What does No Fault really mean?

A: No Fault was created in the early 1970's for New York. 

If you are a passenger or driver of a car injured in an accident, the No fault insurance of the car you are in pays for your "medically necessary" medical bills and resulting lost wages, stemming from the car accident.  The car insurance of the car you are in is primary, regardless of who was at fault for the accident.  Hence, the term No Fault.  It is possible that your own car insurance or that of a household family memeber could also apply. 

If you are a pedestrian, the vehicle that strikes you provides only basic No Fault protection.  It is possible that your own car insurance or that of a household member could also apply here also.

PLEASE BEWARE- there are some tricky exceptions to this general rule (buses. rental vehicles, out of state accidents, out of state vehicles, uninsured vehicles, or a combination of all of these) that can make a simple no Fault claim very very complicated.  You should consult our office immediately at 718-918-9090 to analyze your particular situation/

In exchange for this No Fault medical and lost wage coverage system, you must then "qualify" for a recovery (settlement or award of damages) for pain and suffering.  How do you qualify?

According to Regulation 5102(d) of the Insurance Law, you qualify, by breaching one of the following "serious injury threshold" requiremen sections, outlined below:

1. Death
2. Dismemberment
3. Significant disfigurement
4. Fracture
5. Loss of a fetus
6. Permanent loss of a body organ, member, function, system
7. Permanent consequential limitation of of use of a body organ or member
8. Significant limitation of use of a body function or system, or
9. A medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitue such person's usual and customary daily activities for not less than 90 days during the 180 days immediately following the occurrence of the injury or impairment.

If you fit one of these categories, you qualify.  Not so fast, we then must analyze the liability of the accident and the insurance coverages available to determine what type of recovery can be achieved in any given case.  All of these factors determine the potential outcome in your case.