A Guide to Personal Injury Protection (PIP) in New York

Many New Yorkers assume the at-fault driver's insurance covers everything after a crash. That's not how NYC PIP works. New York is a no-fault state, which means your own insurance policy pays your medical bills and lost wages first, regardless of who caused the accident. As experienced Rockland County car accident lawyers who handle these cases across the county, the Bronx, and New York City, we field these questions constantly: what does PIP actually cover, how do you file a claim, and when can you step outside the no-fault system to pursue the at-fault driver directly?

What Is Personal Injury Protection (PIP) in New York State

Personal Injury Protection in New York is a fundamental component of the state's no-fault insurance system. Established in 1974, New York's no-fault system was designed to provide prompt payment for medical expenses, lost earnings, and other reasonable expenses incurred by persons injured in motor vehicle accidents, regardless of who was at fault.

Under New York's no-fault system, your own insurance company pays for your medical expenses and other losses regardless of who caused the accident. This approach aims to reduce litigation and ensure injured parties receive necessary medical treatment without delay.

PIP is often referred to as "Basic Economic Loss Coverage" in New York insurance policies and legal documents. This coverage is mandatory for all vehicle owners in the state and provides essential financial protection after auto accidents.

How Does PIP Work in New York

New York operates under a no-fault insurance system, meaning that when you're injured in a car accident, you turn to your own insurance company for coverage of medical expenses and other losses, regardless of who caused the collision.

Here's how the process typically works:

• After an auto accident, you file a claim with your own insurance provider, not the other driver's.
• Your PIP coverage pays for your medical expenses, a portion of lost wages, and other necessary expenses up to your policy limits.
• These benefits are paid regardless of who was at fault in the accident.
• In exchange for this guaranteed coverage, your right to sue the at-fault driver is limited unless you suffer a "serious injury" as defined by New York law.

This system aims to provide quick payment for medical treatment and lost earnings while reducing the number of lawsuits arising from auto accidents.

Is PIP Required in New York

Yes. Personal Injury Protection is mandatory in New York. All vehicle owners must carry at least the minimum PIP coverage as part of their auto insurance policy. The state requires drivers to maintain:

• A minimum of $50,000 in PIP coverage per person
• Liability coverage for bodily injury ($25,000 per person/$50,000 per accident)
• Liability coverage for property damage ($10,000 per accident)
• Uninsured motorist coverage — UM ($25,000 per person/$50,000 per accident)
• Underinsured motorist coverage (UIM) is optional

Driving without the required PIP coverage can result in fines, license suspension, and other penalties. Additionally, if you're involved in an accident without proper insurance, you may be personally responsible for substantial medical expenses and other costs.

Who Does PIP Cover in New York

PIP coverage extends beyond the policyholder. Under New York's no-fault framework, the following individuals are covered regardless of who caused the accident:

• The named policyholder is covered whether driving or riding as a passenger in their own insured vehicle.
• All passengers in the vehicle at the time of the accident, regardless of who owns the car.
• Pedestrians struck by the insured vehicle, a frequently overlooked provision that applies even when the pedestrian has no auto insurance of their own.
• Household members of the policyholder injured in a covered vehicle.
• Any permitted driver operating the insured vehicle with the owner's permission.

Coverage applies to accidents occurring in New York State. Your NYC PIP policy also typically follows you if you are injured in another state, though the benefits applied will be the greater of New York's minimums or the other state's requirements.

What Is Covered by PIP Insurance in New York

New York's PIP coverage is comprehensive, providing benefits for various expenses related to injuries sustained in an auto accident. Your PIP benefits typically cover:

Medical Expenses

PIP covers all necessary and reasonable medical expenses related to injuries from the accident, including:

• Hospital care and emergency room visits
• Doctor visits and medical treatments
• Surgical procedures
• X-rays and diagnostic tests
• Prescription medications
• Physical therapy and rehabilitation
• Dental services for accident-related injuries
• Psychiatric services when medically necessary

These medical expenses are covered up to your policy limit, typically $50,000 for standard policies, although you can purchase higher coverage limits if you choose.

Lost Earnings

If your injuries prevent you from working, PIP provides compensation for lost wages. This benefit:

• Covers 80% of your lost earnings.
• Has a maximum payment of $2,000 per month.
• Available for up to three years from the date of the accident.
• Requires documentation from both your doctor and employer.

Household Help

When injuries prevent you from performing household tasks, PIP can cover:

• Up to $25 per day for reasonable and necessary household services.
• This may include cleaning, cooking, childcare, and other domestic tasks you cannot perform due to your injuries.

Funeral Expenses

In the tragic event of a fatal accident, PIP provides:

• Up to $2,000 in funeral expenses for a person killed in an auto accident.

Additional PIP Coverage Options

Beyond the mandatory basic coverage, New York allows for optional additional PIP coverage, including:

• Additional Personal Injury Protection (APIP): Increases your total available benefits beyond the standard $50,000.
• Optional Basic Economic Loss (OBEL): Provides an additional $25,000 of coverage that can be allocated to medical expenses, lost income, or other reasonable expenses.

How to File a PIP Claim in New York

Filing a PIP claim promptly and correctly will allow you to receive the benefits you need after an accident. Here's a step-by-step guide:

1. Notify Your Insurance Company

• Report the accident to your insurance company as soon as possible.
• Most insurers require notification within 30 days of the accident.
• Provide basic information about the accident, including date, time, location, and parties involved.

2. Complete the No-Fault Application

• Your insurer will provide a No-Fault Application form (NYS Form NF-2).
• Complete this form thoroughly and accurately.
• Submit the application within 30 days of the accident.
• Send the form by certified mail with a return receipt requested to preserve proof of timely filing.

3. Attend Required Medical Examinations

• Attend any independent medical examinations (IMEs) requested by your insurer.
• These examinations help verify your injuries and the necessary treatment.
• Failure to attend can result in the denial of benefits.

4. Submit Medical Bills and Lost Wage Documentation

• Ensure all healthcare providers submit their bills directly to your insurer.
• Healthcare providers must submit bills within 45 days of treatment.
• For lost wage claims, submit verification from your employer and medical provider.
• Use the prescribed forms: NF-3 for medical providers and NF-6 for wage loss.

5. Follow Up on Your Claim

• Keep copies of all documents related to your claim.
• Monitor the status of your claim and follow up with your insurer regularly.
• Under New York Insurance Law § 5106, insurers must pay or deny valid claims within 30 days of receiving proper documentation. If payment runs past that deadline without a written denial, the insurer owes 2% monthly interest on the unpaid balance, a penalty that applies automatically.

Track your submission dates and follow up in writing if the 30-day window passes without a response.

PIP Coverage Limitations in New York

PIP covers a substantial range of losses, but several restrictions can reduce or eliminate your benefits if you're not prepared:

Policy Limits

• Standard PIP coverage in New York is limited to $50,000 per person.
• Once this limit is exhausted, you may need to rely on health insurance or pursue a lawsuit against the at-fault driver if you qualify.

Time Limitations

• Medical bills must be submitted within 45 days of treatment.
• Lost wage claims must be filed within 90 days of the date the disability began.
• The claim notification deadline is 30 days from the date of the accident.

Treatment Restrictions

• Insurers often require pre-authorization for certain treatments.
• Some treatments may be denied if deemed medically unnecessary.
• Insurers may require you to see specific healthcare providers in some cases.

Established Fee Schedules

• Payments to healthcare providers are subject to established fee schedules.
• Providers cannot bill you for the difference between their charges and what PIP pays (no balance billing).

When PIP Does Not Apply

PIP benefits can be denied outright when an accident falls within specific policy exclusions. New York insurers may lawfully refuse benefits if:

• The driver was intoxicated or impaired by drugs at the time of the accident.
• The driver was committing a felony, including fleeing law enforcement.
• The injury was intentionally self-inflicted.
• The vehicle was stolen at the time of the accident.
• The driver was participating in a race or speed test.

One exclusion many accident victims don't know about: motorcycles are not covered by New York's no-fault PIP system under NY Insurance Law § 5103(a). Motorcyclists injured in accidents cannot file PIP claims and must pursue compensation directly through a fault-based lawsuit.

These exclusions apply to the driver's own claim. Passengers and pedestrians generally retain PIP coverage even when the driver who hit them falls under an exclusion. If your insurer has denied your claim on exclusion grounds, that denial is governed by the procedures set out in 11 NYCRR Part 65 (Regulation 68), and it can be contested.

The Serious Injury Threshold and Pursuing Additional Compensation

New York's no-fault system limits your right to sue the at-fault driver for pain and suffering unless you've sustained a "serious injury". This threshold is defined by New York Insurance Law §5102(d) and includes such injuries as:

• Death
• Dismemberment
• Significant disfigurement
• Bone 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
• Medically determined injury or impairment that prevents you from performing substantially all of your usual and customary daily activities for at least 90 of the 180 days following the accident

If your injury meets one of these criteria, you may pursue a claim against the at-fault driver for:

• Non-economic damages (pain and suffering)
• Economic losses beyond what PIP covers
• Medical expenses that exceed your PIP limits

Factors Affecting PIP Cost in New York

New York mandates a $50,000 minimum, but what you actually pay for that coverage depends on several variables:

• Your driving record: Prior at-fault accidents and moving violations raise your PIP premium directly.
• Vehicle type: Higher-value or statistically higher-risk vehicles carry higher base premiums.
• Location: NYC drivers pay considerably more than drivers in upstate or suburban areas. Accident frequency and medical costs in the five boroughs push premiums up. Rockland County rates typically fall below the boroughs but above rural areas.
• Coverage level: Adding Additional Personal Injury Protection (APIP) or Optional Basic Economic Loss (OBEL)increases your premium but raises your recovery ceiling above the $50,000 baseline.
• Your insurer's approved rate filing: Carriers set their own rates within limits approved by the New York Department of Financial Services (DFS).

Under NY Insurance Law § 5108, the DFS also establishes fee schedules that govern what medical providers may bill for PIP-covered services. These caps limit insurer exposure and are one reason PIP premiums haven't escalated at the same rate as broader medical costs.

Fellows Hymowitz Rice: Fighting for Your Maximum Compensation

Personal Injury Protection covers the basics, but the claims process rarely runs as smoothly as the statute intends. Insurers schedule independent medical examinations, dispute treatment plans, and deny benefits on procedural grounds that injured people rarely anticipate.

Fellows Hymowitz Rice has handled no-fault disputes and personal injury cases throughout New York for over 40 years, from Rockland County to the Bronx to Manhattan. Contact us today for a free consultation, and let us help you secure the benefits you deserve.