Is New York a No-Fault State? Coverage, Lawsuits, and Deadlines

Yes, New York is a no-fault state for auto insurance. After a car accident, you file your medical bills and lost wage claims with your own insurance company rather than the other driver’s, and you get paid regardless of who caused the crash — up to $50,000 in what the statute calls basic economic loss.¹ The trade-off is that you generally cannot sue the other driver for pain and suffering unless your injuries meet a specific legal threshold set by state law.²

What No-Fault Pays For

Every auto policy sold in New York must include first-party benefits, usually called Personal Injury Protection or PIP. Those benefits cover three categories of loss, all sharing a combined $50,000 cap per person per accident.³

Medical expenses that are reasonable and necessary: hospital stays, surgery, nursing care, dental treatment, ambulance transport, X-rays, prescription drugs, and prosthetic devices.
Lost wages at 80 percent of your income, capped at $2,000 per month, for up to three years from the accident date. The remaining 20 percent is a statutory deductible.³
Other necessary expenses like transportation to medical appointments and household help, capped at $25 per day for one year after the accident.³

Two things no-fault does not pay for: damage to your vehicle, and pain and suffering. Property damage is handled through separate coverage. Pain and suffering is available only through a lawsuit, and only if your injuries qualify.

Your PIP coverage is primary for auto injuries and pays before your health insurance. Once the $50,000 is exhausted, health insurance picks up further medical costs. If you were injured on the job, workers’ compensation is primary and no-fault becomes the excess layer.⁴

Who Is Covered

No-fault reaches further than just the person named on the policy. If you hold a New York auto policy, members of your household are covered even when riding in someone else’s car. Passengers in your insured vehicle are covered. Pedestrians and cyclists struck by an insured vehicle are covered too, and in that case the striking vehicle’s insurer pays their benefits.⁵

Motorcyclists are the notable exception. Riders and their passengers are excluded from no-fault benefits entirely and must rely on health insurance or a lawsuit against the at-fault party.¹

When You Can Still Sue

The core bargain of a no-fault state is that in exchange for guaranteed benefits from your own insurer, you give up the right to sue the other driver for pain and suffering unless your injuries cross a specific bar. New York Insurance Law Section 5102(d) defines “serious injury” as one that results in any of the following:⁶

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 a body organ or member
Significant limitation of a body function or system
A non-permanent injury that prevents you from performing substantially all of your usual daily activities for at least 90 days during the 180 days immediately following the accident

Some categories are clean. A fracture qualifies. Others — “significant limitation” and the 90/180-day rule especially — are where insurers push back hardest, and where claims most often fail. Subjective complaints of pain are not enough. You will need objective medical evidence: imaging, documented examination findings, and typically a medical expert who can tie the injury to the accident and describe its long-term impact. If you rely on the 90/180-day rule, the records need to show consistent treatment and functional limitations during that specific window.

When your injuries do meet the threshold, you can sue for pain and suffering, and you can also pursue economic losses that go beyond the $50,000 no-fault cap.² The deadline to file that lawsuit is three years from the date of the accident.⁷

New York also follows pure comparative negligence, so even if you were partly at fault, you can still recover damages in a suit; your award is reduced by your share of the responsibility.⁸ Your no-fault benefits are unaffected by fault, which is the point of the system.

Deadlines That Decide Whether You Keep Your Benefits

No-fault benefits come with strict paperwork rules, and missing them is one of the most common reasons people lose coverage they were otherwise entitled to.

File Form NF-2, the written no-fault application, with your own insurer within 30 days of the accident. Your insurer can deny the entire claim if you file late.⁹ If you do miss the 30 days, you can still submit the form with written proof of a reasonable justification such as hospitalization or an inability to identify which insurer to contact, but the insurer is not required to accept your reason.¹⁰

After that initial application, send written proof of each medical bill and expense to your insurer within 45 days of the date services were rendered. Keep copies of everything.⁹

Get medical attention promptly, even if the injuries seem minor. Gaps in treatment give insurers a reason to deny or reduce benefits.

Independent Medical Examinations

Your insurer has the right to require you to attend a medical examination with a doctor of its choosing, as often as it reasonably sees fit. These are called Independent Medical Examinations, or IMEs.¹¹ The exam must be scheduled at a reasonable location, usually the county where you live, and you must receive written notice. You can reschedule once. If you miss the rescheduled appointment, the insurer can cut off your benefits.

The insurer cannot stop paying benefits just because an IME is pending. Benefits can only be denied after the examination takes place and the insurer issues a formal denial on Form NF-10, unless the scheduling delay is your fault.¹¹

If Your Claim Is Denied

If your insurer denies a claim or lets it sit unpaid for more than 30 days, you can file for no-fault arbitration through the American Arbitration Association. Requests sent to the Department of Financial Services for this purpose will be returned.¹²

To start, complete the back of the NF-10 denial form with an itemized list of the bills in dispute, or submit AAA Form AR1 if you never received a denial. Attach supporting documents, send a copy to the insurer, and pay the $40 filing fee to the AAA.¹²

If you win at arbitration and the insurer still does not pay within 30 days, you can file a consumer complaint with the DFS at no cost. Overdue benefits also accrue interest at two percent per month, calculated on a 30-day month, and interest above $5 must be paid automatically without you having to demand it.¹³

Optional Coverages Worth Knowing About

The $50,000 basic economic loss cap disappears quickly with a serious injury. Two optional coverages sit on top of it.

Optional Basic Economic Loss, or OBEL, adds $25,000 in coverage that can be applied to lost wages or to psychiatric, physical, and occupational therapy and rehabilitation once the initial $50,000 is exhausted. Every insurer is required to offer OBEL and explain it at renewal.¹⁴

Supplementary Uninsured/Underinsured Motorist coverage, or SUM, protects you when the at-fault driver has no insurance or carries limits too low to cover your injuries. Insurers must offer SUM with minimum limits of $25,000 per person and $50,000 per accident, though higher limits are available. If your liability policy already carries limits above $100,000/$300,000, your insurer may structure SUM options differently.¹⁵

Both are worth asking about before you need them. After an accident is too late.

1
Cornell Law Institute. New York Codes, Rules, and Regulations Title 11 65-1.1 – Requirements for Minimum Benefit Insurance Policies for Personal Injuries
2
New York State Senate. New York Insurance Law 5104 – Causes of Action for Personal Injury
3
Department of Financial Services. OGC Opinion No. 03-04-24 – No-Fault Insurance; Coordination with Workers’ Compensation
4
Department of Financial Services. OGC Opinion No. 03-04-06 – Workers’ Compensation and No-Fault Coverage
5
New York State Senate. New York Insurance Law 5103 – Entitlement to First Party Benefits
6
New York State Senate. New York Insurance Law 5102 – Definitions
7
New York State Senate. New York Civil Practice Law and Rules 214 – Actions to Be Commenced Within Three Years
8
New York State Senate. New York Civil Practice Law and Rules CVP 1411 – Damages Recoverable When Contributory Negligence Is Established
9
Department of Financial Services. OGC Opinion No. 08-06-01 – NF-2 Submission Timeframe
10
Department of Financial Services. NY Motor Vehicle No-Fault Insurance Law Cover Letter
11
Department of Financial Services. Regulation No. 68 (11 NYCRR 65) – Mandatory Personal Injury Protection Endorsement
12
Department of Financial Services. No-Fault Claims and Arbitration
13
Cornell Law Institute. New York Codes, Rules, and Regulations Title 11 65-3.9 – Interest on Overdue Payments
14
Department of Financial Services. OGC Opinion No. 08-05-17 – No-Fault Insurance Policy Additional Personal Injury Protection
15
Cornell Law Institute. New York Codes, Rules, and Regulations Title 11 60-2.1 – Supplementary Uninsured/Underinsured Motorist Coverage