Who Pays Medical Bills After a Car Accident in New York?

Getting into a car accident is stressful enough without having to worry about who will cover the mounting medical bills. In New York, the answer might surprise you. Unlike many other states where the at-fault driver's insurance pays first, New York operates under a no-fault insurance system. This means your own auto insurance company typically pays your medical bills after an accident, regardless of who caused it. This doesn't prevent you from recovering from the at-fault driver, provided that you meet certain legal criteria under New York law.

New York's No-Fault Insurance System Explained

New York requires every driver to carry Personal Injury Protection, commonly called PIP coverage. This is the insurance that pays your medical bills after a car accident. The state mandates a minimum of $50,000 in PIP coverage per injured person on every auto insurance policy.

The beauty of this system, at least in theory, is speed. Because fault doesn't need to be determined before medical bills get paid, injured people can receive treatment and have their expenses covered more quickly than they would in a traditional fault-based system. Your insurance company pays for your injuries, and the other driver's insurance pays for theirs.

PIP coverage applies to you as the policyholder, anyone riding in your vehicle as a passenger, and even pedestrians or cyclists your vehicle strikes. The coverage kicks in immediately after an accident, allowing you to focus on recovery rather than fighting over who caused the crash.

What Medical Expenses Does PIP Cover?

Personal Injury Protection in New York covers a comprehensive range of medical expenses related to your accident injuries. This includes emergency room treatment, hospital stays, doctor visits, physical therapy sessions, prescription medications, medical equipment like wheelchairs or crutches, chiropractic care, and diagnostic tests such as X-rays, MRIs, and CT scans.

Beyond medical bills, PIP also covers 80% of your lost wages up to $2,000 per month for up to three years if your injuries prevent you from working. It provides $25 per day for necessary transportation to medical appointments and another $25 per day for essential services you can't perform yourself due to your injuries, like housekeeping or childcare.

If someone dies in the accident, PIP provides $2,000 toward death benefits and funeral expenses.

Many people don't realize they can purchase optional Basic Economic Loss coverage, which adds another $25,000 to their PIP limits for a total of $75,000. This additional coverage can be valuable if you sustain serious injuries with extensive medical needs.

How Do You Actually Get Your Medical Bills Paid?

The process for getting your medical bills paid through PIP has specific requirements and deadlines. Missing these deadlines can jeopardize your coverage, so understanding the timeline matters.

First, you must notify your insurance company within 24 hours of the accident. This doesn't need to be a formal claim, just notification that an accident occurred. Then, within 30 days of the accident, you need to submit Form NF-2, the official no-fault application. If you're physically unable to file within 30 days due to your injuries, the law recognizes reasonable excuses for delay.

Your medical providers have their own deadline. They must submit bills to your insurance company within 45 days of providing treatment. This means you generally don't need to pay upfront and seek reimbursement. Most healthcare providers in New York are familiar with the no-fault system and bill insurance directly.

Your insurance company may request that you undergo an Independent Medical Examination, or IME, within 10 days of receiving your claim. Despite the name, these examinations are conducted by doctors hired by the insurance company to evaluate your injuries. While the insurer has a right to request an IME, these examinations sometimes become a tool for denying or limiting coverage.

When Does the At-Fault Driver's Insurance Pay Instead?

The $50,000 PIP minimum covers many accident injuries, but serious crashes can easily exceed this amount. Additionally, PIP only covers economic losses like medical bills and lost wages. It doesn't compensate you for pain and suffering, emotional distress, or the overall impact the injuries have on your quality of life.

This is where the at-fault driver's insurance comes into play, but there's a significant catch. New York law doesn't allow you to sue the at-fault driver or access their insurance for pain and suffering unless you meet the state's definition of "serious injury."

What Qualifies as a Serious Injury in New York?

New York Insurance Law Section 5102(d) defines serious injury very specifically. You must have suffered one of the following:

Death, obviously, qualifies. So does dismemberment, meaning the loss of a limb or body part. Significant disfigurement that is permanent and substantial also meets the threshold. The loss of a fetus is considered a serious injury under the law.

Any bone fracture qualifies as a serious injury. This includes even small fractures, though insurance companies often fight claims involving minor fractures.

Permanent loss of use of a body organ, member, function, or system counts, as does a permanent consequential limitation of use. The word "permanent" is key here. Temporary injuries, even severe ones, may not qualify unless they meet the next category.

A significant limitation of use of a body function or system also qualifies, as does a medically determined injury or impairment that prevents you from performing substantially all of your usual daily activities for at least 90 days during the 180 days immediately following the accident.

This last category, the 90/180 day rule, causes considerable litigation. Insurance companies scrutinize medical records, looking for gaps in treatment, return to work dates, or any evidence you performed normal activities during the 180-day period. Even posting vacation photos on social media during your recovery can be used against you.

If you meet the serious injury threshold, you can file a claim against the at-fault driver's bodily injury liability insurance. New York currently requires drivers to carry minimum bodily injury coverage of $25,000 per person for non-death injuries. Death claims have different minimums, and accidents involving multiple injured people have higher aggregate limits.

These minimums are often inadequate for serious injuries. Many drivers carry higher limits, and some have umbrella policies that provide additional coverage. Identifying all available insurance policies becomes crucial when injuries are severe.

Can You Sue the Other Driver After a Car Accident?

Yes, but only if you meet the serious injury threshold described above. New York's no-fault system was designed to keep minor injury cases out of court, reducing litigation and theoretically lowering insurance costs.

If you can prove serious injury, you can sue the at-fault driver for pain and suffering, mental anguish, loss of enjoyment of life, and economic damages that exceed your PIP coverage. This includes future medical expenses, lost earning capacity, and other long-term impacts of your injuries.

New York follows a pure comparative negligence rule. This means even if you were partially at fault for the accident, you can still recover damages, but your compensation will be reduced by your percentage of fault. If you were 30% responsible for the accident and your damages total $100,000, you would recover $70,000.

What Happens When Medical Bills Exceed Your PIP Coverage?

When your medical expenses surpass your $50,000 PIP limit, or $75,000 if you purchased optional coverage, you have several options depending on your situation.

If you have health insurance, it typically becomes secondary coverage once PIP is exhausted. Your health insurer may place a lien on any settlement or verdict you receive from the at-fault driver, meaning they can recover what they paid from your eventual recovery.

If you meet the serious injury threshold, the at-fault driver's bodily injury liability insurance should cover excess medical expenses. However, this requires either a settlement negotiation or a lawsuit, which takes time. Medical providers may place liens on your case or require payment arrangements while your claim proceeds.

Some medical providers, particularly those experienced with personal injury cases, will treat you on a lien basis. This means they agree to wait for payment until your case settles or goes to trial. They're essentially betting on your case's success. If you don't recover money from the at-fault driver, you may still owe these providers.

Medicare and Medicaid can also serve as secondary coverage, but these programs have strict reimbursement requirements if you later recover money from the at-fault party.

Why Do Insurance Companies Deny PIP Claims?

Despite the no-fault system's promise of quick payment, insurance companies frequently deny or delay PIP claims. Understanding common reasons for denial helps you avoid problems or challenge improper denials.

Gaps in treatment are a favorite excuse. If you don't seek immediate medical attention after the accident, or if you miss appointments or have significant breaks between treatment sessions, insurers argue your injuries weren't serious or weren't caused by the accident. They claim that truly injured people seek consistent care.

Medical necessity disputes arise frequently. After an Independent Medical Examination, the insurance company's doctor may opine that your treatment is unnecessary, excessive, or unrelated to the accident. Your own doctors may disagree completely, but insurers often use these IME reports to cut off benefits.

Missed deadlines provide another reason for denial. If you don't file Form NF-2 within 30 days, don't notify the insurer within 24 hours, or your providers don't submit bills within 45 days, the insurance company may deny coverage. While the law allows reasonable excuses for some delays, fighting a denial based on missed deadlines can be difficult.

Pre-existing conditions give insurers ammunition to deny claims. If you had back pain before the accident and now claim back injuries, the insurer will argue your current pain stems from your pre-existing condition, not the crash. This becomes a medical dispute requiring expert testimony to resolve.

Fraud suspicions, whether warranted or not, can lead to claim denials. New York has seen significant problems with staged accidents and inflated medical claims. While cracking down on fraud is necessary, legitimate injury victims sometimes get caught up in overly aggressive fraud investigations.

What About Passengers in Car Accidents?

Passengers occupy a unique position in New York's no-fault system. If you're injured as a passenger, you claim PIP benefits from the insurance policy of the vehicle you were riding in. This applies regardless of whether that driver caused the accident.

The same $50,000 minimum PIP coverage applies, and passengers receive the same medical expense coverage, lost wage benefits, and other no-fault benefits as drivers.

For pain and suffering claims, passengers must still meet the serious injury threshold. However, passengers have a potential advantage. If both drivers share fault for the accident, the passenger can pursue bodily injury claims against both drivers' insurance policies. Since the passenger bears no responsibility for the crash, there's no comparative negligence reduction.

This can be particularly important when injuries are severe and one driver's insurance policy limits are insufficient. Having access to multiple insurance policies increases the available compensation.

How Do Pedestrians and Cyclists Get Their Medical Bills Paid?

Pedestrians and cyclists injured by vehicles are covered under New York's no-fault system, even though they don't own auto insurance themselves. The PIP coverage of the vehicle that struck them pays their medical bills and other no-fault benefits up to the policy limits.

This protection exists because pedestrians and cyclists are vulnerable road users who shouldn't be left without coverage when a vehicle injures them. The system recognizes that requiring pedestrians to carry their own auto insurance would be absurd.

Like drivers and passengers, pedestrians and cyclists must meet the serious injury threshold to sue for pain and suffering. However, in crashes between vehicles and pedestrians or cyclists, the vehicle driver is often at fault, making bodily injury claims more straightforward.

One complexity arises in hit-and-run accidents where the striking vehicle is never identified. In these cases, the pedestrian or cyclist may need to look to their own auto insurance policy if they have one, or to the Motor Vehicle Accident Indemnification Corporation, a state fund that provides limited benefits in hit-and-run cases.

Recent Changes to New York Auto Insurance Law

New York's auto insurance landscape is shifting. As of January 1, 2026, new minimum liability limits took effect. Drivers must now carry at least $35,000 per person and $70,000 per accident in bodily injury liability coverage, up from previous minimums of $25,000 per person. Uninsured and underinsured motorist coverage minimums also increased to match these amounts.

Importantly, the mandatory PIP minimum remains at $50,000 per person. The increase applies only to liability coverage for injuries you cause to others.

What Should You Do Immediately After a Car Accident?

The steps you take immediately after an accident can significantly impact your ability to get your medical bills paid and recover full compensation for your injuries.

Seek medical attention right away, even if you don't think you're seriously hurt. Adrenaline masks pain, and some injuries don't manifest symptoms immediately. Having a medical record from the day of the accident creates documentation linking your injuries to the crash. Waiting days or weeks to see a doctor gives insurance companies ammunition to deny your claim.

Report the accident to the police and get a copy of the police report. This creates an official record of the accident and often includes the officer's determination of fault.

Notify your insurance company within 24 hours. This is a requirement under New York law. You don't need to provide a detailed statement immediately, but you must report that an accident occurred.

Document everything. Take photos of vehicle damage, the accident scene, visible injuries, and anything else relevant. Get contact information from witnesses. Keep copies of all medical bills, prescription receipts, and documentation of missed work.

File Form NF-2 with your insurance company within 30 days. This form officially starts your no-fault claim. Your insurance company should provide this form, or you can find it through the New York Department of Financial Services.

Follow your doctor's treatment recommendations consistently. Gaps in treatment or missed appointments will be used against you if you later need to prove serious injury.

Be cautious about what you say to insurance adjusters. While you must cooperate with your own insurance company's no-fault investigation, you're not required to give recorded statements to the other driver's insurance company. Anything you say can be used to minimize or deny your claim.

Don't post about the accident on social media. Insurance companies routinely monitor claimants' social media accounts looking for evidence that injuries aren't as serious as claimed. A photo of you smiling at a family gathering might be used to argue you're not suffering, even if you're in constant pain.

Understanding the Difference Between PIP and Bodily Injury Claims

The distinction between PIP claims and bodily injury claims confuses many accident victims, but understanding the difference is crucial.

Your PIP claim is against your own insurance company. It's a no-fault benefit you're entitled to regardless of who caused the accident. The process is relatively straightforward, though insurance companies still find ways to complicate it. PIP covers economic losses only: medical bills, lost wages, and related expenses. It doesn't compensate for pain, suffering, or the intangible ways injuries affect your life.

A bodily injury claim is against the at-fault driver's insurance company. This is a fault-based claim, meaning you must prove the other driver caused the accident through negligence. You must also prove you suffered a serious injury as defined by New York law. Bodily injury claims compensate for both economic losses that exceed your PIP coverage and non-economic damages like pain and suffering.

These claims often proceed simultaneously. Your PIP claim should start paying medical bills within weeks of the accident, while your bodily injury claim may take months or years to resolve. You don't need to wait for your PIP benefits to exhaust before pursuing a bodily injury claim, though the final settlement or verdict will account for what PIP already paid.

The insurance companies handling these claims have different interests. Your own insurer, while obligated to pay PIP benefits, still wants to minimize what they pay. The at-fault driver's insurer wants to deny liability entirely or minimize the value of your claim. Neither insurance company is on your side, despite what their advertisements suggest.

How Multiple Insurance Policies Work Together

Car accidents often involve multiple insurance policies that can provide coverage. Understanding how these policies interact helps maximize your recovery.

Your own auto insurance provides PIP coverage first. If you were driving someone else's vehicle, that vehicle's insurance provides PIP coverage. If you're a pedestrian or cyclist, the striking vehicle's insurance provides PIP coverage.

Once PIP is exhausted, your health insurance becomes secondary coverage for ongoing medical treatment. Health insurers typically have subrogation rights, meaning they can recover what they paid from any settlement or verdict you receive from the at-fault driver.

The at-fault driver's bodily injury liability insurance pays for damages beyond PIP, but only if you meet the serious injury threshold. If the at-fault driver's insurance is insufficient to cover your damages, your own uninsured/underinsured motorist coverage may provide additional compensation.

Umbrella policies provide extra liability coverage beyond standard auto policy limits. If the at-fault driver has an umbrella policy, it can provide additional compensation when injuries are severe and underlying policy limits are exhausted.

In accidents involving commercial vehicles, the company that owns or operates the vehicle may have substantial commercial auto insurance policies. These policies often have much higher limits than personal auto policies.

Identifying all potentially applicable insurance policies requires investigation. Insurance companies don't volunteer information about umbrella policies or other coverage that might increase what they have to pay. Getting full information often requires legal discovery.

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Summing It Up

Navigating medical bills after a car accident in New York requires understanding the state's unique no-fault insurance system. Your own auto insurance company pays your medical bills through PIP coverage, regardless of who caused the accident, up to at least $50,000 per person. This system is designed to get you treatment quickly without fighting over fault.

However, PIP has limitations. It only covers economic losses and has dollar limits that serious injuries can quickly exceed. When you need compensation for pain and suffering or when your medical bills surpass PIP limits, you must prove the at-fault driver caused the accident and that you suffered a serious injury as defined by New York law.

The process involves strict deadlines, potential disputes with insurance companies, and complex legal standards. Insurance companies, even your own, often look for reasons to deny or minimize claims. Missing deadlines, gaps in treatment, or failing to properly document your injuries can jeopardize your recovery.

Recent changes to New York insurance law have increased minimum liability coverage, but proposed reforms may make it harder for injured people to recover full compensation. The landscape continues to evolve as lawmakers balance competing interests of reducing fraud, lowering premiums, and protecting injured victims.

If your injuries are serious, if your medical bills are mounting, or if the insurance company is denying your claim, the complexity of New York's no-fault system and serious injury threshold makes professional legal guidance valuable. The difference between receiving fair compensation and being left with unpaid medical bills often comes down to understanding these rules and having someone who can navigate them on your behalf. Reach out to the Porter Law Group for a free consultation, and know more about how you can recover the best compensation possible. Call 833-PORTER9 or email info@porterlawteam.com to get started.