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How long do I have to file a PIP claim in New York?


A

You need to file a written notice of claim for no-fault (Personal Injury Protection also known as PIP coverage) within 30 calendar days of the accident unless you can provide reasonable and justifiable proof of why there is a late filing.

The New York Insurance Department, the insurance regulator for the state, notes that that in the event you are injured in a motor vehicle accident, you should file a written notice of claim with the No-Fault insurer setting forth details sufficient to identify the injured person(s), along with reasonably obtainable information regarding the time, place and circumstances of the accident, as soon as reasonably practicable, but in no event more than 30 calendar days after the date of the accident, unless you can submit written proof providing clear and reasonable justification for late filing.

Generally, if the accident took place in New York State, you should file your No-Fault claim with the insurer of the vehicle you were in when the accident occurred or, if you were a pedestrian, with the insurer of the vehicle that struck you. If the accident was outside of New York State, and you were in a vehicle other than your own, file your claim with your own insurance company. If you were injured in a motor vehicle accident while you were a passenger on a bus your no-fault benefits would be provided by your automobile policy or the automobile policy of a member of your household. If you or a member of your household does not have automobile insurance then the insurer of the bus would provide your no-fault benefits.

Basic NYS 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.

If you (or a relative with whom you live) do not have an auto insurance policy, and are injured 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 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). It is important that the accident be reported to the proper authority within 24 hours.

Within five business days after the insurer (or MVAIC) receives this notice of a No-Fault claim, they are required to send you an Application for Benefits and a letter explaining the No-Fault coverage available and your rights and obligations. Once you receive the Application for Benefits form, complete and return it as soon as possible.

If you need medical treatment, you: (1) can pay the doctor or hospital directly and submit your receipts or bills to the insurer for reimbursement; or (2) may be able to assign your benefits to the doctor or hospital and have them submit their bills directly to the No-Fault insurer for direct payment, or (3) can permit the health care provider to bill the No-Fault insurer directly by providing them with a "direction to pay" for claims.

No-Fault benefits are paid in accordance with prescribed fee schedules, which the health care provider is required by law to accept as full payment. It is important that you make clear to the health care provider that you are being treated for injuries related to an auto accident. Unless additional verification is requested, the insurer is required to make payment within 30 days of receipt of your physician's and hospital's treatment report, or your employer's report of earnings you have lost.

If the insurer fails to make a timely payment of a No-Fault claim, it must pay 2 percent interest per month on the unpaid amounts and any reasonable attorney's fees (in accordance with Insurance Department regulations) you have incurred in order to collect your overdue No-Fault benefits.

If all or part of your No-Fault benefits are denied or paid late, you may: (1) file a complaint with the Insurance Department, as detailed later in this Guide; (2) request No-Fault arbitration; or (3) bring an action in court. No-Fault arbitration can be requested if the insurer denies your claim in whole or part, fails to make a timely payment of benefits owed, or fails to inform you in a timely manner if your claim has been denied.

The No-Fault arbitration process is designed to resolve disputes as swiftly as possible. The results of arbitration are final and binding on all parties (unless appealed under certain strict circumstances).

If you have more questions about the No-Fault/Personal Injury Protection claims process speak with your car insurance agent. If you need more consumer information or need to ask about NY insurance law contact the New York Insurance Department directly.


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