Understanding New York’s No-Fault Insurance System

How Rochester’s No-Fault System Helps After a Crash

Getting into a car accident in Rochester can be overwhelming. Between the pain, the paperwork, and the worry about missed work, it’s a lot to handle. The good news? New York’s no-fault insurance system is designed to take some of that stress off your shoulders. It exists to help you get paid for medical bills and lost wages, quickly and without needing to prove who caused the crash.

At Horn Wright, LLP, we help Rochester car accident victims make sense of this system every day. Our attorneys know the rules inside and out, and we’re here to help if your claim gets delayed, denied, or just doesn’t feel right. If you’re hurt in a crash, let us help you focus on recovery while we handle the rest. 

What Is New York’s No-Fault Insurance Law?

New York’s no-fault law means that after a car accident, your own auto insurance pays for your basic medical and wage loss expenses, even if someone else caused the crash. This system removes the need to argue about fault for smaller accidents, so you can get care and income support faster.

In Rochester and the rest of Monroe County, every registered driver must carry no-fault insurance. That coverage applies statewide. The goal is simple: reduce delays and lawsuits in minor injury cases. If you’re driving along Lake Avenue or through the busy traffic near East Main Street and someone rear-ends you, you won’t need to sue just to pay your medical bills. You’ll start by filing with your own insurer.

What Does No-Fault Insurance Actually Cover?

No-fault insurance, formally called Personal Injury Protection or PIP, pays for specific expenses after a crash. It does not cover everything, and it doesn’t pay for damage to your car or for pain and suffering.

Here’s what it does cover:

• Medical treatment for injuries caused by the crash (up to $50,000 per person unless extra coverage was purchased)
• 80% of lost earnings, up to $2,000 per month, for up to three years
• Transportation costs to and from doctor appointments
• Necessary household help if prescribed by a doctor

If you were injured in a crash near I-490 or the Inner Loop, these benefits kick in regardless of who caused the accident. But the system has strict limits, so it’s important to understand when your expenses might fall outside that coverage.

For more on coverage limits and required minimums, the New York Department of Financial Services provides detailed guidance on no-fault insurance.

Who’s Covered Under No-Fault in Monroe County?

PIP coverage protects more than just the driver. Several groups qualify for benefits under your policy, depending on the situation.

Covered individuals include:

• You (the policyholder) while driving your insured vehicle
• Passengers in your car
• Pedestrians struck by your car

However, there are exceptions. Motorcyclists are not covered by no-fault insurance. If you’re riding on West Henrietta Road and get hit, you’ll need to rely on other forms of insurance or pursue a personal injury claim if your injuries are serious.

Some Rochester residents get confused when rideshare or commercial vehicles are involved. In those cases, the source of coverage depends on who was driving, what kind of vehicle was involved, and whether the vehicle was being used for business at the time.

How Do You File a No-Fault Claim in Rochester, NY?

Filing a no-fault claim isn’t overly complex, but timing and documentation matter. If you miss a deadline or skip a step, you might lose your right to benefits.

Start by notifying your insurance company within 30 days of the crash. That’s your first and most urgent deadline. After that, you’ll need to fill out a form called NF-2 (Application for No-Fault Benefits) and submit it to your insurer.

If you were treated at Strong Memorial Hospital or Rochester General Hospital, get a full copy of your medical records and billing. Doctors must send their invoices within 45 days of service, and you should double-check that they do. If you’re missing work, ask your employer to prepare a statement of your earnings. Keep copies of everything. Submit:

• Medical records and bills
• Proof of income from your employer
• Notes from your doctor about work restrictions
• Receipts for mileage or transportation

The more complete your file, the smoother the process.

What Are the Deadlines You Must Know?

New York’s no-fault system runs on deadlines. Missing one could cost you your benefits. Don’t rely on your insurance company to remind you.

Key timelines include:

• 30 days: Time to notify your insurer after the crash
• 45 days: Time for medical providers to submit bills
• 90 days: Time to submit proof of lost wages

Providers in Monroe County are busy, and things fall through the cracks. If you were seen in an urgent care clinic near Greece or Irondequoit and never followed up, you might lose eligibility. Keep track of all visits and send copies to your insurer. If you need help with paperwork, ask your provider’s billing office. Most are familiar with the no-fault process.

When Can You Step Outside the No-Fault System?

No-fault insurance only covers certain losses. If you suffer a serious injury, New York law allows you to sue the at-fault driver directly. This is called stepping outside the no-fault system.

Serious injuries include:

• Broken bones
• Significant disfigurement
• Permanent loss of use of a body part or system
• Major limitation of use
• A medically determined injury that limits your daily activities for 90 out of the first 180 days

If you needed back surgery after a crash on Route 104 or sustained a head injury near Monroe Avenue, you might meet the serious injury threshold. When you qualify, you can pursue a lawsuit to recover for pain and suffering, emotional distress, and other losses.

What If the Insurance Company Denies Your Claim?

Insurers deny no-fault claims more often than you’d expect. Sometimes the denial is valid, but other times it’s based on paperwork mistakes or questionable medical reviews.

You might get denied because:

• You missed the 30-day reporting deadline
• Your medical provider didn’t submit bills in time
• An Independent Medical Exam (IME) claimed you no longer needed care
• Your application was incomplete

Many drivers in Rochester don’t realize they can fight these denials. You can request arbitration through the Department of Financial Services or file a lawsuit in certain cases. If you receive a denial letter, read it carefully and act quickly. These decisions often come with tight response windows.

How Does No-Fault Impact Car Accident Lawsuits in Rochester?

Think of no-fault coverage as your first financial safety net. It kicks in immediately after the crash and covers the basics. But once your losses exceed what PIP provides, or you meet the serious injury threshold, the legal landscape changes.

That’s when you can file a personal injury lawsuit against the at-fault driver. Courts in Monroe County, like the Supreme Court building on Main Street, regularly handle injury lawsuits from motor vehicle accidents.

If you’re injured badly in a crash at the intersection of East Avenue and Alexander Street, your lawsuit might include:

• Medical costs beyond the $50,000 PIP limit
• Long-term rehabilitation expenses
• Pain and suffering damages

You’ll still file your no-fault claim, but your attorney will also prepare your case for court if the injuries justify it.

How Are Rideshare Accidents and No-Fault Claims Handled?

Uber and Lyft crashes bring extra layers of complexity. Coverage depends on whether the driver was logged into the app, carrying a passenger, or between rides.

If you’re a passenger in a rideshare vehicle in downtown Rochester or on your way to the airport, you’re usually covered by the rideshare company’s no-fault policy. If you’re a driver, your personal no-fault coverage might not apply unless you purchased rideshare-specific insurance.

These cases often involve multiple insurance policies. Determining which one applies can be frustrating, especially when companies point fingers. Keep detailed records, including ride receipts, app screenshots, and police reports.

What Should Rochester Drivers Keep in Mind About No-Fault Insurance?

New York’s no-fault system is meant to help, but only if you understand it and act fast. Many drivers think their insurer will handle everything. That’s not always the case.

Here’s what to remember:

• File your claim within 30 days of the crash
• Keep detailed records of your injuries, appointments, and expenses
• Don’t assume the insurer will gather everything for you
• Check that doctors and employers send documents on time
• Know when your injuries may fall outside the no-fault limits

Whether your accident happened near Genesee Valley Park or on a snowy stretch of Route 590, the right steps early on can protect your health and finances.

Let Horn Wright, LLP, Help You Move Forward

You don’t have to deal with confusing paperwork or pushy insurance adjusters alone. At Horn Wright, LLP, our attorneys help injured drivers across Rochester and Monroe County understand their rights and get the benefits they deserve. If you’ve been hurt in a crash and have questions about no-fault insurance or a possible lawsuit, we’re ready to listen.