After a car crash, figuring out how medical bills and lost wages get paid shouldn’t add to your stress. If you’re dealing with injuries or grieving a loved one who died in a wreck someone else caused, you need straight answers. Many people start by asking: What is a no fault car accident claim?
In a no fault system, your own insurance pays for your basic medical expenses and lost income, regardless of who caused the crash. This system aims to simplify things and get money into your hands faster—but it’s not without drawbacks.
Only a small number of states follow this model. As of now, 12 states and Puerto Rico use a no fault approach, either fully or with a choice-based option. Virginia, for example, gives drivers a choice between traditional fault-based coverage and no fault coverage like personal injury protection.
Understanding how no fault claims work can mean the difference between getting your bills covered or getting stuck with them. When insurance companies stall, underpay, or deny valid claims, a car accident lawyer can step in. If that’s where you are, Allen & Allen offers a free consultation to go over your options.
What is no fault insurance?
No fault insurance lets drivers recover compensation for basic out-of-pocket losses—like hospital bills or time missed from work—directly from their own insurer. You don’t have to prove the other driver caused the crash before benefits kick in.
Why no fault systems were created
No fault laws started gaining traction in the 1970s. Lawmakers saw courts jammed with minor injury cases, and insurers dragging their feet on payment. The goal was faster reimbursements, less courtroom drama, and lower premiums overall. It sounded good in theory: pay your own way, no finger-pointing required—at least at first.
No fault vs. traditional tort systems
In traditional fault-based (or tort) systems, the person who caused the accident pays. You file a claim with the at-fault driver’s insurance, and you may need to sue if the offer doesn’t cover everything. In contrast, no fault systems shift that initial responsibility to your own policy, at least for specific costs and within certain limits.
States with no fault insurance laws
Only some states use no fault systems, and even those apply them differently. The full no fault states include:
- Florida
- Michigan
- New York
- New Jersey
- Pennsylvania
- Hawaii
- Massachusetts
- Kentucky
- Minnesota
- North Dakota
- Utah
- Puerto Rico
What about “choice” states?
A few states let drivers choose between no fault and traditional coverage when they buy their policy. These include:
- Kentucky
- New Jersey
- Pennsylvania
Choosing the no fault option limits your right to sue unless injuries meet certain thresholds.
Virginia’s take
Virginia isn’t a full no fault state. Instead, drivers can buy Medical Payments Coverage (MedPay), which works like a limited version of personal injury protection (PIP). It pays for things like emergency care and follow-up treatment, up to the purchased limit, no matter who caused the crash. Virginia has specific insurance requirements you must understand if you live in the state.
How no fault claims work
A no fault claim starts with your own insurance company, not the other driver’s. That’s the core difference from traditional car accident claims. You don’t need to prove who caused the crash to get basic benefits like medical payments or wage reimbursement—at least not at first.
Step-by-step process after an accident
- Get medical care immediately. Don’t delay. Waiting to see a doctor can not only worsen injuries but also give the insurer a reason to question your claim.
- Report the accident to your insurance company. Most policies require this within a short window—often 24 to 72 hours.
- File a personal injury protection (PIP) claim. This means submitting documentation like hospital bills, wage loss proof, and provider statements. Your insurer uses this to calculate what it owes under the PIP portion of your policy.
- Submit any required forms. Some states require specific forms to trigger no fault benefits. If your insurer doesn’t provide these automatically, request them.
- Keep records. Every document, receipt, and communication with the insurer matters. Save everything in one place.
- Monitor the response. Insurers are required to process no fault claims quickly—often within 30 days. If they request more information, respond promptly, but keep an eye out for delays or stalling tactics.
- Escalate when needed. If the insurance company denies benefits or drags things out, you may need a legal advocate to get the compensation your policy provides.
Types of benefits available
No fault insurance usually covers:
- Medical expenses – Hospital bills, outpatient care, physical therapy, prescriptions, and sometimes mileage to and from appointments.
- Lost income – If injuries prevent you from working, PIP pays a portion of your missed wages up to a set limit.
- Replacement services – If you can’t perform daily tasks like childcare or household chores, some policies pay for outside help.
- Funeral and burial expenses – In fatal crashes, PIP often pays these costs up to the policy’s cap.
Note: No fault insurance doesn’t cover vehicle damage. For that, you’ll file a separate property damage claim, often with the other driver’s insurer (if they were at fault) or your own policy’s collision coverage.
Timeline expectations
PIP claims move faster than liability-based ones. Many states set deadlines for insurers to act—usually around 30 days from receiving your documents. But the clock only starts once the insurer gets everything it needs. Incomplete paperwork gives them an excuse to delay.
If your insurer doesn’t pay on time, they may owe penalties or interest under state law. That said, enforcing those rights often takes pressure—and that’s when having legal help becomes useful.
Personal injury protection (PIP) coverage
Personal injury protection—better known as PIP—is the core feature that makes a no fault system work. Instead of waiting to see who caused the accident, your PIP benefits kick in right away to handle urgent expenses. This helps keep injured drivers and passengers from falling behind on bills while insurance companies figure out liability.
What PIP typically covers
PIP steps in to pay for a specific list of losses after a crash:
- Medical expenses – This includes emergency treatment, surgery, follow-up care, prescription medication, physical therapy, and sometimes chiropractic visits or psychological services related to the accident.
- Lost wages – If the injury keeps you from working, PIP replaces part of your income, usually a set percentage for a limited period.
- Essential services – When injuries prevent someone from doing regular household tasks, PIP can cover hired help. That might include laundry, cleaning, childcare, or grocery shopping.
- Funeral costs – In fatal accidents, PIP often includes a benefit for funeral and burial expenses, up to the policy’s cap.
- Survivor benefits – If someone dies in the crash, their dependents may receive lost income benefits for a period of time.
These benefits apply regardless of fault. Even if you caused the crash, your PIP coverage still applies, as long as your policy is active and the situation falls within the state’s no fault rules.
PIP usually doesn’t cover pain and suffering or other non-economic damages. To pursue those, you’d need to meet your state’s lawsuit threshold and take action outside the no fault system.
Some states, particularly no fault states, require drivers to carry pip insurance. As an at-fault state, Virginia doesn’t have a requirement. However, it may still benefit you to obtain pip coverage.
Threshold requirements for lawsuits
Even in no fault states, you might still file a lawsuit—but only if your injuries qualify under specific thresholds.
Verbal thresholds
A verbal threshold means you can sue only if your injuries fall into categories like:
- Permanent disfigurement
- Loss of a body function
- Death
These definitions vary. In some states, a herniated disc might count; in others, it wouldn’t.
Monetary thresholds
Monetary thresholds trigger when your medical expenses exceed a certain dollar amount. If your bills go past the set limit, the door opens to sue the at-fault driver.
Pros and cons of no fault claims
No fault insurance offers some clear benefits, but also imposes real limitations.
Pros
- Quick payment: No waiting for fault to be decided.
- Less litigation: Fewer lawsuits for bumps, bruises, and low-dollar fender benders.
- Stable premiums: Some states report fewer premium hikes due to reduced legal costs.
Cons
- Limited lawsuits: You lose the automatic right to sue unless your injuries meet specific standards.
- Partial compensation: PIP doesn’t cover pain, suffering, or other non-economic damages unless you qualify to go outside the system.
- State-by-state confusion: Each system works differently, and figuring out thresholds or deadlines can trip people up.
Common misconceptions about no fault claims
No fault insurance causes plenty of confusion. Here are a few common myths:
“No one is blamed for the accident”
That’s false. Fault still matters for things like property damage or when injuries exceed the threshold. The police report may still name the responsible driver.
“I can’t sue at all under no fault”
You can sue—but only if your injuries qualify. That bar may be lower than you think, depending on the state and facts.
“No fault covers all my accident costs”
Not quite. PIP pays only up to its limit. If your hospital bills total $25,000 but your PIP maxes at $10,000, you’ll need another source—like a lawsuit or health insurance—to make up the difference.
Tips for maximizing your no fault benefits
Even with no fault coverage, mistakes in the early stages can cost you.
Keep thorough records
Save every bill, receipt, and prescription. Get written work excuses from doctors. Track mileage for medical appointments. These details support your claim and can mean the difference between approval and denial.
Communicate clearly
Respond to your insurer’s requests promptly. If they ask for forms, don’t delay. Keep copies of everything you submit.
Consider legal help when needed
Some claims get delayed or denied for no good reason. If that happens, or your injuries cross a threshold, hiring a lawyer may help you recover the full compensation available.
When you need an attorney for a no fault claim
Not every no fault claim requires legal action. When things go wrong though or you suffer significant injuries and losses, a lawyer becomes a valuable ally.
Denied or delayed claims
Some insurers deny claims for missing information or alleged policy violations. Others slow-walk payments to pressure you into accepting less. A lawyer can challenge those tactics and push for a fair outcome.
Coverage disputes
Sometimes the insurer says your injuries don’t qualify, or claims the care you received wasn’t necessary. Legal representation brings in medical evidence and case law to support your position.
Serious injuries
If your injuries meet the verbal or monetary threshold, you may have the right to sue for full damages—including pain and suffering. Filing that case without help often leaves money on the table.
Bad faith conduct
When insurance companies act dishonestly or unfairly—delaying, denying, or undervaluing claims without good reason—you may also have a separate case for bad faith practices.
Contact our experienced car accident attorneys now
No fault claims can speed up medical payments and protect drivers from minor crash lawsuits. But they also limit legal options and don’t always pay enough to cover all your losses. Knowing how your state’s system works matters, especially if you’re trying to recover after a serious crash.
Allen & Allen helps accident victims understand their rights and demand the compensation they’re owed. The firm takes every case personally—because your fight becomes their fight. Whether you’re struggling with unpaid bills, denied coverage, or long-term injuries, you don’t have to deal with the insurance company alone.
Contact Allen & Allen today for a free consultation. Let’s talk about your next steps.
