Understanding No-Fault Benefits in New York and Pennsylvania


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New York and Pennsylvania are among a handful of states that have enacted “No-Fault” laws to ensure that insurance carriers pay for medical expenses, lost wages, and various incidental costs associated with injuries sustained in motor vehicle accidents. Under such laws, injured parties are covered regardless of who was at fault in an accident. These laws are intended to ensure quick payments to injured parties, as well as to avoid costly and time-consuming litigation.

Claims under No-Fault laws are often referred to as “Personal Injury Protection” (PIP) claims.  There are certain timelines that must be met in order to pursue PIP claims. Failure to comply with these timelines may destroy an injured party’s right to collect No-Fault benefits.

New York’s No-Fault law provides compensation up to $50,000 for basic economic loss incurred by individuals injured in motor vehicle accidents. This includes loss of earnings from work which the person would have performed had he or she not been injured as well as medical and reasonable out-of-pocket expenses. No-Fault coverage covers up to 80% of an individual’s lost wages, up to $2000 a month.

Coverage offered through No-Fault insurance is often not enough to fully compensate an individual for losses. To account for any gaps in coverage, New York State carriers offer additional coverage options, known as Additional Personal Injury Protection (“APIP”) and Optional Basic Economic Loss (“OBEL”). APIP is similar to No-Fault and covers medical expenses, lost wages, and reasonable out-of-pocket expenses. OBEL coverage, available only after No-Fault limits have been reached, may be utilized to reimburse medical bills or lost wages.

In Pennsylvania, the minimum No-Fault coverage required to be carried by policyholders is $5000, which is limited to medical expenses. Lost wage coverage may be purchased separately, up to the limits chosen by the policyholder. As in New York, individuals are entitled to 80% of their weekly earnings until policy limits are reached.

Reimbursement rates for medical expenses are determined by fee schedules according to law and vary by state and year.

When disputes arise over PIP claims, injured parties are often faced with the choice of whether to pursue arbitration or litigation. Arbitration is often less expensive and less time-consuming, but results in binding decisions. Litigation, on the other hand, can be slow-moving, expensive, and formal.

The attorneys at Levene Gouldin & Thompson are well-versed in No-Fault laws, and can assist you in pursuing your PIP claim from start to finish, as well as help you weigh your options regarding arbitration or litigation should any disputes arise with an insurance carrier. Contact an attorney at Levene Gouldin & Thompson today at (607) 763-9000 to set up a consultation. For more information on No-Fault claims, as well as the rules pertaining to claims for pain and suffering, please visit our website at https://www.lgtlegal.com/practice-areas/NY-PIP-No-Fault-Insurance-Law-Binghamton-Ithaca-Car-Accident-Lawyer_17-38-expertise.htm.