I was involved in a fender bender. I went to the hospital then missed about eight days of work following the accident. Does insurance cover these expenses?
A prior post described some aspects of No-Fault benefits. As explained in the earlier post, no-fault benefits (called Personal Injury Protection in your insurance endorsement) are part of car insurance policies. No fault benefits (called first-party benefits in the insurance regulations) cover medical expenses and lost wage benefits.
New York No Fault Benefits Follow the Vehicle
In New York, generally, the vehicle you occupy will pay for your no fault benefits. Even if you own a car or you live in home with a relative related by blood, the insurance covering the car you were driving or in which you were a passenger will cover lost wages and medical benefits. Insurance Law section 5103. (New Jersey no fault benefits cover the person rather than the vehicle. So in New Jersey, if you are driving someone else’s car or a passenger in someone’s car, the car insurance that covers you will pay medical bills and lost wages.)
Lost Wage and Medical Benefits
In order to receive first-party benefits you must apply for the benefits within 30 days after your accident. The minimal benefits for lost wages is 80% of your salary up to $2,000 per month. 11 NYCRR 65-1.1(d)(I). Lost Wage benefits cover up to three years lost work time following an accident. 11 NYCRR 65-1.1(d)(I).
Insurance companies deduct disability insurance benefits from the amount of lost wage benefits received. Every employee in New York is covered by mandatory short term disability. Short term disability covers employees up to 50% of the employees weekly wage for a maximum up to $170 per week for at most 26 weeks. NY Worker’s Compensation Law section 204.
Medical benefits are paid according to a fee schedule depending upon the procedure billed for. (Worker’s Compensation and no fault have the same fee schedule for medical providers. 11 NYCRR 68.1.)
Other Expenses
Claimants can also request reimbursement of other expenses not included in medical or lost wage benefits up to $25 per day. Covered expenses could be travel expenses to and from a doctor’s appointment. Reimbursement for household services during a period of disability. 11 NYCRR 65-1.1(d)(I).
Basic Economic Loss
Basic economic loss is the sum of all medical, lost wage and other expenses. The minimal policy provides up to $50,000 in coverage for a minimal policy. Insurance companies do sell double and triple benefits which could pay up to $100,000 and $150,000 in benefits for an additional premium. 11 NYCRR 65-1.1(d)(I).
Assignment of Benefits
Normally, medical providers will bill the insurance carrier directly. In order to bill the insurance company, the carrier will ask the claimant (the injured party) to sign an assignment of benefits. The assignment gives the medical provider the authority to pursue the claim directly with the insurance company.
Timely Notice
In order to receive benefits, the claimant must not only file the claim within 30 days, bills for medical and other expenses must be submitted with 45 days after the service was provided. 11 NYCRR 65-1.1(d)(I).
Exceptions to No Fault Coverage
Motorcycle riders and passengers are not covered by no fault. Insurance Law section 5103. An injured motorcycle rider submits claims for medical expenses and lost wages to private health insurance and disability insurance, respectively.
By James Santner, Esq.
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