New Hampshire is the only state that does not require every driver to have some kind of third party auto insurance, and drivers are expected to drive at their own risk. Virginia gives drivers the option not to have auto insurance, although they have to pay an annual $500 to exercise this right. North Carolina goes to the other extreme and refuses to issue a license unless the driver can
demonstrate that they have auto liability insurance.The auto insurance regimes used in different states are called tort and no fault. In the no fault system the insurance provider pays all claims from an accident no matter which party was at fault.
In tort those injured have to first get and pay for their medical care and then get reimbursed. If they are at fault then they will not get reimbursed. Most states use the tort fault system, although some large states such as Florida, New York and Pennsylvania are under the no fault system.