A. Basic Information:
No-Fault is the name traditionally given to health and disability benefits payable to anyone hurt in an auto accident. It covers loss of earnings, medical bills, prescriptions, travel expenses and household help usually up to $50,000.00. It covers anyone hit by a car as a pedestrian or injured by the operation, use or maintenance of a motor vehicle.
You must file an application within 30 days with the carrier of the car you operated or in which you were a passenger or the carrier of the car that struck you if you were a pedestrian. [Do this immediately as a late application may affect your benefits.] After filing your application, the carrier will send appropriate forms to the medical providers. Your medical providers will usually direct bill the no-fault carrier. They must do so within 45 days.
To be reimbursed for travel expenses, household care, prescriptions and lost earnings, you must mail this information to the no-fault carrier. [You should keep a copy for your records and so that we may have these records as well.] You may be reimbursed as follows:
- Travel Expenses: You are eligible for reimbursement for the number of miles traveled for medical care, physical therapy and hospitals. [The carrier will require the name of the doctor, the date of visit and the number of round trip miles; limitation of 1 year.]
- Household Care: You are eligible for reimbursement [$25.00 per day, household and travel expenses combined] if your doctor provides a note indicating that such household care is needed. This note together with a form signed by you and the person doing the care listing the dates [note that spouses, parents or family members are usually excluded and limitation of 1 year].
- Prescriptions: Send to carrier and keep records of what is being sent. Always refer to claim number provided by carrier.
- Lost Earnings: Your employer must complete a certain form and you will need a physician’s note indicating that you are unable to work. If you receive NYS Disability, mail a copy of your disability check to the carrier. It will deduct this sum from your no-fault loss wages payment. If self-employed, you will need a different form and you must submit copies of your two previous years tax returns.
[Note: Your medical provider must submit bills directly to the carrier within a time provided. If not done by the time allowed, such a bill may be denied by the carrier. See that your provider is submitting bills to the correct carrier with accurate claim numbers.]
D. Other Information:
The no-fault carrier can take up to thirty days from the date the bill is received to make payment. NYS Disability will pay for 26 weeks excluding the first week you are disabled. No Fault will pay for the first week you are out of work. The No-Fault carrier will pay lost wages up to three years from the date of your injury provided your physician documents that you are unable to return to work. [The carrier may have you examined by their physician consultant in the meantime.] New York State no-fault provides a death benefit of $2,000.00.
New York State no-fault will only pay 80% of your gross wages together with any disability payment. You should check your policy to see what wage benefits are payable to you.
E. New York Disability & Workers Compensation:
You must file a NY Disability form with your employer within 20 days from the date of your accident or the date you became disabled. If you were in the course of your employment at the time of your accident, you must apply for workers compensation benefits through your employer. The W.C carrier will pay you a portion of your earnings and No-Fault will pay a portion totaling 80% of your gross earnings.
F. Denial of Benefits:
NEVER SUBMIT A DEMAND FOR ARBITRATION. IF YOU LOSE YOUR CLAIM, YOUR LAWSUIT FOR INJURIES MAY BE ADVERSELY AFFECTED.
H. No-Fault Physical Examinations:
Your no-fault carrier can have you examined by a physician to determine if benefits should continue. If you fail to attend, your benefits may be denied. In some circumstances, you may request an adjournment of such exam.
G. Other Recommendations & Information:
Never discuss your injury or accident with anyone. Please check with our office if you have any questions. Keep copies of all submissions to the no-fault carrier. Put the date of mailing in your cover letter to the carrier. Make copies of checks received before cashing them. Although you must generally cooperate with your no-fault carrier for benefits, you do not have to speak with any representative from the offending vehicle’s carrier. Call us if you have any question or refer such person to our office. We would be glad to speak with anyone inquiring as to your claim.
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Note: The information contained herein is for informational purposes only and is not to be considered legal advice.
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