New York No-Fault Insurance Law: The Complete Guide

Your Definitive Resource by New York's Leading No-Fault Authority

Since 2008, attorney Jason Tenenbaum has analyzed thousands of no-fault insurance cases, building the most comprehensive collection of no-fault case analysis available online. Over 17 years of continuous legal commentary, Jason has authored more than 2,000 posts examining every aspect of New York's complex no-fault insurance system — from landmark appellate decisions to nuanced trial court rulings that shape daily practice.

With 287 posts specifically tagged "No-Fault," plus hundreds more covering specialized areas like Examinations Under Oath (196 posts), Medical Necessity disputes (171 posts), Independent Medical Examinations (149 posts), Coverage Issues (149 posts), Evidence and Business Records (125 posts), and Fee Schedule disputes (118 posts), no other legal commentator has documented New York no-fault law with this depth and consistency.

This comprehensive guide distills nearly two decades of case law analysis into the definitive resource for both legal practitioners and individuals navigating New York's no-fault insurance system. Whether you're an attorney seeking authoritative precedent analysis or a car accident victim trying to understand your rights, this guide provides the expert insight you need.

What is No-Fault Insurance in New York?

New York's no-fault insurance system, codified primarily in Insurance Law Article 51, fundamentally changed how motor vehicle accident victims receive compensation for medical expenses and lost wages. Unlike traditional tort systems where fault must be established before recovery, New York's no-fault system provides immediate access to Personal Injury Protection (PIP) benefits regardless of who caused the accident.

Core Components of New York No-Fault Coverage

When No-Fault Doesn't Apply

New York's no-fault system has important exceptions. Benefits may be reduced or denied when accidents involve:

Motorcycles (no-fault doesn't apply)

Drivers under the influence of drugs or alcohol

Intentional acts or criminal behavior

Vehicles not required to have insurance (farm vehicles, off-road vehicles)

Understanding these nuances is crucial for both claimants and practitioners navigating the system's complexities.

Independent Medical Examinations (IMEs)

Independent Medical Examinations represent one of the most contentious areas of no-fault practice. Insurance companies use IMEs to challenge the necessity and reasonableness of medical treatment, often leading to claim denials that require legal intervention to overturn.

The IME process involves several critical elements that have generated extensive case law. The insurance company must provide proper notice of the examination, typically requiring at least 10 days' advance notice with specific details about the examination location, doctor, and scope. The examining physician must be appropriately licensed and qualified to evaluate the specific injuries claimed.

Perhaps most importantly, the failure to appear at a properly scheduled IME can result in suspension of benefits until the examination occurs. However, as Jason's analysis reveals, insurance companies often overreach in their IME demands, and there are numerous grounds to challenge improper IME notices or requirements.

Key IME Issues and Recent Developments

The courts have established clear standards for valid IME procedures, but these standards are frequently litigated. Common disputes include whether the IME doctor has appropriate qualifications, whether sufficient notice was provided, and whether the examination scope is reasonable given the claimed injuries.

The strategic handling of IME issues often determines the success or failure of a no-fault claim. Understanding when to object, how to prepare clients, and what constitutes valid grounds for non-appearance requires deep knowledge of both the statutory framework and evolving case law.

Examinations Under Oath (EUOs)

The Examination Under Oath stands as perhaps the most powerful investigative tool available to no-fault insurers, and consequently, the source of some of the most complex procedural disputes in no-fault litigation. An EUO allows the insurance company to examine the claimant under oath about any matter related to the claim, creating a formal record that can be used in subsequent litigation.

The EUO process is governed by strict procedural requirements that, if not followed precisely, can invalidate the examination and any resulting claim denial. The insurance company must provide proper notice specifying the time, place, and general scope of the examination. The notice must be served in accordance with statutory requirements, typically requiring personal service or certified mail.

EUO Procedure and Common Pitfalls

The failure to appear at a properly noticed EUO can result in immediate suspension of benefits and potential forfeiture of the entire claim. However, there are numerous grounds to challenge EUO demands, including inadequate notice, improper scope, or harassment through repeated examinations.

The courts have established clear standards for what constitutes a valid EUO notice and procedure, but these standards are frequently the subject of appellate review. Issues such as the permissible scope of questioning, the right to counsel, and the consequences of non-appearance continue to evolve through case law.

The strategic approach to EUOs requires careful preparation of the claimant, thorough review of the notice for procedural defects, and detailed understanding of the permissible scope of examination. Experienced practitioners know that the EUO can make or break a no-fault claim.

Medical Necessity Disputes

Medical necessity determinations represent the battleground where clinical medicine meets insurance law. Under New York's no-fault system, covered medical expenses must be "reasonable and necessary" for treatment of injuries related to the motor vehicle accident. This seemingly simple standard has generated thousands of disputes and extensive appellate precedent.

The burden of establishing medical necessity typically falls on the claimant, who must demonstrate that the treatment was appropriate for the diagnosed condition and causally related to the accident injuries. This often requires expert medical testimony and detailed analysis of medical records, treatment protocols, and accepted medical standards.

Peer Review and Expert Standards

Insurance companies frequently rely on peer review determinations to deny claims based on alleged lack of medical necessity. However, these peer reviews must meet specific evidentiary standards to be admissible and persuasive in subsequent litigation. The reviewing physician must have appropriate qualifications, access to complete medical records, and detailed understanding of the claimant's condition.

Successful resolution of medical necessity disputes requires comprehensive understanding of both medical standards and legal precedent. The practitioner must be able to evaluate medical records, identify appropriate experts, and present compelling evidence that treatment was both reasonable and necessary.

Fee Schedule & Billing Disputes

New York's no-fault fee schedules establish maximum allowable charges for medical services, creating a complex regulatory framework that governs provider reimbursement. These schedules vary by type of service and are regularly updated, requiring constant attention to current rates and proper billing procedures.

Fee schedule disputes often involve technical issues such as proper CPT coding, bundling rules, and geographic variations in allowable charges. Providers must understand not only the applicable fee schedule rates but also the documentation requirements necessary to support their billing submissions.

Common Fee Schedule Issues

Disputes frequently arise over proper application of fee schedule rates, particularly in cases involving multiple procedures, modifier usage, or services not explicitly addressed in the schedules. The 120-day rule for fee schedule applicability creates additional complexity, as does the interaction between fee schedules and medical necessity determinations.

Understanding the nuances of fee schedule application requires detailed knowledge of both the regulatory framework and the case law interpreting schedule requirements. Successful practitioners must stay current with schedule updates and understand the procedural requirements for challenging improper fee schedule applications.

The intersection of fee schedule compliance and medical necessity creates additional complexity, as services may be properly coded and within fee schedule limits but still subject to denial on necessity grounds. Practitioners must understand both aspects to effectively advocate for their clients.

Coverage Issues and Policy Interpretation

Coverage disputes in no-fault cases involve fundamental questions about the scope and applicability of insurance protection. These cases often turn on policy language interpretation, statutory construction, and the complex interplay between no-fault benefits and other insurance coverages.

Key coverage issues include policy limits and exhaustion, priority of coverage when multiple policies may apply, and the application of exclusions or limitations. The $50,000 minimum PIP requirement creates baseline coverage, but many policies provide higher limits, and understanding how these limits apply in specific circumstances requires detailed analysis.

MVAIC and Uninsured Motorist Issues

The Motor Vehicle Accident Indemnification Corporation (MVAIC) provides a crucial safety net for accidents involving uninsured vehicles or hit-and-run situations. MVAIC coverage involves specific notice requirements and procedural rules that differ from standard no-fault claims processing.

Priority of coverage issues arise frequently in cases involving multiple vehicles, borrowed vehicles, or commercial insurance. Understanding which policy provides primary coverage and how benefits coordinate between multiple insurers requires careful analysis of policy terms and statutory priorities.

Coverage disputes often involve complex factual and legal questions that require thorough investigation and detailed understanding of both insurance law and no-fault statutory requirements. The interaction between coverage questions and other no-fault issues creates additional layers of complexity.

Serious Injury Threshold (Insurance Law § 5102(d))

New York's serious injury threshold represents one of the most significant limitations on tort recovery in motor vehicle cases. Under Insurance Law § 5102(d), a plaintiff may not recover non-economic damages unless they can demonstrate a "serious injury" as defined by the statute.

The serious injury threshold includes nine specific categories: death, dismemberment, significant disfigurement, fracture, loss of a fetus, permanent loss of use of a body organ, member, function or system, permanent consequential limitation of use of a body organ or member, significant limitation of use of a body function or system, or a medically determined injury or impairment of a non-permanent nature which prevents the plaintiff from performing substantially all of the material acts which constitute the person's usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.

Proving Serious Injury: Medical Evidence and Expert Testimony

Establishing serious injury requires objective medical evidence supported by competent expert testimony. The courts have developed detailed standards for the type and quality of evidence necessary to survive summary judgment and prove serious injury at trial.

Range of motion testing, diagnostic imaging, and contemporary medical records form the foundation of serious injury proof. However, the defense frequently challenges these foundations through competing medical evidence, IME findings, and arguments about pre-existing conditions or gaps in treatment.

The interplay between no-fault benefits and serious injury threshold creates strategic considerations in case development and resolution. Understanding both aspects is essential for comprehensive representation in motor vehicle cases.

Why Choose the Law Office of Jason Tenenbaum?

When you're facing a no-fault insurance dispute, you need an attorney who doesn't just practice in this area — you need someone who has helped define it through nearly two decades of dedicated analysis and advocacy. Jason Tenenbaum has built his reputation as New York's foremost no-fault insurance law authority through consistent, detailed examination of every significant development in this complex field.

Unparalleled Experience and Knowledge

Comprehensive Practice Focus

The Law Office of Jason Tenenbaum concentrates exclusively on areas of law where Jason has developed recognized expertise — no-fault insurance disputes, personal injury cases involving the serious injury threshold, and related insurance matters. This focused practice ensures that clients receive representation from someone who truly understands the nuances of their specific legal issues.

Whether you're dealing with denied medical benefits, IME or EUO demands, fee schedule disputes, or threshold injury questions, Jason brings both broad knowledge of the field and specific experience with your particular type of case.

Client-Centered Approach

Jason understands that legal disputes can be overwhelming, particularly when you're dealing with injuries, medical treatment, and financial pressures. His approach emphasizes clear communication, thorough preparation, and aggressive advocacy combined with realistic assessment of case strengths and challenges.

The firm serves clients throughout Long Island and the five boroughs of New York City, with offices conveniently located to serve the metropolitan area. Evening and weekend consultations are available when necessary to accommodate work schedules and medical appointments.

Frequently Asked Questions About New York No-Fault Insurance

1. How long do I have to file a no-fault insurance claim after an accident?

You must submit your initial no-fault claim (NF-2 form) within 30 days of the accident. This is an absolute deadline with very limited exceptions. Missing this deadline can result in complete loss of your right to no-fault benefits, making it crucial to act quickly after any motor vehicle accident.

2. What is the minimum amount of no-fault coverage required in New York?

New York requires minimum Personal Injury Protection (PIP) coverage of $50,000 per person. This coverage includes medical expenses, lost wages (up to $2,000 per month), essential services, and death benefits. Many policies provide higher coverage limits.

3. Can my no-fault benefits be denied, and what can I do if they are?

Yes, no-fault benefits can be denied for various reasons including failure to attend IMEs or EUOs, lack of medical necessity, or procedural issues. If your benefits are denied, you have the right to challenge the denial through arbitration or court litigation. Working with an experienced no-fault attorney significantly improves your chances of overturning improper denials.

4. What is an Independent Medical Examination (IME) and do I have to attend?

An IME is an examination by a doctor chosen by the insurance company to evaluate your injuries and treatment. Generally, you are required to attend properly scheduled IMEs, and failure to appear can result in suspension of benefits. However, there are grounds to challenge improper IME demands.

5. What happens if I'm asked to attend an Examination Under Oath (EUO)?

An EUO is a formal proceeding where the insurance company can question you under oath about your claim. You have the right to have an attorney present. Failing to appear at a properly noticed EUO can result in denial of your entire claim, so it's essential to understand your rights and prepare properly.

6. How does the serious injury threshold affect my case?

New York's serious injury threshold (Insurance Law § 5102(d)) limits when you can sue for pain and suffering damages. You must prove a "serious injury" as defined by statute to recover non-economic damages. This doesn't affect your no-fault benefits but impacts any additional lawsuit against the at-fault driver.

7. What if the other driver doesn't have insurance?

If you're injured by an uninsured driver or in a hit-and-run accident, you may be eligible for benefits from the Motor Vehicle Accident Indemnification Corporation (MVAIC). This involves specific notice requirements and procedures different from standard no-fault claims.

8. Can I choose my own doctor for treatment under no-fault insurance?

Generally yes, you can choose your own treating physicians. However, the treatment must be reasonable and necessary, and the charges must comply with applicable fee schedules. The insurance company may challenge treatment decisions through peer review or IME processes.

9. What should I do if my no-fault insurance company is not paying my medical bills?

Insurance companies must pay or deny claims within 30 days of receiving complete claim information. If they fail to act timely, interest penalties may apply. If bills aren't being paid, you should investigate whether proper claims were submitted, whether there are outstanding requests for information, and consider legal action to compel payment.

10. How long do no-fault benefits continue?

No-fault benefits continue until the policy limits are exhausted (minimum $50,000), the treatment is no longer medically necessary, or the insurance company successfully establishes grounds for discontinuation. The duration depends on the severity of injuries, cost of treatment, and ongoing medical necessity.

Get Expert Legal Help with Your No-Fault Insurance Claim

Don't let insurance companies take advantage of you during your time of need. If you're dealing with denied benefits, IME demands, EUO requirements, or any other no-fault insurance issue, you need representation from New York's leading authority on no-fault insurance law.

With 17 years of specialized experience and the most comprehensive knowledge of New York no-fault case law, Jason Tenenbaum has the expertise to protect your rights and maximize your recovery. Whether you're facing initial claim denials, complex coverage disputes, or threshold injury questions, Jason provides the authoritative representation you need.

Don't wait — no-fault insurance claims involve strict deadlines and complex procedures that require immediate attention. Contact the Law Office of Jason Tenenbaum now to ensure your rights are protected and your benefits are secured.