, agent or broker about whether your policy affords bodily injury liability coverage to your spouse.

Uninsured Motorists Coverage

Another important feature of your auto insurance policy is bodily injury protection for you, all family members who reside in your household, and occupants of your car, in the event you or they are injured as the result of negligent actions by an uninsured vehicle or hit-and-run motorist. This mandatory coverage applies only in regard to bodily injury due to accidents occurring in New York State, and does not cover auto body damage to your car or damage to other property.

For New York accidents, the amount of uninsured motorists protection required to be provided is the same minimum bodily injury limits as required for liability insurance. For a small additional charge, this uninsured motorists coverage can be extended to provide coverage for out-of-state accidents by endorsement, so you should check with your agent, broker or insurer if you want this extension of coverage.

If anyone in your car is injured by the driver of an uninsured vehicle or a hit-and-run motorist, a claim should be filed with your auto insurance company under this coverage. Similarly, you should file a claim with your automobile insurer if you or a member of your family is injured while unknowingly occupying an uninsured vehicle, or injured as a pedestrian by an uninsured or hit-and-run motorist. If you do not own a car, but a relative in your household does, you may file a claim under that policy.

If you don't have your own policy and are not covered by a family member's policy in your household and if you are injured as a pedestrian by an uninsured vehicle or hit-and-run driver or as an occupant of an uninsured vehicle in New York State, you may still be eligible for uninsured motorists protection and No-Fault coverage. You or your representative should immediately report the accident to proper authorities, and then promptly (because there are stringent time limits) file a claim with the Motor Vehicle Accident Indemnification Corporation (MVAIC), located at 110 William Street, 19th Floor, New York, New York 10038 (Tel: 646-205-7800) (Fax: 212-732-1826). Additional information on the MVAIC website.