Key points
- New York no-fault covers up to $50,000 per person in basic economic loss, including medical bills, 80 percent of lost earnings and some other expenses.
- Written notice of your claim is due within 30 days of the accident, and medical providers must submit bills within 45 days of treatment.
- The insurer can require medical examinations by its doctors and examinations under oath, and missing them can lead to a denial.
- If benefits are denied, you can choose arbitration or a lawsuit, and overdue benefits earn interest of 2 percent per month.
- Motorcycle riders and passengers do not receive New York no-fault benefits for their own injuries.
New York calls its system “no-fault” because the benefits do not depend on who caused the crash. If you were hurt in a car accident in New York, your no-fault coverage, often called PIP (personal injury protection), pays your basic medical bills and much of your lost income.1
No-fault is helpful, but it is strict about paperwork and deadlines. This guide explains what it pays, who is covered, and what to do if the insurer refuses to pay.
What no-fault pays
No-fault pays “basic economic loss,” which is up to $50,000 per person for these combined items.1
| Benefit | What New York law provides |
|---|---|
| Medical and related expenses | Necessary medical, hospital, surgical, nursing, dental, ambulance, x-ray, prescription and prosthetic expenses, plus rehabilitation and certain other services.1 |
| Lost earnings | 80 percent of lost earnings from work, because the law subtracts 20 percent.1 The payment is capped at $2,000 per month for up to three years from the accident.13 |
| Other reasonable expenses | Other reasonable and necessary expenses, up to $25 per day for up to one year from the accident.1 |
| Death benefit | A $2,000 death benefit to the estate of a covered person, in addition to basic economic loss.4 |
Some amounts reduce what no-fault pays. Benefits are reduced by amounts recovered or recoverable from Social Security disability, workers’ compensation, New York disability benefits and, with limits, Medicare, as well as by any policy deductible.1
Optional basic economic loss
Your policy may also include optional basic economic loss coverage, known as OBEL. It adds $25,000, which raises the total to $75,000 per person, and pays only after the first $50,000 is used up.5 OBEL can be applied to basic economic loss generally, to lost earnings, to psychiatric, physical or occupational therapy and rehabilitation, or to a combination of lost earnings and therapy.5
The injured person makes that choice after the accident, once basic economic loss reaches $30,000.5 The election form is the NF-13.6 If the injured person does not respond to the insurer’s second notice within 15 calendar days, OBEL is applied to all elements of basic economic loss.5
Who is covered
The mandatory endorsement covers the named insured and relatives in the household injured in a car accident. It also covers other people hurt by the insured vehicle in New York while not in another motor vehicle, and New York residents hurt by the insured vehicle outside the state.3
Pedestrians
A pedestrian hit by an insured car in New York is generally covered. The regulation covers people injured by the insured vehicle in New York “while not occupying another motor vehicle.”3 Your own New York policy, or one held by a relative in your household, can also apply. When more than one source of no-fault benefits applies, the regulation addresses how the insurers share the claim.3 If the car that hit you was uninsured or left the scene, and you have no other auto insurance available, the Motor Vehicle Accident Indemnification Corporation (MVAIC) may provide no-fault benefits to eligible New York residents.8 MVAIC requires the accident to be reported to police within 24 hours. Its notice of intention deadline is 90 days for a hit-and-run or unidentified vehicle and 180 days for an identified uninsured vehicle.8
Motorcyclists
New York no-fault excludes motorcycle riders. The definition of “motor vehicle” does not include a motorcycle, and the standard endorsement excludes “any person while occupying a motorcycle.”13 A motorcycle policy must provide no-fault benefits only to people outside the motorcycle, such as a pedestrian it strikes, not to its own rider or passenger.4 Injured riders usually rely on health insurance and on a claim against the at-fault driver.
People who can be excluded
The law allows insurers to exclude certain people from coverage. These include someone who intentionally causes their own injury, a driver injured while intoxicated or impaired by drugs, and someone injured while committing a felony, racing, or using a car they know is stolen.4 The intoxication exclusion does not eliminate coverage for necessary emergency health services in a general hospital, including ambulance services and related medical screening. The insurer may seek repayment from a person found to have violated Vehicle and Traffic Law § 1192.4 Others include an owner hurt in their own vehicle that was uninsured, and people injured while repairing or servicing a vehicle as part of a business.4
The deadlines that matter most
No-fault deadlines are short, and missing one is a common reason claims are denied.
- Written notice within 30 days. Written notice of the claim must be given to the insurer as soon as reasonably practicable, and in no event more than 30 days after the accident.3 The standard application form is the NF-2.6
- Medical bills within 45 days. Proof of claim for medical treatment must be submitted no later than 45 days after the services are rendered.3 Your providers usually handle this, but confirm that they have your claim number.
- Lost wages and other expenses within 90 days. Proof of claim for work loss and other necessary expenses is due no later than 90 days after the loss is incurred or the services are rendered.3
Missing one of these limits is excused only if the injured person, or someone acting for them, submits written proof giving clear and reasonable justification for the delay.3
Medical exams and examinations under oath
As a condition of coverage, you must submit to medical examinations by doctors the insurer selects, “when, and as often as, the Company may reasonably require.”3 These are commonly called IMEs (independent medical examinations), even though the insurer chooses and pays the doctor.
The insurer can also require an examination under oath, or EUO.3 An EUO is sworn questioning, usually by the insurer’s lawyer, about the accident, your injuries and your treatment. Missing a properly scheduled IME or EUO can lead to a denial, so keep every appointment or reschedule in writing, and bring a lawyer to an EUO if you can.
Denials, arbitration and court
No-fault benefits are due as the loss is incurred. They are overdue if not paid within 30 days after the insurer receives proof of the fact and amount of the loss.2 Overdue payments earn interest of 2 percent per month, and a claimant who must fight for overdue benefits can recover reasonable attorney’s fees.2
If the insurer denies a claim, you have a choice. Every insurer must give you the option of submitting the dispute to arbitration under simplified procedures.2 You may instead file a lawsuit in court.11 The American Arbitration Association administers New York no-fault arbitrations.7
An arbitrator’s award can be reviewed by a master arbitrator. When a master arbitrator’s award is $5,000 or more, not counting interest and attorney’s fees, either side may bring a new court action on the dispute.2
Workers’ compensation comes first for work injuries
If you were hurt in a crash while working, workers’ compensation generally pays before no-fault. First-party benefits are reduced by workers’ compensation amounts that are “recovered or recoverable.”13 If workers’ compensation is denied, the no-fault insurer may ask you to sign an NF-9, which is an agreement to keep pursuing workers’ compensation while no-fault pays.6
The fee schedule
Medical providers cannot charge whatever they want for no-fault treatment. Under Insurance Law § 5108, charges may not exceed the amounts in schedules prepared by the chair of the Workers’ Compensation Board, except in limited situations.9 No provider may demand or request payment beyond the amounts the law allows.9 Providers who accept an assignment of benefits usually bill the insurer directly and pursue denials themselves.11
No-fault is not your injury claim
No-fault is your own coverage, not a lawsuit against the driver who caused the crash. Pain and suffering, and economic losses above basic economic loss, come from a separate claim against the at-fault driver.10 To recover pain and suffering, New York law requires a serious injury. Our serious injury threshold guide explains that test and its 2026 changes.
No-fault rules are full of short deadlines and technical requirements. If a claim was denied or you are unsure which insurer should pay, talk to a lawyer about your situation.
Common questions
Sources
Statutes, court rules, regulations and court decisions cited on this page. Numbers match the markers in the text.
- N.Y. Ins. Law § 5102Definitions of basic economic loss, first party benefits, motor vehicle and covered personView source
- N.Y. Ins. Law § 5106Fair claims settlement, overdue benefits, interest, and arbitrationView source
- 11 NYCRR 65-1.1Mandatory personal injury protection endorsement, including notice, proof of claim, IMEs and EUOsView source
- N.Y. Ins. Law § 5103Entitlement to first party benefits, death benefit, exclusions and motorcycle coverageView source
- 11 NYCRR 65-1.2Optional basic economic loss (OBEL) coverage endorsementView source
- N.Y. Dep’t of Fin. Servs., No-Fault Forms (NF-2, NF-9, NF-13)Standard no-fault application, workers’ compensation agreement and OBEL election formsView source
- American Arbitration Association, New York No-FaultAdministrator of New York no-fault arbitrationsView source
- Motor Vehicle Accident Indemnification Corporation (MVAIC), Do You QualifyEligibility and notice deadlines for no-fault claims involving uninsured or hit-and-run vehiclesView source
- N.Y. Ins. Law § 5108Limit on charges by providers of health servicesView source
- N.Y. Ins. Law § 5104Causes of action for personal injury and the serious injury requirementView source
- N.Y. Dep’t of Fin. Servs., FAQs on the No-Fault Fee Schedule (Regulation 83)Providers must bill under the fee schedules and cannot balance bill patientsView source