What Does Choice No Fault Actually Mean?
In a choice no fault state your own policy pays your first medical bills whoever caused the crash, and a box you ticked when you bought the policy decides whether you can claim for pain at all.
What choice no fault actually means
People use the phrase no fault to mean two different things, and only one of them is true here. It is true that your own auto policy pays your first medical bills after a crash regardless of who caused it: those are called first party benefits, and many states require every auto policy on a vehicle registered in the state to carry a medical benefit. It is not true that fault stops mattering. Fault still decides who pays for everything the first party benefits do not cover, and whether you can be paid for pain at all.
The choice part is the tort election. When the policy was written, the named insured was given two versions of the same policy in writing and picked one. That decision, not the crash, decides whether a claim for pain and suffering is open to you.
Who pays the first medical bills
The statute sets an order. A named insured recovers first party benefits against the policy on which they are the named insured. An insured recovers against the policy covering them. The occupants of an insured vehicle recover against the policy on that vehicle. A person who is not in a vehicle at all, a pedestrian or a cyclist, recovers against the policy on any vehicle involved in the crash. Where two insurers sit at equal priority, the one asked first has to process and pay the claim as though it were wholly responsible, and sort out contribution afterwards.
Auto is also primary. Except for workers compensation, the auto policy issued under this subchapter pays before a health plan or any other group arrangement, and those other arrangements are read as covering only what is left over.
How much cover is there
Every policy has to include a medical benefit; the statute fixes the floor and your declarations page shows what you actually bought above it. Separately, the insurer has to make available for purchase a wider set of first party benefits: reasonable and necessary medical treatment and rehabilitative services with no time limit, an income loss benefit that pays a share of lost gross income, an accidental death benefit and a funeral benefit. Whether you hold those extras is on the same page. If you cannot find it, the insurer has to produce it.
When you can still sue the other driver
- Full tort keeps the right to seek compensation for noneconomic loss, which the statute defines as pain and suffering and other nonmonetary detriment
- Limited tort keeps the economic side and rules out a claim for noneconomic loss unless the injury is a serious injury
- A serious injury is defined as a personal injury resulting in death, serious impairment of body function or permanent serious disfigurement
- If the named insured never answered either notice from the insurer, full tort is conclusively presumed
- Several exceptions let someone bound by limited tort recover as though they held full tort, including a crash caused by a driver convicted of or accepting a diversion program for driving under the influence
What happens when the benefits run out
First party benefits are not a ceiling on the claim, they are the first payer. What the statute does say is that you cannot be paid twice: in an action against the person at fault, or in an uninsured or underinsured motorist proceeding, you are precluded from recovering the amount of benefits paid or payable under this subchapter, or under workers compensation, or under the other arrangements the chapter defines. Losses beyond what those benefits covered are a different question and depend on the tort election, on the other driver's coverage and on your own uninsured and underinsured coverage.
The practical version: find your declarations page before you talk to anybody about what a claim is worth, and ask someone to read it with you. That reading is free here and it can happen entirely by phone.
- Required medical benefitStates that require a medical benefit on auto policies set a minimum amount and often exempt motorcycles from it.
- Optional benefitsPolicies can usually add more: higher medical limits, income loss and funeral benefits, if the policyholder chose them.
- Which policy pays firstRules that set the order of policies usually look first to your own policy, then to the vehicle you were in, then to a vehicle involved.
- If no policy appliesWhere no policy covers an injured person, some states run a fund or plan that pays a basic benefit.
- Coordination with health plansWhere the auto medical benefit applies, it usually pays before a health plan, and the rules set how the two coordinate.
- The default choiceWhere the policyholder never makes a choice, the rule usually sets which option applies by default.
- Vehicle definitionsInsurance rules usually define the vehicles they reach, and motorcycles and commercial vehicles are often outside the definition.
- No double recoveryBenefits already paid by your own policy usually cannot be claimed again from the driver who caused the crash.
