How To Make A 3 Month Old Scar Less Tender Everything You’ve Ever Wanted to Know About New York No-Fault

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Everything You’ve Ever Wanted to Know About New York No-Fault

The “New York Comprehensive Automobile Insurance Act,” which most people call the “no-fault statute,” was enacted in 1973 and went into effect the following year. The purpose of the law was to limit the amount of personal injury claims for car accidents, as many politicians had this agenda on their platforms.

The no-fault statute was revolutionary in that it provided immediate payment for medical care, lost earnings and other reasonable out-of-pocket expenses incurred as a result of injuries from a motor vehicle accident. The law provides that these expenses must be paid up to $50,000 per person. These payments are what is known as “first-party benefits” or “basic economic loss.” The reason it is called no-fault, is that these payments are made regardless of fault. If you lose control of your car and drive into a tree, you still have these payments.

If your medical bills, lost earnings and/or out-of-pocket expenses are more than $50,000, you can also sue the party that caused your injuries for these additional amounts (as well as for pain and suffering). serious” and caused by someone else’s negligence, you can still bring an action. No-fault does not cover property damage, so you still need to claim for damage to your car, unless you bring “collision” or “full coverage” for your vehicle.

WHO IS COVERED?

“No-Fault benefits are provided for economic loss arising from the use or operation of a motor vehicle (Insurance Law Section 5103). Section 5102 defines a motor vehicle as “all vehicles driven on a public road accept motorcycles”. motorcycles were intentionally excluded due to the frequency of accidents, which would have made motorcycle insurance too expensive.

You are covered by no-fault insurance and so what the statute calls a “covered person”, if you are the insured, a driver or a passenger in the vehicle or a pedestrian who is injured by the operation of the vehicle. If you are not the owner of the insurance and the car insurance is not in effect, you will be covered for the no-fault benefits of “first party” in any car insurance policy in your house For example, if your adult child in your household owns a car, it would cover you. If there is no “home car”, there is a state fund called the “Motor Vehicle Accident Indemnification Corporation” (MVAIC) that provides “no-fault” benefits.

There are some exclusions you should be aware of. First, there must be an accident. No-fault benefits will not be paid if an injury is caused by an intentional act. Most insurance policies cover intentional acts, no-fault and other types of claims. For example, you did not expect that the insurance of the owners of the house will pay for the damages caused because you did not like your carpet more so you spilled ink. Likewise, if someone intentionally rams into your car, insurance will not cover the loss. Luckily, things like that don’t happen very often!

They are also not covered if you are in the “course of your employment”. This applies, for example, if you are driving a taxi, work as an assistant in an ambulance or are on a sales call. In most cases, worker’s compensation will pay similar benefits that will be covered in another article.

If you are the driver, and you are driving under the influence, no-fault benefits will not be paid for you, but they will be paid for the passengers or pedestrians you injured. It is not surprising, if you are injured while committing a crime or when trying to avoid law enforcement authorities, no benefits will be paid. Coverage will also not be provided if you operate a vehicle known to be stolen.

So, the plus side of “no fault”, is that you are automatically entitled to payment for medical expenses and many other things if you are involved in a car accident, except for the exclusions discussed above. The downside is that in order to have a “tort” claim for negligence against the operator who caused your injuries, you must have what the law defines as “serious injury.” I will explain this in more detail later in this article.

WHAT DO YOU GET IF YOU ARE COVERED?

Insurance Law Section 5102 defines it as $50,000 per person for:

All necessary expenses for medical and related services, therapy, certain non-medical treatment by an accepted religious method, and other professional health services, provided that their occurrence was verifiable within one year of the injury;

The loss of earnings and the reasonable and necessary expenses incurred in obtaining services instead of those that such persons have realized for income, up to $2,000 per month for a maximum of three years;

All other reasonable and necessary expenses are incurred up to $25 per day for no more than one year after the accident.

The first paragraph outlines the types of medical treatment that are covered. Non-medical treatments may include acupuncture and some other holistic therapies, but I would not risk pushing for “religious” treatments that are not widely recognized. Benefits paid are on a “fee schedule,” and treating medical professionals cannot pay a higher rate, making it a challenge to find doctors willing to accept no-fault payments. Most chiropractors and physical therapists are happy to accept them, but specialists like orthopedic doctors, neurologists and plastic surgeons can be hard to find.

The second paragraph allows payment for lost earnings proven due to an accident. If you are self-employed, you can submit your tax returns to show a loss of income. In general, you need to provide three years of tax returns – two previous years that show what you usually earn and the year the accident occurred that shows you made less. If you need to hire someone to temporarily replace you, such as someone to drive your taxi when you have the medallion, the amount you pay for the replacement driver can be refunded. Obviously, if you have been working “off the books”, you cannot make a claim for lost earnings benefits.

The third paragraph offers a small amount of money that is usually used for reimbursement of taxis to medical treatment and similar costs. You can also be reimbursed for family help if you can’t take care of your children or take care of your house (but only $25 a day). choose to purchase this additional coverage. Your no-fault insurance benefits will, under certain circumstances, also cover you for accidents that occur in other States.

HOURS

A no-fault claim must be filed with the insurance company within thirty days of the accident. All requests must be submitted within 180 days of their date of service. Most insurance companies pay benefits immediately. There may be issues related to the adequacy of the proof provided, which may delay payment. The insurance companies sometimes declare that the treatment is not medically necessary and deny the payment, in which case the doctor can arbitrate this denial or sue the insurance company for the payment of his bills. It is worth dealing with medical professionals who are willing to do these arbitrations, instead of ending up responsible for payment, or with a lien in your case, if the insurance company refuses to pay. The insurance company also has the right to be seen by the doctors who hire them to determine if your treatment is necessary. Eventually, as your injuries improve, the insurance company’s associate doctor will “deny” your medical treatment as no longer necessary, which can also be arbitrated or disputed by the treating medical professional.

HOW DOES NEW YORK LAW DEFINE “SERIOUS INJURY?”

The threshold for “serious injury” is defined in §5102(d). Damages for pain and suffering are only recoverable if the claimant suffers injuries that result in:

Death; o

dismemberment; o

Fracture; o

significant disfigurement; o

loss of the fetus; o

permanent loss of use of an organ, limb, function or body system; o

permanent limitation of the use of a body function or system; o

significant limitation of the use of a body function or system; o

Medically determined injury or impairment of a non-permanent nature, which prevents the injured person from performing substantially all material, acts that constitute the habitual or usual activity of such person for not less than 90 days during the 180 days immediately following occurrence or injury.

The first two categories above are obvious. Fractures appear on X-rays and always meet the limit of serious injuries, no matter how minor they are. A fracture of the hair of the left pinky toe will be enough, even if no treatment is required and there is no disability. Significant disfigurement is less clear. Usually, the problem is cuts and abrasions on the face or other visible parts of the body that result in “scars” and whether or not the remaining marks are really disfiguring. Case law explains that the scar must be so unattractive that the person is a target of “pity and contempt.” A mark that should be “pointed” does not meet the threshold.

With the loss of a fetus, it must be shown that the abortion was actually caused by the accident. It would not be credible to claim that a miscarriage was caused by a minor impact, especially if the woman did not immediately seek medical treatment for any injuries and lost the child a month later.

The “permanent loss” and “significant limitation” section was intended to cover paralysis or other severe loss of use, but has grown to include much less severe impairments, such as ligament tears and herniations of the neck and back. . There must always be objective evidence, such as MRI and the doctor’s report to reinforce these statements, the subjective claims of pain are never enough to meet the threshold of serious injury.

The limit is met when an injured person misses more than 90 days of work due to their injuries. The time off work does not have to be immediate and it does not have to be consecutive. For example, a person could be out of work for a month after an accident, try to return to work, be out again, return, surgery and then be out again to recover. As long as he is more than 90 days out of the first 180 days, he meets the serious injury limit, as long as a doctor certifies that he was not really unable to work. It is not impossible, but much more difficult to qualify under this prong without a full-time paid job, but there are many circumstances where it could apply. For example, a housewife with small children may be unable to provide care and need to hire childcare for her children, losing 90 out of 180 from her usual activities.

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