How No-Fault Insurance Covers Medical Bills in New York

For a typical New York car crash, submit eligible medical bills to the no-fault insurer of the vehicle you occupied, not automatically your own auto insurer. A pedestrian generally claims with the insurer of the vehicle that struck them. Open the claim promptly, give the claim details to your providers, and track accident notice separately from each bill's proof deadline.

Basic no-fault coverage pays eligible economic losses without deciding who caused the crash, up to a combined $50,000 per person and subject to coverage rules. It is not a promise that every bill will be paid, and it does not pay for vehicle repairs or pain and suffering.

Which Insurer Should Receive the Bills?

The New York Department of Financial Services filing instructions identify the usual starting points:

• Driver or passenger in a car: Start with the insurer of the vehicle occupied in the New York crash.
• Pedestrian: Start with the insurer of the vehicle that struck you.
• Bus passenger: Your own or a household member's auto no-fault coverage may come first; if there is none, the bus insurer may be responsible.
• Uninsured or unidentified vehicle: Ask about your own or a resident household relative's policy. If no such coverage applies, the Motor Vehicle Accident Indemnification Corporation (MVAIC) may be a route for an eligible claimant. Eligibility and prompt police-reporting requirements apply; DFS identifies a 24-hour reporting requirement for that route.

Out-of-state accidents can have a different coverage order. Motorcycle operators and passengers generally do not receive no-fault benefits. Certain exclusions are allowed by Insurance Law § 5103. Even an intoxication-related exclusion has a statutory exception for specified emergency hospital and ambulance services, with possible insurer recoupment. Ask for the actual exclusion and written reason instead of assuming every claim is covered or every excluded situation means all care is unpaid.

Use the insurer's official claim channel. Request a claim number, the bill-submission address or portal, the adjuster's contact details, and the required forms. Give those details to each provider and keep proof of what you submitted. Do not assume a hospital's billing office has also provided your initial accident notice.

Keep the 30-, 45-, and 90-Day Requirements Separate

These are the usual no-fault notice and proof rules, not deadlines to file a negligence lawsuit. The Regulation 68 mandatory endorsement sets these separate requirements:

The NF-2 application is a normal way to provide claim information, but the initial requirement is sufficient written notice, not waiting for a particular form to arrive. If a deadline was missed, submit the missing material and a clear written explanation. The rules allow late submissions where the insurer receives written proof of clear and reasonable justification. That exception requires review; it is neither an automatic extension nor a reason to abandon a late claim without checking.

Respond to legitimate verification requests and keep copies. A claim number alone does not show that every bill or wage-loss period has been documented.

What the $50,000 Basic Benefit Includes

Insurance Law § 5102 combines medical expenses, work loss, and other reasonable necessary expenses within basic economic loss. The $50,000 amount is not a separate allowance for each category. Limits and statutory offsets apply.

• Medical care: Eligible reasonable and necessary accident-related medical expenses are subject to the statutory fee and coverage rules. The insurer may ask for evidence about causation, necessity, or the bill.
• Lost earnings: Benefits are generally 80% of lost earnings up to $2,000 monthly, for no more than three years after the accident, subject to other statutory benefit coordination.
• Other necessary expenses: Up to $25 daily for no more than one year after the accident, subject to proof and the overall limit.

The three-year wage-loss period is not a three-year cutoff for all medical bills. Section 5102(a)(1) does not impose a medical time limit if, within one year of the accident, it is ascertainable that further medical expenses may be incurred. The remaining coverage limit, medical eligibility, and timely proof requirements still matter.

Ask for a payment ledger showing the amount used and remaining. Optional Basic Economic Loss (OBEL) and additional PIP are different policy options, not automatic extra benefits. OBEL adds $25,000 for the selected categories specified in the law; broader additional coverage depends on the purchased endorsement.

If the Insurer Does Not Pay a Bill

First distinguish a bill awaiting information, a denial, and exhausted benefits. Ask the provider and insurer for the same service date, billed amount, amount paid, and reason for the remaining balance. Otherwise, a duplicate bill or an unprocessed submission can look like a coverage denial.

• Information missing: Obtain the actual verification request and confirm who must respond.
• Medical necessity or accident connection disputed: Send the written reason to the treating provider so the response addresses the disputed issue.
• Coverage or eligibility denied: Request the policy provision, denial form, and facts relied on.
• Benefits exhausted: Request the payment ledger and the date exhaustion occurred, then check any additional auto coverage and health-plan billing options.

Do not treat the 30-day claim-payment rule as a guarantee of payment 30 days after the crash. Payment timing depends on receipt of the required proof and applicable verification rules. A disputed New York no-fault claim may be addressed through a DFS complaint, arbitration, or a court action. Their procedures and deadlines differ; choose a route after reviewing the denial rather than assuming a complaint pauses other deadlines.

Health coverage may address eligible expenses after no-fault benefits are exhausted, but network, coordination, and cost-sharing rules can still apply. Confirm the billing instructions with the health plan. Neither the existence of PIP nor a provider's original bill proves what you personally owe.

Can You Recover Medical Costs Beyond No-Fault?

Potentially. Insurance Law § 5104 separates basic economic loss from excess economic loss and non-economic loss. In the covered-person actions governed by that section, pain and suffering requires a qualifying serious injury, but a claim for economic loss exceeding basic economic loss does not require that threshold. You must still establish the responsible party's liability, the recoverable loss, and compliance with other legal rules.

For Article 51 personal-injury actions begun on or after May 26, 2026, CPLR 1411(b) bars recovery when the claimant's fault exceeds the fault of the person, or combined persons, against whom recovery is sought. Otherwise, the proportionate reduction applies. This is not the old unrestricted pure-comparative rule.

Chapter 58 of 2026, Part EE also removed the former 90-out-of-180-days serious-injury category for actions and proceedings commenced on or after that date. The commencement date, not just the accident date, controls this amendment's application. Current § 5102(d) lists the remaining categories. Earlier proceedings require a prior-law assessment.

Most ordinary negligence injury actions have a three-year period under CPLR 214, generally from the accident. That period does not replace the shorter no-fault notice and proof rules. Government claims, wrongful death, minors, and insurance disputes require separate deadline checks.

One Record for Each Unresolved Bill

Make one entry per service date: provider, amount charged, submission date, payer response, amount paid, and remaining issue. Attach the actual request or denial. This gives the provider, insurer, or adviser a specific question to answer instead of an unexplained stack of statements.

The DMV report is another separate obligation. For a New York crash involving death, injury, or more than $1,000 damage to any one person's property, the required driver report is due within 10 days under Vehicle and Traffic Law § 605. Sending it does not notify the no-fault insurer.

If you need help with a denial, approaching deadline, or uncertain payer, use our official legal-help resources. TurnYourClaim does not receive your medical bills or provide legal representation.

This article provides general information, not legal or medical advice. Coverage and legal deadlines depend on the facts and the policy in force. A New York-licensed attorney can assess your claim.