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Frequently Asked Questions (FAQ's) by M&T : Part 1 Q: I was involved in an motor vehicle accident and my insurance company keeps talking about 1st party and 3rd Party benefits. I do not understand what these terms mean. A: The no-fault act provides two broad divisions
of claims; "economic" and "non-economic." "Non-economic"
loss is commonly referred to as pain and suffering damages or "3rd
party damages" because they are paid by someone other than the insurance
company. "Economic" loss is called "1st Party"
coverage, no-fault or "PIP" benefits. These benefits are paid
by your insurance company. Q: Am I eligible for no-fault benefits? A: Benefits are provided for "accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle." If you were injured in a motor vehicle accident, or were hit by an motor vehicle, you are entitled to no-fault benefits. There is an exception to this rule for uninsured drivers. If you did not have insurance when the accident occurred, please consult with an attorney to determine your eligibility for benefits. Q: How do I make a no-fault claim? A: Contact your insurance agent or the claim reporting center and let them know you were involved in an accident. An adjuster should contact you within a few days and explain no-fault benefits to you. After this initial contact, you should receive an "application for PIP benefits" form. Complete this form and return it to the claims adjuster. This form must be submitted to your insurance company within one year of the accident for you to obtain benefits. Q: Do I need a lawyer to make a no-fault claim? A: As a general rule, you should be able to make a no-fault claim without the assistance of an attorney. Q: Are snowmobile and motorcycle accidents covered by no-fault? A: Only if a motor vehicle is involved in the accident. Snowmobiles and motorcycles are not considered to be motor vehicles. If a snowmobile or motorcycle collides with a tree or flips over, there is no no-fault coverage. However, if a motorcycle or snow mobile is hit by a car or truck, then a motor vehicle is involved and there is no-fault coverage. Q: What if I was a pedestrian hit by a motor vehicle? A: Many persons are under the impression that, in order to be entitled to no-fault benefits, an injury victim must have paid for these benefits in the form of purchasing a no-fault policy. The general rule should be understood: Everybody injured in a motor vehicle accident is covered by no-fault. Note the exception to this rule for uninsured drivers. (See question below on uninsured drivers.) Q: I did not have insurance on my vehicle when I was involved in a motor vehicle accident. Am I still entitled to no-fault benefits? A: An uninsured passenger or pedestrian is entitled to no-fault benefits. If you were the owner of the uninsured motor vehicle involved in the accident then you are not entitled to no-fault benefits. Q: I am receiving social security or worker’s compensation. Will this affect my no-fault claim? A: Yes. If you are already obtaining benefits from a governmental source, you will not be able to "double dip" by also getting paid from no-fault. A substantial amount of litigation has occurred to determine what kinds of government benefits must be subtracted from no-fault benefits. For example, workers’ compensation benefits, social security disability benefits and others have been held to be subject to this subtraction from no-fault benefits. There are many more benefits that have been the subject of litigation and an attorney should be consulted to determine whether a specific benefit is indeed subject to subtraction. Note, this subtraction occurs even if you have uncoordinated no-fault benefits.
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