New York no-fault insurance: what PIP pays, the claim deadlines and what DFS requires

New York no-fault pays an injured driver, passenger or pedestrian up to $50,000 per person regardless of who caused the crash, according to the Department of Financial Services (DFS): medical and rehabilitation bills, 80% of lost earnings capped at $2,000 a month for three years, up to $25 a day of other costs, plus a separate $2,000 death benefit. The claim starts with written notice to the insurer within 30 days of the accident. New York is one of nine full no-fault states; how it compares with the choice, add-on and tort states is mapped in no-fault vs at-fault states.

That summary hides most of what decides a real claim: who counts as a covered person, which offsets shrink the wage benefit, how medical bills and wages compete for one $50,000 pool, which forms and deadlines follow the notice, and where a dispute goes when the insurer denies. Each of those is set out below from the statute (Insurance Law Article 51), the DFS consumer guide and the DFS no-fault forms page, all read on 2026-10-22.

Estimates and published averages, not a quote. Not insurance advice. State rules and insurer rules vary. Confirm requirements with your state insurance regulator or a licensed agent in your state.

What no-fault is, in New York terms

No-fault is the personal injury protection (PIP) part of a New York auto policy. The statute calls the money it pays first party benefits, and it calls the losses it reimburses basic economic loss (Insurance Law 5102). Because the benefits come from the policy covering the vehicle rather than from the driver who caused the crash, the injured person does not have to prove anyone was at fault to collect. In exchange, the right to sue the other driver for injuries is narrowed, which is the trade every no-fault state makes in some form.

Two things follow for anyone reading a New York policy. First, the PIP amounts are set by statute and regulation, not by the insurer's marketing, so the minimum benefits are the same on every private passenger policy. Second, the time limits are strict and are written into the mandatory PIP endorsement, so a late notice can cost a claim that would otherwise be paid. The state's liability minimums, uninsured motorist amounts and published premium averages are on the New York car insurance rates and requirements page; this page stays with the no-fault benefit itself.

Who no-fault covers, and who an insurer may exclude

Insurance Law 5103(a) lists the people an owner's policy must protect. For a crash in New York, that is anyone injured through the use of the insured vehicle other than an occupant of another motor vehicle or a motorcycle, which takes in passengers and pedestrians. The named insured and household members are also covered when they are hurt by an uninsured vehicle anywhere in the United States, its territories or Canada, or in an insured vehicle outside New York in those places. New York residents who are not owners or household members of an owner get coverage for out-of-state crashes involving an insured vehicle. An injured person usually claims from the policy of the vehicle they were in or were struck by; a household policy matters when the person was hurt by an uninsured car.

Section 5103(b) then lets an insurer exclude certain people, and DFS repeats the list in plain language as reasons a person is ineligible. An insurer may exclude someone who intentionally caused their own injury; a driver injured while intoxicated or impaired by drugs; someone hurt while committing a felony, fleeing police, racing, or riding in a vehicle they knew was stolen; and an owner hurt while driving or riding in their own vehicle that lacked the required coverage, or struck by it as a pedestrian. DFS words that last one simply as having been the owner of an uninsured vehicle. Motorcycle and ATV operators and passengers are outside basic no-fault, though DFS notes that a pedestrian struck by one is covered.

The intoxication exclusion has a built-in limit. Under 5103(b)(2) the insurer may not exclude necessary emergency care at a general hospital, including ambulance service and medical screening. If the driver is later found to have violated Vehicle and Traffic Law 1192, the insurer may sue that person to recover what it paid. DFS describes the same rule: emergency care is covered, and the insurer can seek the money back after a conviction.

Basic no-fault carries no per-person deductible. Section 5103(c) allows a family deductible of up to $200, and only for the named insured and household members, so a passenger or pedestrian from outside the household never meets one.

The benefit table

The table pairs each benefit with its limit, its time cap and the source that sets it. The basic $50,000 is one pool shared by medical bills, lost earnings and other expenses, not three separate pots; the death benefit sits outside it.

The 80% rule and the offsets that come off the wage benefit

The wage benefit is the line most often misread. The statute builds it in two steps. Section 5102(a)(2) defines lost earnings, plus reasonable costs for substitute services, capped at $2,000 a month and payable for a maximum of three years. Section 5102(b) then defines first party benefits as that loss reduced by 20% of the lost earnings, by amounts recovered or recoverable from Social Security disability, workers' compensation, New York disability benefits and Medicare (with stated exceptions), and by any policy deductible. DFS states the result for consumers as 80% of lost earnings, up to a maximum payment of $2,000 per month.

The words 'recovered or recoverable' matter. An injured worker who could claim workers' compensation is expected to do so, and DFS lists two forms for this: an agreement to pursue Social Security disability benefits (NF-8) and an agreement to pursue workers' compensation or New York disability benefits (NF-9). How the offsets and the 20% reduction combine for a particular earner is a calculation the insurer should show in writing; if the figure looks wrong, the arbitration route below applies to amounts as well as to denials.

Illustration: how medical bills and wages share one $50,000

Labelled illustration with stated inputs, not a prediction of any claim. Inputs: an injured driver with gross earnings of $3,500 a month who cannot work for 18 months, no Social Security disability or workers' compensation offset, and medical bills paid at the fee schedule totaling $32,000 by the time wage payments begin. The policy has basic no-fault only.

Step 1: 80% of $3,500 is $2,800, which is above the cap, so the monthly wage benefit is $2,000. Step 2: 18 months at $2,000 would be $36,000. Step 3: the pool has $50,000 minus $32,000, or $18,000, left. Step 4: $18,000 at $2,000 a month covers nine months of wages; months ten to eighteen are not paid by basic no-fault, and any later medical bills have nothing left to draw on either.

Same inputs with OBEL added: the $25,000 extra layer could cover the remaining nine months ($18,000) and leave $7,000 for further medical or rehabilitation costs, because DFS says the injured person can direct OBEL to wage loss, rehabilitation or other basic economic loss. The three-year wage limit is unchanged either way. Arithmetic: 0.8 x 3,500 = 2,800; 50,000 - 32,000 = 18,000; 18,000 / 2,000 = 9; 25,000 - 18,000 = 7,000.

The point of the illustration is the shape, not the figures. A higher earner reaches the $2,000 cap quickly, so the cap and the shared pool bind sooner than many expect. Whether an extra layer is worth its premium is a household question about income, other disability cover and health insurance; the how much car insurance you need guide sets out how to weigh limits against what you could lose.

OBEL and additional PIP: the two optional layers

DFS describes two ways to raise no-fault protection above the statutory floor. Optional Basic Economic Loss coverage (OBEL) adds $25,000 to the basic $50,000. The statute describes the same $25,000 option in 5102(a) as available for an additional premium. The DFS forms page lists the election form for it, 'Election of Option, Optional Basic Economic Loss Coverage (NF-13)', which is how the injured person tells the insurer where to apply the extra amount.

Additional PIP is a separate endorsement that raises the overall no-fault limit to $100,000 or higher and, DFS says, extends to out-of-state guest occupants. Neither option lengthens the three-year limit on wage payments, so a long disability still runs out of wage benefits at 36 months whatever the dollar limit. Both are optional and priced by the insurer, so the only reliable way to compare them is to price each on the same quote; the quote comparison guide explains how to hold every other line constant.

The claim timeline and its deadlines

The deadlines come from three places: the mandatory PIP endorsement in 11 NYCRR 65-1.1, the prompt-payment rule in Insurance Law 5106(a), and, for uninsured and hit-and-run crashes, Insurance Law 5208. DFS's consumer guide repeats the notice and payment rules. The two proof-of-claim limits below are taken from the text of 11 NYCRR 65-1.1 and 65-2.4 as reproduced by Cornell LII (read October 22, 2026), and match the quotation in DFS Office of General Counsel Opinion 08-06-01 (June 2, 2008); check the current endorsement in your policy for any change since.

Practical order: report the crash to the insurer in writing the day you can, keep a copy with the date, complete the NF-2 as soon as it arrives, and ask every provider to bill the no-fault insurer directly. The general claim sequence for property damage and liability, which runs alongside no-fault, is in how to file a car insurance claim.

The forms that carry a no-fault claim

DFS publishes the standard claim forms on its no-fault forms and resources page. Knowing which is which makes the insurer's letters easier to follow.

• NF-2, Application for Motor Vehicle No-Fault Benefits: the injured person’s claim form, sent by the insurer after notice.
• NF-3 and NF-4: verification of treatment by a physician or other health provider, and verification of hospital treatment.
• NF-5, Hospital Facility Form: the hospital’s bill to the insurer.
• NF-6 and NF-7: employer’s wage verification and verification of self-employment income, the evidence for the wage benefit.
• NF-8 and NF-9: agreements to pursue Social Security disability, workers’ compensation or New York disability benefits, which feed the offsets.
• NF-10, Denial of Claim Form: the insurer’s written denial, which states the reason and starts any dispute.
• NF-13: the OBEL election; NF-AOB: the assignment of benefits that lets a provider bill the insurer directly.

What no-fault does not pay for

No-fault reimburses economic loss from injury. The 5102(a) definition lists health care, lost earnings and other necessary expenses, and nothing in it covers a damaged car, a fence or any other property. Damage to your own vehicle is a collision or comprehensive claim on your policy, and damage you cause to someone else's vehicle is a property damage liability claim; the difference between the two physical damage coverages is in comprehensive vs collision coverage. New York's Regulation 64 timetable for those physical damage claims is summarized on the state rates page.

No-fault also does not pay for pain and suffering. In a suit between covered persons, section 5104(a) allows recovery of non-economic loss only where the injury is a serious injury as defined in 5102(d), and the court or jury must make that finding before any non-economic damages attach. Whether an injury crosses that threshold is a legal question for a New York attorney. If the at-fault driver's liability limits are too low for a serious injury, the gap is filled, if at all, by your own uninsured and supplementary underinsured motorist coverage; the uninsured and underinsured motorist guide explains how those layers sit above liability.

When the insurer denies or underpays

A denial should arrive in writing, usually on the NF-10 form, with a reason. From there DFS lists three routes: a complaint to DFS, arbitration, or a lawsuit. Insurance Law 5106(b) requires every insurer to give the claimant the option of submitting a dispute over first party or additional first party benefits, including the amount, to arbitration under simplified procedures approved by the superintendent. The DFS forms page links the American Arbitration Association's New York no-fault program as the forum.

An arbitrator's award binds both sides unless a master arbitrator vacates or modifies it (5106(c)). A master arbitrator's award is in turn binding except on the narrow court-review grounds of CPLR article 75, with one exception that matters for larger claims: where the master arbitrator's award is $5,000 or more, not counting interest and attorney's fees, either the insurer or the claimant may take the dispute to court for a new trial. DFS adds that arbitration results are final and binding unless appealed under strict circumstances.

Arbitration is a claimant's choice, not a requirement, and the right forum depends on the amount and the type of dispute. A licensed New York attorney can say which route fits a given denial; this page does not predict outcomes.

When two insurers point at each other

Some crashes leave more than one insurer with a possible duty to pay, and each may say the other is responsible. Section 5106(d)(1) lets the insurers agree which one pays first where there is a valid basis. Without agreement, the first insurer to receive notice of the claim must pay, and it can then recover its share from the others through mandatory arbitration between insurers. DFS's forms page lists Arbitration Forums Inc. for these inter-company disputes. For the injured person, the rule means the dispute between insurers is not supposed to hold up the claim.

Section 5106(d)(2) adds a rule for app-based driving. When it is disputed whether a driver was working for a transportation network company or a peer-to-peer car sharing program at the time of the loss, the group policy issued for that program must provide first party benefits, and the company must tell the owner's insurer about the dispute within ten business days of learning of it. The broader picture of personal and app-company coverage is in the rideshare insurance guide.

Uninsured and hit-and-run crashes: MVAIC

When no insurer is responsible, injured New York residents without their own coverage, and household members who lack it, can claim through the Motor Vehicle Accident Indemnification Corporation (MVAIC). DFS gives its address as 110 William Street, 19th Floor, New York, NY 10038, phone (646) 205-7800, and it is the body that sends the no-fault application in those cases. Section 5106(d)(1) also points claimants to MVAIC where no insurer is liable for an accident in New York.

MVAIC has its own clock under Insurance Law 5208. For an injury caused by an identified uninsured vehicle, a sworn notice of claim is due within 180 days after the claim arose. Where the at-fault driver cannot be identified, the accident must be reported to a police, peace or judicial officer, or to the DMV commissioner, within 24 hours, and the sworn statement is due within 90 days. Where the other driver's insurer disclaims or denies coverage, the 180 days run from receipt of that notice. A late filing can be excused for incapacity or reliance on wrong vehicle information, or a court can grant leave on application made within one year, but none of that is automatic.

How lapses are caught, and what a lapse does to no-fault

New York checks insurance through the registration, not at the roadside. DFS describes the Insurance Information and Enforcement System (IIES) as a DMV system that monitors the insurance status of New York-registered vehicles; insurers report changes in coverage to DMV, so a cancellation reaches the DMV without the owner doing anything. The DMV then sends the owner a letter about the lapse, and the owner must answer with proof of coverage, proof the car was sold, stolen, impounded or repossessed, or surrender the plates.

The DMV's day-rate civil penalties and the suspension that applies after 90 days are tabled on the New York rates and requirements page, so they are not repeated here. The no-fault point is different: 5103(b)(3) lets an insurer exclude an owner injured in, or struck by, their own vehicle that lacked the required coverage. An owner who lets the policy lapse can lose no-fault benefits for their own injuries as well as facing the registration penalty. What a lapse does to future pricing and eligibility in general is covered in what happens when car insurance lapses.

Discounts and surcharges that touch the no-fault premium

The no-fault portion of the premium is priced like any other coverage, and DFS lists which discounts and surcharges reach it. Seat belt and airbag discounts apply to no-fault and medical payments coverage. Anti-lock brake and daytime running lamp discounts apply to liability, collision, no-fault and medical payments. Surcharges, DFS says, apply only to the liability, no-fault and collision premiums.

The course-based discount is New York's accident prevention course, which DFS says must be applied to the liability, collision and no-fault coverages for three years. How the course works, what the DMV says it is worth, and how other states compare is set out in the defensive driving course discount guide.

Limits of this reference

This page summarizes the statute and regulator guidance as read on 2026-10-22. It does not replace the policy's own PIP endorsement, which controls the claim, and it does not cover commercial vehicles, motorcycles or buses in detail. Benefit levels, deadlines and forms can change by statute or regulation; the DFS no-fault pages are the place to confirm current versions. Complaints about how an insurer handled a claim go to DFS, and questions about a specific injury claim or a missed deadline belong with a licensed New York attorney.

Questions readers ask

Pair the no-fault rules with New York’s liability and uninsured motorist minimums, the lapse penalty table and the state’s published premium averages before you compare quotes.