Hey guys, sorry I haven't been around in a while, new baby on the way has been keeping pretty busy: anyway I had written this article for the Electrical Contractors Association and thought you guys may be interested. Please feel free to email me with any questions, on any legal topic.
NO FAULT, what do you mean no fault?
It was entirely the other guy’s fault!
New York Insurance Law requires that every automobile policy have a mandatory personal injury protection endorsement, sometimes referred to as PIP, but most commonly known as “No Fault” insurance. No Fault says that your own insurance will cover your basic economic losses, for up to $50,000, caused from the use and operation of a motor vehicle: regardless of how the accident occurred or whose fault it was- hence the name No Fault.
No Fault was established for two reasons; first was to avoid the situation in which one driver didn’t have insurance, if the driver with insurance suffered economic loss, he could not recover from the “financially irresponsible motorists.” Second, if the offending vehicle did have insurance, economic loss would have to be endured until the possible outcome of endless litigation. So to avoid these problems, the NYS legislature enacted this law that allows financial victims of incidents arising from the use and operation of a motor vehicle , to turn to their own insurance company for reimbursement.
What is basic economic loss? Any medical expenses, for up to the Workers compensation fee schedule allowable amount. Loss of earnings, for up to $2,000 a month for up to a period of three years. Other expenses (for example cleaning service) for up to $25 a day for up to one year. A one-time $2,000 death benefit.
Who is eligible? A typical PIP endorsement qualifies eligible people like this: (1) The named insured and any relative who sustains personal injury arising out of the use or operation of any motor vehicle, (2) The named insured and any relative who sustains personal injury arising out of the use and operation of any motorcycle, while not occupying a motorcycle, (3) any other person who sustains personal injury arising out of the use and operation of the insured motor vehicle in the state of New York while not occupying another motor vehicle, or (4) any NYS resident who sustains personal injury arising out of the use and operation of the insured motor vehicle outside of NYS while not occupying another motor vehicle. This seems to cover a lot of people, but there are specific exclusions, to name a few- (1) Any person occupying a motorcycle, (2) Any person who intentionally causes his/her own personal injury, (3) Any person operating a motor vehicle, while intoxicated, (4) any person injured while committing a felony, (5) any person injured while racing, (6) any person injured while operating a vehicle, known to him to be stolen, (7) any person injured while repairing, servicing, or otherwise maintaining a motor vehicle, and such conduct is within the course of business, and the injury occurs on the business premises.
As you might imagine, with such a beast in place there is vast amount of exposure for abuse. Think about it, you can go to your own carrier to be reimbursed for chiropractic visits, acupuncture, and physical therapy, lost earnings, transportation or even a cleaning service. “Investigations by insurers and law enforcement agencies show that organized crime rings along with a small number of unscrupulous medical providers and attorneys are manipulating the personal injury protection (PIP) part of the New York state no-fault auto insurance plan at the expense of the state’s policyholders.” These elements are actually imposing a tax on every honest driver in New York State. To counter the abuse Insurance carriers are permitted to verify the accident, treatment and injuries. They do this thru internal investigation departments, Examinations Under Oath (EUOs allow the carrier to demand either the injured party and/or the medical provider to appear and give sworn testimony as to the occurrence or treatment,) Peer reviews (which allows the carrier to have a doctor review your medical file to determine if the treatment rendered was necessary) and by conducting Independent Medical Examinations (IMEs are when the carriers hire a doctor to examine the injured party, to determine if the treatment rendered was necessary, and if it should continue.)
If I have given you too much info, I apologize, I am not trying to make you all into No Fault attorneys, but rather just to make you aware that such coverage is available. Many people don’t know that this protection is available thru their own policies. Hopefully none of us ever need it, but know it is there if you do.