What If Your No Fault Claim Is Denied in New York
A no-fault denial in New York is not final. New York Insurance Law § 5106 gives you three ways to challenge it, a written request that the insurer reconsider, no-fault arbitration through the American Arbitration Association, or a lawsuit against the insurance company. The right route depends on why the claim was denied and how much is in dispute, so the first step is always to read the denial itself.
At William Mattar, P.C. our team has focused on motor vehicle accidents for more than 30 years, with attorneys and offices and intake locations across the state. We do not handle no-fault insurance claims, but understand that no-fault insurance claims can impact bodily injury liability or supplementary uninsured motorist (SUM) claims.
Key facts about no-fault denials in New York
- New York no-fault coverage pays up to $50,000 per person in basic economic loss, including medical bills and a portion of lost earnings, under Insurance Law § 5102(a).
- Any dispute over first party benefits can go to arbitration under Insurance Law § 5106(b). The Department of Financial Services directs all filings to the American Arbitration Association with a $40 filing fee.
- Motorcyclists are excluded from no-fault benefits under Insurance Law § 5103(a), so this denial process applies to car occupants, pedestrians, and bicyclists rather than riders.
- No-fault claims can affect third-party claims for pain and suffering.
Why New York no-fault claims can get denied
When a no-fault insurer denies all or part of a claim, it must issue a formal denial of claim on Form NF-10. The most common grounds are late filing of the written notice of claim beyond the 30-day window, a missed independent medical examination, treatment that the insurer's reviewing doctor calls not medically necessary, bills submitted more than 45 days after treatment, and coverage disputes over which policy should pay. Each of these has a different fix, and none of them automatically ends the claim. If the no-fault claim is not moving forward, it is often difficult to obtain medically necessary treatment.
The NF-10
The NF-10 states exactly what was denied and why, and a denial is often partial rather than total. An insurer may reject one chiropractic bill while continuing to pay everything else. A short written request for reconsideration, backed by the missing verification, a doctor's letter, or proof of timely mailing, resolves many denials without any formal proceeding.
No-fault arbitration under Insurance Law § 5106
Insurance Law § 5106(b) requires every insurer to offer arbitration for any dispute over first party benefits. The Department of Financial Services directs all requests to the American Arbitration Association, which runs the New York Insurance ADR Center, an online platform where you can file the AR1 request form, upload supporting documents, and track the case. You must include everything that supports your position with the original filing, because later document submissions are generally limited to ongoing bills.The AAA conducts New York no-fault hearings by videoconference.
The deadlines that control a denied claim
Under Regulation 68, written notice of claim is due within 30 days of the accident, health care bills within 45 days of treatment, and lost wage claims within 90 days. If the insurer does not respond to a submission within 30 days of receiving it, the claim is overdue and you may proceed straight to arbitration or court under DFS rules. Your separate bodily injury lawsuit has different time deadlines.
Motorcyclists are outside the no-fault system
Operators and passengers of motorcycles are generally excluded from no-fault benefits under Insurance Law § 5103(a), which means a rider's medical bills are never paid by the no-fault system in the first place, and a rider may sue the at-fault driver from the first dollar of loss. William Mattar, P.C. has explained this trade-off in detail in its article on why New York motorcyclists are exempt from the serious injury threshold. Pedestrians struck by a motorcycle do receive no-fault benefits, as covered in the firm's guide to no-fault benefits for injured pedestrians.
Frequently asked questions
Does a no-fault denial stop me from suing the at-fault driver?
No. The no-fault claim and the bodily injury lawsuit are separate. The lawsuit generally must be filed within three years under CPLR § 214, whatever happens with the benefits dispute. An experienced attorney can explain how no-fault benefits impact a third-party case for pain and suffering.
Do motorcyclists get no-fault benefits in New York?
No. Riders and their passengers are excluded under Insurance Law § 5103(a), so there is no no-fault claim to deny. Riders instead pursue the at-fault driver directly, without the serious injury threshold that applies to car occupants.
What is Form NF-10?
The NF-10 is the state-prescribed denial of claim form. The Department of Financial Services notes that the back of the NF-10 can be completed and used as the request for arbitration for the items denied on it.
About William Mattar, P.C.
William Mattar, P.C. is a New York law firm that only handles motor vehicle accident cases and has represented injured people for over 30 years. William Mattar, P.C. does not handle no-fault claims, but understands how no-fault claims can impact third-party claims for pain and suffering. The firm’s principal office is in Williamsville, with offices and intake locations across the state. It represents motorcycle, car, truck, bus, pedestrian, and rideshare accident victims throughout New York State, with free case reviews available 24/7 at (844) 444-4444.
Related reading from William Mattar
- What Legally Qualifies as Distracted Driving in New York
- How Much Does a Lawyer Cost for a Car Accident in New York
- What Happens in a Car Accident Lawsuit
- Rideshare Accidents in New York
- How Proving Distraction Helps You Meet New York’s Serious Injury Threshold
Each of the above is part of William Mattar’s New York State accident resource library.
Sources
- New York State Senate, Insurance Law Section 5106, Fair claims settlement. nysenate.gov/legislation/laws/ISC/5106
- New York State Senate, Insurance Law Section 5102, Definitions. nysenate.gov/legislation/laws/ISC/5102
- New York State Senate, Insurance Law Section 5103, Entitlement to first party benefits. nysenate.gov/legislation/laws/ISC/5103
- New York State Department of Financial Services, File for No Fault Arbitration. dfs.ny.gov/complaints/file_no_fault_arbitration
- New York State Department of Financial Services, Consumer FAQs About No-Fault Insurance. dfs.ny.gov/consumers/auto_insurance/nofault_faqs
- New York State Department of Financial Services, Regulation No. 68 (11 NYCRR 65), full text. dfs.ny.gov
- American Arbitration Association, New York No-Fault Arbitration. adr.org/special-services/new-york-state-insurance/no-fault
- New York State Senate, CPLR Section 214. nysenate.gov/legislation/laws/CVP/214
Attorney Advertising. This article provides general information about New York law and is not legal advice for any specific situation. Prior results do not guarantee a similar outcome. Last updated July 2026.