No-Fault Denied?
We Fight Back.

Long Island NY No-Fault Experts

At The Law Office of Jason Tenenbaum, P.C., we've guided countless clients through the complexities of New York's no-fault system. Whether your benefits have been denied, your insurer is demanding an Examination Under Oath, or you've received a suspicious Independent Medical Examination, our team knows how insurers operate — and how to stop them in their tracks. This page breaks down what you need to know about New York's no-fault landscape and what you can do if the system isn't working for you.

How No-Fault Insurance Works in Real Life

New York's no-fault system requires your own car insurance to cover initial medical costs and lost wages after an accident, no matter who caused the crash. Under Personal Injury Protection (PIP) coverage, your insurer is obligated to pay up to $50,000 for reasonable and necessary medical treatment and a portion of lost wages. While this sounds straightforward, real-world claims almost always hit roadblocks.

Common Roadblocks in No-Fault Claims

Insurance companies have refined their claim-denial strategies over decades. The most common tactics used against Long Island claimants include:

• IME cutoffs: The insurer orders an Independent Medical Examination — conducted by a doctor on their payroll — who concludes that further treatment is "not medically necessary," abruptly terminating your benefits.
• EUO non-appearance denials: If you miss an Examination Under Oath — even due to a scheduling conflict — the insurer may use it as grounds to deny your entire claim.
• Delay tactics: Insurers have 30 days to accept or deny a completed claim. Deliberate paperwork requests and processing delays are used to stretch that window while you go without needed care.
• Pre-existing condition arguments: Insurers routinely blame prior conditions for current injuries, shifting the burden to you to prove the accident caused new damage.
• Medical necessity disputes: Insurers challenge the scope and duration of treatment, disputing specific procedures, specialist referrals, and diagnostic imaging as excessive.

When No-Fault Isn't Enough

No-fault insurance caps payments at $50,000 in New York. For serious injuries like fractures or prolonged disabilities, costs often exceed this limit. This is when personal injury claims become critical to recover additional damages like pain and suffering. New York's "serious injury threshold" allows you to sue the at-fault driver directly if you suffered: a significant limitation of a body function or system, a permanent consequential limitation, a fracture, or 90 days of disability within the first 180 days of the accident. Understanding when you've crossed that threshold — and proving it — requires experienced legal counsel.

Personal Injury Law: Beyond Car Accidents

While car crashes dominate personal injury cases in New York, no-fault principles interact with other injury scenarios. Other situations that often require legal action alongside or beyond no-fault coverage include:

• Defective Products: Malfunctioning equipment causing workplace injuries — where product liability claims supplement workers' compensation coverage.
• Premises Liability: Slip and falls and other property accidents where no-fault may not apply but property owner liability does.
• Catastrophic Injuries: Spinal cord damage, traumatic brain injuries, and other severe harm that far exceeds any no-fault cap and demands full tort recovery.

Proving Your Case

Four key elements determine whether you have a strong personal injury claim beyond the no-fault system:

• Duty of care: The other party owed you a legal duty — such as a driver's duty to operate safely.
• Breach: That duty was violated through careless or reckless conduct.
• Causation: The breach directly caused your injuries — not a pre-existing condition or an unrelated event.
• Damages: You suffered quantifiable harm: medical bills, lost wages, pain and suffering, or permanent impairment.

From Paperwork to Courtroom: What to Expect

No-Fault Claim Timeline

The no-fault process moves on strict deadlines. After an accident in Nassau County or Suffolk County, you must notify your insurer within 30 days and submit medical bills within 45 days of treatment. Your insurer has 30 days to respond to a complete claim — but can extend that by scheduling an IME or EUO. If benefits are wrongfully terminated, you can initiate arbitration through the American Arbitration Association, which typically resolves within 90 days, or pursue litigation in court for larger disputes.

Personal Injury Lawsuit Steps

When your injuries clear the serious injury threshold, a personal injury lawsuit follows a structured path: pre-suit investigation and demand letter, filing of the complaint, discovery (exchanging evidence, deposing witnesses), independent medical examinations, summary judgment motions if applicable, and ultimately trial or a negotiated settlement. Most cases resolve well before trial — but having an attorney who is genuinely prepared to go to court forces insurers to offer fair value.

When Injuries Change Everything: Catastrophic Cases

Severe injuries like spinal damage or traumatic brain injuries require specialized legal approaches. No-fault's $50,000 cap is meaningless in the face of lifetime care costs, lost earning capacity, and the irreversible impact on quality of life. These cases demand expert medical witnesses, life-care planners, vocational economists, and aggressive litigation strategy. Our firm has handled catastrophic injury cases resulting in seven-figure recoveries for clients across Long Island.

Real Cases, Real Lessons

Case 1: Spotting Insurance Bad Faith

A client's insurer delayed approving surgery for a herniated disc, claiming they needed "more proof." We filed a bad faith lawsuit, forcing them to pay the claim plus penalties for unreasonable delays. This case is a reminder: insurers who stall without legitimate reason face consequences — but only when claimants have counsel who knows how to apply pressure.

Case 2: Beating the "Pre-Existing Condition" Defense

After a truck accident, the insurer argued our client's back pain stemmed from old injuries. MRI comparisons proved the accident caused new damage, leading to a $850,000 settlement. Detailed medical record review and expert testimony made the difference — the kind of thorough preparation that routinely separates our results from the average.

Why Legal Experience Changes Outcomes

Clients without lawyers average settlements 40% lower than those with experienced representation. In no-fault and personal injury cases, attorneys excel at:

• Preserving critical evidence before it disappears
• Navigating mandatory IME and EUO procedures without triggering denial grounds
• Identifying and challenging bad-faith insurer conduct
• Retaining the right medical and forensic experts at the right time
• Calculating true damages — including future costs — rather than accepting an insurer's lowball figure
• Applying litigation pressure that forces fair settlement negotiations

What's Next for Injury Law?

New York's no-fault landscape continues to evolve. Ongoing legislative scrutiny of the no-fault system, increased insurer use of AI-driven claim review, and stricter medical necessity standards all make 2025–2026 a critical time to have experienced counsel. Our firm stays current on regulatory changes affecting Nassau County and Suffolk County claimants so that your legal strategy reflects the law as it actually applies to your case today.

Take Control of Your Recovery

Dealing with injuries is hard enough without legal confusion. If you are facing any of the following, do not wait to contact us:

• Getting pushback from insurers on legitimate medical claims
• Unsure if your settlement offer reflects the true value of your case
• Facing mounting medical bills without income while your claim is "under review"
• Received notice of an IME or EUO and don't know your rights
• Had no-fault benefits cut off after an insurance-ordered examination

The Law Office of Jason Tenenbaum, P.C. offers free consultations to accident victims and claimants across Long Island, including Nassau County and Suffolk County. Call 516-750-0595 or contact us online to speak with a no-fault litigation attorney today.