After an accident, most people feel extremely stressed out. Between the pain, missed work, and confusing paperwork, it’s hard to know where to begin. That’s where New York’s no-fault insurance steps in. It’s designed to cover basic accident-related costs quickly, without pointing fingers. But the rules aren’t always clear.
This guide breaks down what personal injury protection pays for, what deadlines you must meet, and when the law lets you step outside the no-fault system to file a lawsuit. If you’re hurting and overwhelmed, knowing your options can help take that stress off your shoulders.
What PIP Covers in New York
New York’s no-fault law requires every registered vehicle to carry personal injury protection coverage. This covers up to $50,000 in basic economic losses per person, regardless of who caused the crash, whether you hire a Rochester car accident lawyer, or handling the filings yourself.
Here’s what that includes:
- Medical treatment: PIP pays for reasonable and necessary medical care related to the crash.
- Lost income: If the injury keeps you from working, you can recover 80% of your wages (capped at $2,000 per month) for up to three years.
- Household help and other services: You’re entitled to up to $25 per day for a year to cover help with everyday tasks, transportation to appointments, and other essential services.
Optional add-ons like OBEL (Optional Basic Economic Loss) can extend coverage beyond the base $50,000. If you bought it, OBEL may kick in once basic PIP runs out, covering things like rehabilitation or psychiatric care.
It’s important to know: motorcyclists aren’t considered “covered persons” under no-fault. That means they don’t get PIP benefits. But pedestrians struck by motorcycles might still qualify.
The Must-Hit Deadlines That Protect Your Benefits
No-fault coverage sounds automatic—but it isn’t. You must act fast and follow strict rules, or the insurance company can deny your claim.
These are the key deadlines:
- Within 30 days: You must give the insurance company written notice of the accident. This is often done using the NF-2 form, but the key is timely notice, even if the form follows later.
- Within 45 days: Medical providers must submit bills within 45 days of service. Late billing can get denied.
- Within 90 days: To claim lost wages, you must submit proof, including an NF-6 form from your employer and verification from a doctor, within 90 days of your first missed day at work.
In rare cases, insurers will accept late submissions if you show a valid reason like being hospitalized or incapacitated. But don’t count on leniency. Late paperwork almost always creates headaches.
When PIP Runs Out or Doesn’t Fit: Stepping Beyond No-Fault
If your economic losses go over $50,000, you may be able to pursue compensation beyond what no-fault covers. That includes uncovered medical bills, additional wage loss, and other out-of-pocket expenses.
You can also sue for pain and suffering, but only if your injury meets New York’s “serious injury” threshold under Insurance Law §5102(d). Here are the qualifying categories:
- Death
- Dismemberment
- Significant disfigurement
- Fracture
- Loss of a fetus
- Permanent loss of use of a body organ, member, function, or system
- Permanent consequential limitation of use
- Significant limitation of use
- A medically determined injury or impairment that prevents you from performing your usual daily activities for at least 90 of the 180 days following the accident
Without one of these, you can’t file a pain-and-suffering lawsuit—even if the crash disrupted your life.
Plain-English Examples
Let’s bring these rules to life with a few real-world scenarios:
- Example 1 (no lawsuit): You strain your neck and back in a rear-end crash. You rack up $12,000 in medical bills and miss two weeks of work. PIP covers all your losses, and you don’t meet the serious injury threshold. No lawsuit allowed.
- Example 2 (lawsuit likely): You break your tibia and need surgery. You’re stuck on crutches for months. A fracture automatically qualifies as a serious injury. You can sue for pain and suffering.
- Example 3 (PIP exhausted): You require long-term rehab and miss ten months of work. Your total economic losses hit $68,000. Since PIP only pays up to $50,000, you can pursue the remaining $18,000, but only if you also meet the serious injury threshold.
How to File Your No-Fault Claim the Right Way (Step-by-Step)
Follow these five steps to protect your benefits:
- Find the correct insurer. If you were driving, it’s your own. If you were a pedestrian, it’s the vehicle owner’s.
- Send written notice within 30 days. This usually means filing the NF-2 form. Always get proof of delivery.
- Share your claim number. Every medical provider must include it when they bill—and bill within 45 days.
- Submit wage documentation. Give your employer the NF-6 form and ask your doctor for a disability note. Submit both within 90 days.
- Cooperate with IMEs and EUOs. These are medical exams or interviews requested by the insurer. Missing them can result in a denied claim.
FAQs (Quick Hits)
Do I need to use my health insurance? No. PIP is the primary payer. Your health insurer only steps in if PIP runs out or denies coverage.
What if I miss the 30-day notice deadline? You can try arguing for a “reasonable justification,” like being unconscious or hospitalized. But insurers often reject late claims.
Does PIP cover pain and suffering? No. PIP only pays for medical bills, lost wages, and other economic losses. Pain-and-suffering claims require a serious injury.
How do motorcycle crashes differ? Riders aren’t covered under PIP. Pedestrians struck by motorcycles may be.
Compliance and Citations Box (Footer Note in Small Type)
Cite Insurance Law §§5102/5103 and Regulation 68 for definitions, limits, and deadlines; link DFS resources for readers who want the source language.
