Are "No-Fault" Benefits Available If I am Injured While Getting Out of a Car?

New York has a “no-fault” liability system. This means that, for most motor vehicle accidents, the injured party must recover benefits from his or her own insurance company. The no-fault system is designed to keep most accident cases out of courts. Only when a party alleges a “serious injury” due to the negligence of another party is litigation an option. For more simple injuries, no-fault benefits are intended to provide total compensation.

But, that does not mean disputes never arise over eligibility for no-fault benefits. A recent decision by a New York appeals court illustrates the types of situations where even no-fault benefits may not be available to an injured party.

Gonzalez v. American Commerce Insurance Co.

In this case, a husband and wife were driving home. After parking in front of their house, the wife exited the vehicle, at which point she said her knee “gave way,” causing her to fall and injure the knee. The wife then sought no-fault benefits from her auto insurance carrier.

The insurer denied coverage. Both Suffolk County Supreme Court and the Appellate Division, Second Department,upheld the carrier's denial. The courts agreed the insurer was entitled to summary judgment, as the wife failed to raise any valid legal claim.

Under New York law, no-fault benefits are intended “to reimburse a person for basic economic loss on account of personal injury arising out of the use or operation of a motor vehicle.” The operative phrase here is “use or operation of a motor vehicle.” Here, the wife was allegedly injured while exiting a motor vehicle, which is not the same thing as during “use or operation.” Indeed, the Second Department noted the injury was caused when the wife's knee suddenly “buckled,” which had nothing to do with the vehicle itself.

New York courts do not allow individuals to claim no-fault benefits for injuries sustained near a motor vehicle or incidental to their operation. As the New York Court of Appeals explained in a 1996 decision: “[a]ny other rule would permit recovery for claims based on back strains, slip-and-fall injuries, and other similar injuries occurring while the vehicle is being used but which are wholly unrelated to its use.” In the 1996 case, the Court of Appeals said a truck driver could not recover no-fault benefits for injuries sustained while unloading his truck with a “levelator” device. The court said those benefits were only available if the injury was caused by the truck, not some other apparatus used to offload the truck. While many private insurance contracts may include such loading and unloading injuries as part of their coverage, no-fault benefits are strictly defined by statute in New York.

Assessing the Cause of Your Injuries

The key point here is that, in order to collect no-fault benefits, it is not enough to simply say you were in an accident; you must be in an accident where your injuries were directly caused by a motor vehicle. However, even if you are unable to recover no-fault benefits, if your injuries were the result of negligence by some other party, you may still be able to pursue a personal injury lawsuit. That is why if you have been in any type of accident, you should consult with an experienced New York personal injury attorney right away. Contact our office if you have any questions.