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Submit a No-Fault Claim

If you were involved in an automobile accident, your treatment may be covered under the no-fault provisions in insurance law. We can help you by submitting your No Fault claim on your behalf.

Filing Time Limits

  • If you are filing a No Fault claim, you must report the accident to your insurance carrier within 30 days of the accident.
  • If your medical service provider is filing a No Fault claim for you, they must submit a claim within 45 days of treatment.

Please provide the following information so that we can submit your insurance claim:

Patient Information *Indicates a required field
Patient Name: * Hospital Account No.: *
Facility Name *
Insurance Information
Insurance Coverage:
Carrier Name: * Phone: *
Street: * Policy Holder's Name: *
City: * Claim No.: *
State: * Date of Accident: *
Zip Code: *  
Contact Information
Email Address *
  I certify that I am the owner of the email account and I am the patient, the financially responsible party for the patient's account, or I am authorized to act on behalf of the patient.

 

Important Notes

For Accidents in New York State
In New York State, each driver must submit claims to their own automobile insurance carrier, regardless of who was at fault.

For Passengers
If you were a passenger in an automobile involved in an accident, you should submit your insurance claim to the insurance carrier of the driver whose automobile you were in.

For Motorcycle Drivers and Passengers
Motorcycles are not covered under No-Fault insurance. For Claims against Unidentified or Uninsured Vehicles If you were a pedestrian hit by an unidentified or uninsured vehicle, or if you were a passenger in an uninsured vehicle, you may qualify for benefits through the Motor Vehicle Accident Indemnity Corporation (MVAIC). To learn more, contact MVAIC at (646) 205-7800.

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