The New York Comprehensive Auto Insurance Act, which most people call the “No Fault Act,” was passed in 1973 and entered into force the following year. The purpose of the law was to limit the number of claims for compensation for personal injuries in car accidents, as many politicians had this agenda on their platforms.
The Innocence Act was innovative in the sense that it provided for the immediate payment of medical care, lost profits and other reasonable expenses out of one’s own pocket incurred as a result of injuries resulting from a car accident. The law provides that these costs must be paid up to $ 50,000 per person. These payments are called “first-party benefits” or “major economic losses”. The reason this is called “no fault” is because these payments are made regardless of fault. If you lose control of your car and drive into a tree, you will still receive these payments.
If your medical bills, lost earnings and / or pocket expenses are more than $ 50,000, you can still sue the party that caused you injuries for these additional amounts (as well as for pain and suffering). If your injuries are “serious” and caused by the negligence of another, you can still sue. Failure does not cover property damage, so you still need to sue for damage caused to your car, unless you bear a “collision” or “full coverage” for your car.
WHO IS CLOSED?
“Accident-free benefits are provided for economic losses resulting from the use or operation of a motor vehicle (Section 5103 of the Insurance Act). Section 5102 defines a motor vehicle as “all motor vehicles on public roads accept motorcycles.” “Motorcycles were deliberately excluded due to the frequency of accidents, which would make motorcycle insurance too expensive.
You are insured against unforeseen errors and, therefore, what is referred to in the charter as the “insured person” if you are the policyholder, driver or passenger of a vehicle or a pedestrian who has been injured as a result of using the vehicle. If you are not an insurer and car insurance is not valid, you will be insured for benefits without the fault of the "first party" for any auto insurance policy in your family. For example, if your adult child has a car in your home, he will cover you. If there is no “household car”, then there is a state fund called the “Accident Compensation Corporation” (MVAIC), which will provide “no-fault” benefits.
There are some exceptions you should be aware of. First of all, there must be an accident. No guilt benefits are not paid if the injury is caused by a deliberate act. Most insurance policies refuse deliberate action without fault or other types of claims. For example, you do not expect your homeowner insurance to pay for damage caused because you no longer like your carpet, so you pour ink on it. Similarly, if someone intentionally crashes into your car, insurance will not cover losses. Fortunately, such things do not happen very often!
You are also not covered if you are on a “course in your work”. This applies, for example, if you are taking a taxi, you are working as an outpatient or talking on the phone. In most cases, compensation for the employee will bring similar benefits, which will be discussed in another article.
If you are a driver and you are under the influence, no-fault benefits will not be paid for you, but will be paid to passengers or pedestrians that you injured. It is not surprising that if you were injured while committing a crime or trying to avoid the actions of law enforcement agencies, benefits are not paid. Coverage will also not be provided if you drive a vehicle that is known to have been stolen.
So, the advantage of “no fault” is that you automatically have the right to pay medical expenses and much more if you have a car accident, with the exception of the exceptions described above. The disadvantage is that in order to have a “tort” lawsuit about the negligence of the operator that caused your injuries, you must have what the law defines as “serious injury”. I will explain this in more detail later in this article.
WHAT DO YOU GET IF YOU COVER?
Section 5102 of the Insurance Act defines it as $ 50,000 per person for:
All necessary expenses related to medical and related services, treatment, certain non-medical treatment by the generally accepted religious method and other professional medical services, if their occurrence was established within one year after the injury;
The loss of earnings and the reasonable and necessary expenses incurred in obtaining services instead of such persons would be made for income up to $ 2,000 per month for up to three years;
All other reasonable and necessary expenses incurred up to US $ 25 per day for no more than one year after the accident.
The first paragraph describes the types of health care that are covered. Non-medical treatment may include acupuncture and some other holistic treatment methods, but I would not take the risk of insisting on “religious” treatment that has not been widely recognized. Allowable benefits are provided on a “pay schedule," and healthcare providers cannot charge a higher fee, making it difficult to find doctors who are willing to accept payments without fault. Most chiropractors and physiotherapists are happy to accept this, but answers to questions such as orthopedic surgeons, neurologists, and plastic surgeons can be difficult to find.
The second paragraph allows for the payment of provable lost earnings in an accident. If you are self-employed, you can file a tax return to show loss of income. As a rule, you need to provide three years of tax returns – the previous two years indicating what you usually earn, and the year of the incident when you earned less. If you need to hire someone to temporarily replace you, such as a taxi driver, when you have a locket, the amount you pay for a new driver can be refunded. Obviously, if you work “out of the register”, you cannot apply for income loss benefits.
The third paragraph offers a small amount of money, which is usually used to recover the cost of a taxi for treatment and similar expenses. You can also get compensation for housework if you are unable to take care of your children or take care of your home (but only $ 25 a day). There is an opportunity to purchase an extra $ 25,000 after running out of $ 50,000, but very few people choose to buy this extra coverage. In some circumstances, your no-fault insurance benefits will even cover you from accidents in other states.
A plea of no fault must be filed with the insurance company within thirty days after the accident. All claims must be filed within 180 days from the date they are submitted. Most insurance companies will pay benefits on time. Problems may arise with the adequacy of the evidence provided, which may delay payment. Insurance companies sometimes claim that treatment is not necessary for medical reasons and are refused payment, in which case the doctor may decide to refuse or sue the insurance company for paying their bills. It is worth contacting the medical staff who are ready to conduct these arbitral proceedings, instead of ultimately being responsible for the payment, or withholding your case if the insurance company refuses to pay. The insurance company also has the right to be examined by the doctors they hire to determine if you need treatment. In the end, as your injuries improve, the hired physician of the insurance company will “refuse” your medical treatment as necessary, which can also be reviewed or authorized by your doctor.
HOW DOES NEW YORK LAW DETERMINE "SERIOUS INJURIES?"
The threshold for “serious injury” is defined in §5102 (d). Damage from pain and suffering shall be compensated only if the plaintiff is injured as a result of which:
Significant disfigurement; or
Fetal loss; or
Permanent loss of use of an organ, member, function, or system of the body; or
Permanent indirect restriction of the use of a function or system of the body; or
Significant restriction of the use of a function or system of the body; or
Medically determined injuries or irregularities that do not allow the victim to carry out almost all the material, actions that are the usual or ordinary actions of such a person for at least 90 days within 180 days immediately following the incident. or injury.
The first two categories above are obvious. Fractures appear on x-rays and will always correspond to the threshold of serious injuries, regardless of how minor they are. A surgical fracture of the left little finger will be enough, even if treatment is not required and there is no disability. Significant deformity is less pronounced. Typically, the problem is cuts and abrasions on the face or other visible parts of the body, which lead to the appearance of “scars” and whether the remaining marks are really ugly. Case law explains that a scar must be so unattractive that a person is the object of "pity and contempt." The mark that should be “indicated” will not correspond to the threshold.
With the loss of the fetus, it is necessary to prove that the miscarriage was really caused by an accident. It would be improbable to say that the miscarriage was caused by a minor effect, especially if the woman did not immediately seek medical help for any injuries and lost the baby after a month.
The “permanent loss” and “significant limitation” sections were intended to cover paralysis or other serious loss in use, but now they include much less serious disorders, such as rupture of ligaments and hernias of the neck and back. There must always be objective evidence, such as an MRI and a doctor’s report confirming these claims, subjective statements about pain are never enough to meet the threshold for serious injuries.
The threshold is reached when the victim loses more than 90 days of work due to injuries. The timeout from work should not be immediate and should not be consistent. For example, a person could remain without work for a month after an accident, try to return to work, exit again, return, undergo surgery, and then recover again. If it is more than 90 days from the first 180 days, it corresponds to the threshold of serious injuries if the doctor certifies that you really could not work. It is not impossible, but it is much more difficult to qualify for this program without a fully paid job, but there are some circumstances in which this may be applicable. For example, a housewife with young children may not be able to provide care and needs to take care of a child for her children, losing 90 out of 180 as a result of her usual activities.