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Know Your Rights:
In the Event of a Car Accident

If you are injured in a car accident any where in the state of New York, there are specific steps you must take in order to protect your rights. All persons injured as a result of the use or operation of a motor vehicle (even pedestrians and bicyclists), are entitled to received No-Fault benefits for accident related losses, regardless of fault. Motorcycles, mopeds and ATV’s are excluded. No-Fault benefits include medical bills, lost earnings, travel expenses, household care, death benefits, and prescriptions.

No-Fault benefits are provided by the insurance company insuring the vehicle you were in (or in the case of a pedestrian or bicycle accident, the vehicle that struck you). The insurance company insuring the vehicle you were in is responsible for paying all properly submitted claims resulting from the accident. However, the company does not have to pay more than the policy limits. There is at least $50,000.00 in No-Fault benefits for each qualifying injured party. However, if you (or the owner of the vehicle) purchased additional Personal Injury Protection (PIP) above the $50,000.00 minimum, then the No-Fault insurance company is responsible for paying up to the full value of that policy.

car accident injuriesThe insurance company providing No-Fault benefits does not provide compensation for “pain and suffering.” The Albany car accident lawyers at Anderson, Moschetti & Taffany will analyze your injuries and disability to determine if you have a claim for “pain and suffering.” In addition, to the extent that your losses are medical expenses and wages totaling in excess of $50,000.00, a claim can be made for the portion of your damages that exceed this amount.

The most important thing for you to know about obtaining No-Fault benefits is that the application must be filed with your insurance company no later than 30 days from the date of the accident. The application process will be one of the first matters that our Albany – Saratoga Springs area car accident attorneys will discuss with you. The second most important thing for you to know is that Anderson, Moschetti & Taffany will be here to answer your questions and ensure sure that your application is completed correctly and filed in a timely manner.

THE NO FAULT INSURANCE COMPANY WILL PAY FOR:

MEDICAL BILLS – 100% of all bills for injuries you sustained in the accident. The New York State Insurance Department has a fee schedule setting forth the maximum a health care provider may charge in a No-Fault case. You are not responsible to pay any portion of the bill not covered under the No-Fault fee schedule.

Your health care providers will submit their bills directly to your No-Fault insurance carrier. You must be sure to provide your health care providers with the name, address and claim number of the No-Fault carrier so they can submit their bills.

LOST WAGES – 80% of gross wages up to $2,000.00 per month, for the first three years after the accident. A doctor must state you are unable to work due to accident related injuries. If your earnings are higher than $2,000.00 per month, we will seek the lost monies from the negligent party’s insurance company. However, if you (or the owner of the vehicle) purchased additional Optional Basic Economic Loss Protection (OBEL) above the $2,000.00 minimum, then the No-Fault insurance company is responsible for paying the additional lost wages up to the value of that policy.

Your employer must fill out an Employer’s Wage Verification Report. Your doctor must complete a form(s) stating you are unable to work. Lost wages will be paid only for three years following the date of accident.

SELF-EMPLOYED INDIVIDUALS – Self-employed people must fill out a Verification of Self Employment form. This form, with copies of your previous two year’s income tax records, must be submitted to your No-Fault insurance carrier in order to receive lost wages. If you hire someone to perform the activities you performed, the No-Fault carrier will pay 100% of your substitute’s salary (even if it’s greater than your salary), up to $2,000.00 per month, for three years.

UNEMPLOYMENT BENEFITS – You will receive 100% of your weekly unemployment rate from the No-Fault carrier to cover unemployment which occurred during your disability. You cannot collect both unemployment and No-Fault benefits at the same time. If, at the time of your accident, you were collecting unemployment benefits and your doctor tells you that you are unable to work, you must advise the unemployment office. To preserve your unemployment benefits and collect No-Fault, here is what you must do:

  1. Obtain a letter of disability from your doctor indicating you cannot work.
  2. Submit the doctor’s letter of disability to the unemployment office, and obtain a letter from Unemployment stating the weekly rate of your payments and the dates you became eligible for benefits.
  3. Mail the unemployment information to the No-Fault insurance carrier.

*New York State Disability. If you are receiving New York State disability, you should mail a photocopy of one of the disability checks to the No-Fault Insurance company, as that amount will be deducted from what No-Fault would otherwise be required to pay. The disability from the accident suspends your unemployment benefits for the time of your disability. If you are disabled as a result of an injury from your accident, but you continue to collect unemployment benefits, you are, in effect, telling the No-Fault insurance carrier that you are able to work when your doctor says you are not. Therefore, once your unemployment benefits run out, you will not be able to collect No-Fault wages because No-Fault wages are based upon an injury that prevents you from working.

TRAVEL EXPENSES – $.345 per mile for travel to and from doctor, physical therapy and hospitals. You must indicate the name of the health care provider, the date of the office visit, and the round trip mileage to receive payment.

HOUSEHOLD CARE – If your doctor believes household care is necessary, he/she must give you a letter stating household care is needed. Once you have the doctor’s letter, send it to the No-Fault insurance company, listing the dates on which care was provided. Remember, both you and the person providing the household care must sign the form. Most No-Fault insurance carriers will not pay for household care that has been rendered by a spouse, parent or family member. Workers’ compensation does not pay for household help, so you should submit for reimbursement directly to your No-Fault insurance carrier.

PRESCRIPTIONS – All prescriptions are covered under the No-Fault fee schedule. Submit receipts for all prescriptions to the No-Fault carrier. Always write the name of the doctor who prescribed the medicine and the name of the medication on the receipt.

DEATH BENEFIT – If death resulted from the accident, the No-Fault insurance company is responsible for paying a $2,000.00 death benefit. You must provide the carrier with a copy of the death certificate.

TIMING AND PAYMENT – The No-Fault carrier has up to 30 days from the date they receive all submissions to evaluate your claim. For example, if you make a claim for mileage due to a doctor visit, the carrier can wait until they receive the corresponding medical record for the same date to confirm that, in fact, you went to the doctor on the day claimed.

The No-Fault carrier is required to pay only $25.00 per day, combined, for travel expense and household help, for only the first year following the accident. To get reimbursed for your travel expenses, household care, prescriptions and lost earnings, you must submit them directly to the No-Fault insurance company within 45 days from the date of service. The company does not have to pay any claims submitted beyond 45 days. Be sure to include your claim number on every piece of paper you send to the insurance company and keep a photocopy of everything you send.

WERE YOU IN THE COURSE OF YOUR EMPLOYMENT AT THE TIME OF THE ACCIDENT?

Who actually pays for you medical, wage and other types of damages depends upon whether or not you were “in the course of your employment” at the time of your accident.

If you were NOT “in the course of your employment” at the time of your accident, your No-Fault insurance carrier provides “primary” insurance coverage. The claim must be submitted to your No-Fault insurance carrier. Your No-Fault carrier is the insurance company covering the car you were riding in, if you were a passenger or the driver, or the car that struck you, if you were a pedestrian.

If you were “in the course of your employment” at the time of your accident, you must apply for workers’ compensation benefits through your employer. Your employer’s workers’ compensation carrier will pay all of your medical bills related to injuries that were caused by the accident.

The workers’ compensation carrier is responsible for paying a portion of your earnings and the No-Fault insurance carrier is responsible for paying the balance, up to 80% of your wages not to exceed $2,000.00 per month. For example, if workers’ compensation is paying 66 2/3 of your wages, your No-Fault carrier will pay 13 1/3 of your wages, for a total of 80% with a maximum of $2,000.00 per month.

To be reimbursed for travel expenses incurred for treatment, you must indicate the name of the health care provider, the date of the office visit and the number of round trip miles to receive payment. Because you were working at the time of your accident, workers’ compensation will pay for these travel expenses.

Submit receipts for all prescriptions. Always write the name of the doctor who prescribed the medicine and the name of the medicine on the receipt.

Workers’ compensation does not provide any benefit for household help. Costs incurred for household help must be submitted to your No-Fault insurance carrier. Read the previous section on No-Fault for full details.

Whether you have experienced personal injury or wrongful death in car accident, Anderson, Moschetti & Taffany can help you through this difficult time. Our experienced personal injury attorneys will be here to answer all of your questions, make sure the No-Fault application is filed in a timely manner, and determine if a claim for “pain and suffering” can be brought on your behalf. Each attorney at Anderson, Moschetti and Taffany has handled these types of claims for over 25 years, and are knowledgeable and experienced in the investigation, litigation, settlement or, if necessary, trial of personal injury and wrongful death claims.

Call (518) 785-4900 today with your questions for the Albany Capital District personal injury attorneys at Anderson, Moschetti and Taffany.

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