NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW APPLICATION FOR MOTOR VEHICLE NO-FAULT BENEFITS * Motor Vehicle Accident Indemnification Corporation 110 WILLIAM STREET NEW YORK, N.Y. 10038 * DATE POLICY
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Who needs the NYS FORM NF-2?

Under the New York No-Fault Law, victims of motor vehicle accidents are entitled to benefits or reimbursement of their basic economic loss. The NYS FORM NF-2 is an application for motor vehicle no-fault benefits.

 

What is the purpose of the NYS FORM NF-2?

The purpose of this form is to apply for benefits. Based on the NYS FORM NF-2, the Motor Vehicle Accident Indemnification Corporation determines whether the applicant is entitled to benefits.

 

When is the NYS FORM NF-2 due?

The applicant should complete and return the form as soon as possible.

 

What information should be provided?

The applicant should provide the following information:

  • (a) personal information: name, phone numbers, address, date of birth, social security number;
  • (b) information about the accident: date and time, place of the accident, brief description of the accident;
  • (c) information about injury;
  • (d) information about the vehicle at the time of accident: owner’s name, make, year, type of vehicle (truck, motorcycle, bus or school bus, automobile).

The applicant has to indicate whether he was the driver of the vehicle, a passenger in the motor vehicle, a pedestrian, a member of policyholder’s household, and whether he or the relative with whom he resides owns a motor vehicle.

The applicant must provide the name and address of the doctors or persons who furnished him health services.

If the applicant was treated at a hospital he should indicate the hospital’s name and address and the date of admission.

Furthermore, the applicant specifies the amount of health bills and answers whether:

  • he would have more health treatments.
  • he was at the time of accident in the course of his employment.
  • he lost time from work, specifying the date absence from work began.
  • he has returned to work, specifying the date when he returned to work and amount of time lost from work.

The following information should also be provided:

  • average weekly earnings;
  • number of working days per week;
  • number of working hours per day;
  • names and addresses of the current employer and other employers for one year preceding the accident, and dates of employment;
  • other expenses resulting from his injury;

Finally, the applicant should indicate whether his injury resulted in any other expenses, and if yes, he should attach explanation and amounts of such expenses.

  • If the applicant has received or is eligible for payment under New York State Disability or workers’ compensation, he should indicate this

Where do I send the NYS FORM NF-2?

The applicant must send the form as soon as possible to the Motor Vehicle Accident Indemnification Corporation with its address at 110 William Street, New York, N.Y. 10038.