A breakdown of what no-fault pays for — and what generally falls outside it — after a car accident in New York.
No-fault covers all reasonable and necessary treatment connected to your accident, up to $50,000 per person combined with lost-wage benefits. "Reasonable and necessary" is the standard your insurer applies — treatment tied to your injuries and recommended by a medical provider generally qualifies.
In most cases, your providers bill your no-fault insurer directly, so covered treatment shouldn't come out of your pocket up front.
To confirm treatment is still reasonable and necessary, your insurer can send you to an Independent Medical Examination (IME) — their doctor, not yours. This is normal and doesn't mean anything is wrong with your claim. Our IME guide covers what to expect.
Do I have to pay anything out of pocket?
In most cases, no — providers bill your no-fault insurer directly for covered treatment, so you shouldn't be paying up front.
Is there a limit on how much treatment I can get?
Treatment is covered as long as it's reasonable and necessary for your injuries, up to the $50,000 combined limit. Your insurer may periodically review ongoing care.
What if my treatment gets denied?
A denial isn't final. You have the right to appeal and request arbitration, and many denials are successfully challenged.
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