If you were injured in a car accident on Long Island, one of the first systems you encounter is New York’s No-Fault insurance law. It can feel confusing. Medical bills are being submitted. Insurance companies are scheduling “independent” medical exams. Payments suddenly stop. And then someone mentions arbitration.
At Palermo Law, we regularly guide injured drivers through the No-Fault system and, when necessary, No-Fault arbitrations. Below is a practical breakdown of how No-Fault works, when arbitration applies, and what options you have if benefits are cut off.
New York is a “No-Fault” state. That means after a car accident, your own auto insurance company pays for certain benefits regardless of who caused the crash.
No-Fault is designed to pay medical bills quickly, cover lost wages, and avoid immediate fault-based litigation for basic economic losses. In most cases, you must file a No-Fault application (Form NF-2) within 30 days of the accident.
Standard New York No-Fault benefits include medical expenses related to the accident, lost wages (typically 80% of gross earnings, capped at $2,000 per month), prescription costs, mileage reimbursement to medical appointments, and limited household help in qualifying situations. The basic policy limit is $50,000 per person unless additional coverage was purchased.
No-Fault does not cover pain and suffering, vehicle damage, or non-economic damages. Those claims are handled separately through a bodily injury claim against the at-fault driver.
| 1 |
Open a No-Fault ClaimContact your insurance carrier and file a claim as soon as possible after your accident. |
| 2 |
Begin Medical TreatmentStart treating with your doctors and specialists for accident-related injuries. |
| 3 |
Providers Submit BillsYour medical providers submit bills directly to the insurance carrier on your behalf. |
| 4 |
Carrier Reviews and RespondsThe carrier either pays, denies, or delays the bills. For the first couple of months, the process often runs smoothly — then IMEs begin. |
Insurance companies have the right to send you to an Independent Medical Examination (IME). Despite the name, these exams are scheduled and paid for by the insurance carrier.
In our experience, IMEs are typically not scheduled until two to three months into treatment. However, carriers may schedule them earlier if they suspect overbilling, policy eligibility issues, inconsistent injury complaints, gaps in treatment, or questions about whether the injured person is properly covered under the policy.
The carrier selects doctors depending on the treatment being reviewed — orthopedic surgeons for physical injuries, neurologists for head and nerve complaints, psychiatrists or psychologists for mental health treatment, pain management specialists for injections, and acupuncturists for alternative care.
If the IME doctor concludes further treatment is not medically necessary, the insurance company may cut off payment for physical therapy, chiropractic treatment, acupuncture, pain management procedures, neurological care, and psychological counseling. This does not mean you are fully healed — it means the carrier has decided to stop paying for that category of treatment.
If your No-Fault benefits are cut off, you generally have three options:
Some providers will shift billing to private insurance, though coverage for accident-related treatment varies.
Certain doctors may agree to continue treating on a lien basis, meaning they are paid from a future bodily injury settlement.
If the termination was improper, the denial can be challenged through arbitration. If you are unsure whether your denial was proper, speak with a Long Island No-Fault insurance lawyer to review the IME report and the carrier’s reasoning.
No-Fault arbitration is the formal dispute process used to resolve disagreements between insurance carriers and medical providers or claimants over unpaid No-Fault benefits. Arbitrations are administered through a state-supervised process. The official procedures for filing No-Fault arbitration in New York are outlined by the New York State DMV.
Common arbitration disputes include denial of medical bills, IME-based treatment terminations, peer review denials, lost wage disputes, transportation reimbursement, eligibility disputes, and fee schedule reductions. In most cases, medical providers file arbitration to recover unpaid bills. In some circumstances, injured individuals may arbitrate wage claims directly.
Providers generally have six years from the denial to file arbitration. Insurance companies must issue denials within strict regulatory deadlines — typically 30 days after receiving proof of claim. If a denial is late or procedurally defective, it may not be enforceable. Do not wait.
| 1 | File the Arbitration Request
Submit the formal arbitration request through the state-supervised process. |
| 2 | Submit Medical Records and Billing Documents
Provide all relevant medical documentation and billing records supporting the claim. |
| 3 | Submit IME or Peer Review Reports
Both sides provide their medical opinions and supporting reports. |
| 4 | Written Arguments
Each party submits written arguments for the arbitrator’s review. |
| 5 | Hearing (Often Virtual)
In some cases, a hearing is held — increasingly conducted remotely. |
| 6 | Written Decision
The arbitrator issues a written decision. There are limited appeal rights to a Master Arbitrator. Arbitration is generally faster and less formal than court litigation. |
No-Fault arbitration can be an effective way to challenge improper denials, but it is not automatically the right move in every situation. Understanding the advantages and limitations helps you make informed decisions.
| Factor | Advantage | Limitation |
| Speed | Much quicker than filing in Supreme or Civil Court — many disputes resolve within months | Still requires preparation time and document gathering |
| Cost | Streamlined process with limited discovery and fewer procedural motions | Professional representation still recommended for complex disputes |
| Appeals | Experienced arbitrators familiar with the No-Fault regulatory framework | Very limited grounds to appeal an unfavorable decision |
| Scope | Isolates the specific benefit dispute without complicating the broader injury claim | Addresses economic benefits only — no pain and suffering or liability disputes |
| Carrier Accountability | Exposes procedural failures when denials are late or defective | IME credibility battles can be difficult — arbitrators rely heavily on written reports |
No-Fault arbitration only addresses economic benefits under your own policy. It does not affect your right to pursue pain and suffering damages against the at-fault driver. Our Long Island car accident lawyers routinely coordinate No-Fault disputes alongside bodily injury claims.
No-Fault arbitration is a powerful tool when benefits are improperly denied. A termination notice does not automatically mean the insurance company is correct. It means a dispute exists — and disputes can be challenged.
If you were injured anywhere on Long Island and have questions about your No-Fault benefits or your broader injury claim, Palermo Law can help you understand your options.
