Ajlouny Injury Law
New York personal Injury Lawyers
The NewYork Comprehensive Automobile InsuranceAct
The “No Fault” Law
Effective date: February 1, 1974
Provide prompt reimbursement of basic economic loss
Reduce lawsuits arising from motor vehicle accidents
NewYork is one of 12 states that have a No-Fault auto insurance
As the name suggests, No-Fault insurance coverage does not depend
upon who is to blame in an accident.
NewYork State’s No-Fault law requires insurance companies to pay up to
$50,000 for accident-related medical expenses, lost earnings and
incidental costs, no matter who is at fault.
The coverage includes the driver and passengers.
Receive payment for medical expenses, lost wages and other expenses
without having to go to court to prove who was at fault in an accident.
Do not have to (but may) sue to prove fault and collect benefits.
NewYork’s No-Fault Law also limits the ability injured persons in a motor
vehicle accident to sue for additional damages or pain and suffering.
To pursue a claim for pain and suffering or damages beyond what No-
Fault Insurance covers, one must meet the “Serious InjuryThreshold.”
NewYork No-Fault covers any person injured in a motor vehicle collision
in the State of NewYork.
NewYork’s No-Fault insurance does not cover drivers or passengers on a
NewYork No-Fault covers injuries in one vehicle accidents (e.g. when a
car strikes a telephone pole) and multiple car accidents.
The driver of a motor vehicle injured in a motor vehicle accident
Any passenger in a injured in a motor vehicle accident
Any pedestrian injured in a motor vehicle accident
Any bicyclist injured in a motor vehicle accident
Any passenger in a bus injured in a motor vehicle accident
Any passenger in a taxi, livery cab or limousine injured in a motor
Any passenger in a truck injured in a motor vehicle accident
NewYork’s No-Fault insurance does not cover drivers or passengers on
No-Fault insurance is part of the coverage provided for every
motor vehicle (except motorcycles) sold in NewYork or by an
insurance company that sells coverage in NewYork.
Motorcycles do carry NF for pedestrians struck.
The injured person generally receives coverage through the
insurance company that insures the vehicle in which the person
Injured driver: coverage through the insurance company of the car that
he or she is driving.
Injured pedestrian: coverage through the insurance company of the car
that struck the pedestrian.
Injured bicyclist: coverage through the insurance company of the car that
hit the bicyclist.
Passenger on a bus: coverage through the insurance company of the bus.
Passenger in a taxi, livery cab or limousine: coverage through the vehicle
in which he or she rode.
Passenger in a truck: coverage through the truck’s insurance company.
Must file a Notice of Accident form (the NF-2) with the No Fault
insurer within 30 days.
IME and Examination UnderOath
Verification of Medical Necessity
All necessary expenses incurred for:
(i) medical, hospital, surgical, nursing, dental, ambulance, x-ray,
prescription drug and prosthetic services;
(ii) psychiatric, physical therapy (provided that treatment is
rendered pursuant to a referral) and occupational therapy and
(iii) any non-medical remedial care and treatment rendered in
accordance with a religious method of healing recognized by the
laws of this state; and
(iv) any other professional health services; all without limitation as
to time, provided that within one year after the date of the
accident causing the injury it is ascertainable that further expenses
may be incurred as a result of the injury.
Loss of earnings from work which the person would have performed had
he not been injured, and reasonable and necessary expenses incurred by
such person in obtaining services in lieu of those that he would have
performed for income, up to $2,000 per month for not more than three
years from the date of the accident causing the injury.
Lost wage less 20%
All other reasonable and necessary expenses incurred, up to twenty-five
dollars per day for not more than one year from the date of the accident
causing the injury.
For example, prescription, taxi or bus fare to a doctor’s appointment,
household help, child care are “other expenses” that should be covered.
Compensation beyond No Fault Coverage is limited to
Economic loss that exceeds the first party benefits of $50,000
Non-economic loss that results in a “serious injury”
Must be pleaded in the complaint
"Serious injury" means a personal injury which results in:
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 injured person from performing substantially
all of the material acts which constitute such 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
Motor vehicle accidents often result in soft-tissue injuries which can be
very painful and debilitating.
AppellateCourt rulings in NewYork make successful prosecution of “soft
tissue claims” difficult.
Soft tissue injuries must meet definitions six, seven or eight and require
documentation of specific injuries, extensive treatment and lost or
Being unable to work for 90 out of 180 days following the accident may
automatically meet the serious injury threshold.
Did the plaintiff make immediate complaints of pain or injury?
Did the plaintiff receive emergency room treatment or urgent
care treatment on the day of the accident or as soon as
possible in the next few days?
Was there a definitive diagnosis? Sore back v. Herniated Disc in
lumbar spine per MRI.
Did the plaintiff miss time from work due to the injury?
Was there regular and consistent medical treatment?
Was a loss of motion documented?
Toure v. Avis Rent A Car Systems, Inc., 98 N.Y.2d 345, 746 N.Y.S.2d 865
Court ofAppeals enunciated the standard by which a plaintiff may meet
their burden of demonstrating that they suffered a “permanent
consequential limitation of use of a body organ or member” or a
significant limitation of use of a body function or system,” as defined by
Section 5102 of the Insurance Law.
1) demonstrate that they suffer from a physical limitation which
prevents them from doing certain daily activities or those
activities which they enjoyed prior to the accident; and
2) present admissible objective medical evidence ascribing a
specific percentage to the loss of range of motion or some other
objective finding; or
3) present admissible medical evidence describing in detail the
qualitative nature of the plaintiff’ limitations.
4) must also offer admissible medical evidence (usually in the form
of affidavits or affirmations) causally relating the above criteria to the
In a companion case toToure, Manzano v. O’Neil, the Court
also addressed an issue common to many “threshold” cases,
that of the “gap in treatment.”
In Manzano, the plaintiff’s expert based his testimony on a
physical examination of the plaintiff which took place more
than four years prior to the trial.
Defendant argued that such a “gap in treatment” prevented
the expert from stating the plaintiff’s condition was
The Court, however, rejected the defendant’s argument,
finding that where the medical evidence suggests that the
plaintiff would not have benefited from any further treatment,
such a “gap” does not preclude an expert’s finding that the
plaintiff’s condition was permanent. Id.
Appellate Divisions and trial courts were requiring medical reports listing
the numerical ranges of motion that were contemporaneous with the
If a doctor did not ascribe a range of motion to the patient right after
injury, subsequent range of motion measurements were argued of no
Perl v. Meher, 18 N.Y.3d 208 (2011).
Court ofAppeals ruled that neither the NF Statute norToure required
contemporaneous range of motion measurement.
Ajlouny Injury Law
NewYork Personal Injury Lawyers