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What You Need To Know About New York’s Serious Injury Threshold

What You Need To Know About New York’s Serious Injury Threshold
Calendar icon October 16, 2024

Car accidents can result in various injuries, ranging from minor bruises to debilitating conditions that change lives. While recovering from such injuries is challenging enough, obtaining compensation in New York requires that your injury meet the serious injury threshold outlined in the state’s insurance law. This threshold ensures that only injuries deemed sufficiently severe are eligible for personal injury lawsuits. 

Navigating the legal and insurance landscape after an accident can be overwhelming, especially if you’re dealing with insurers who may challenge your claims. If you’ve recently been injured in a car accident, consulting an experienced personal injury attorney can help you determine whether your injury qualifies and ensure you pursue the compensation you deserve.

What Is New York’s Serious Injury Threshold?

New York’s serious injury threshold, part of the state’s no-fault insurance system, limits the types of injuries for which you can sue another party for compensation. This system is designed to reduce the number of minor injury lawsuits and keep insurance premiums reasonable. Every driver in New York is required to carry no-fault insurance—known as personal injury protection (PIP)—which covers medical expenses and lost wages regardless of who caused the accident. However, no-fault insurance typically does not cover non-economic damages like pain and suffering. 

To seek compensation beyond what your no-fault insurance covers, such as for pain, suffering, or medical expenses that exceed your policy limit, your injury must meet the serious injury threshold. If your injuries fail to meet this standard, the at-fault party’s insurance company is not obligated to pay damages, limiting your recovery options.

What Injuries Qualify as “Serious” in New York?

Under section 5102(d) of the New York Insurance Law, the following injuries meet the threshold for filing a personal injury lawsuit:

  • Death: If the accident results in the loss of life
  • Dismemberment: Loss of a limb or body part
  • Significant disfigurement: Severe and permanent scarring or disfigurement that affects appearance
  • Fracture: Any broken bone qualifies, regardless of severity
  • Loss of a fetus: Miscarriage or stillbirth resulting from the accident
  • Permanent loss of use: Complete and irreversible loss of function in a body organ, member, or system
  • Permanent consequential limitation: Long-term limitation of use of a body organ or member (e.g., limited joint movement)
  • Significant limitation of use: Substantial impairment in a body function or system, such as chronic back or neck pain that affects mobility
  • Medically determined non-permanent injury: An injury or condition that prevents the individual from performing their normal daily activities for at least 90 out of the first 180 days following the accident.

While some injuries like fractures or disfigurement are straightforward, other conditions—such as herniated discs, muscle strains, or soft tissue damage—require further proof of their impact on your daily life. Insurers often challenge the severity of these injuries, which makes thorough documentation crucial.

Proving Your Injury Meets the Serious Injury Threshold

Even if your injury falls within one of the legal categories, meeting the burden of proof can still be a challenge. Insurance companies are motivated to minimize payouts and may argue that your injury does not meet the required standard. That’s why strong evidence is essential when pursuing a personal injury lawsuit.

Key Evidence to Support Your Case

To successfully demonstrate that your injury meets the threshold, you must provide:

  • Medical records that link the injury directly to the accident.
  • Detailed diagnostic reports from healthcare providers.
  • Ongoing treatment records showing the seriousness and persistence of the injury.
  • Professional medical opinions explaining how the injury limits your abilities.
  • Documentation of changes to your daily activities (e.g., inability to work, do household chores, or participate in recreational activities).

Courts are cautious about accepting conclusory statements from medical experts, meaning you need well-documented evaluations and consistent treatment to strengthen your case. Additionally, if you stop seeking medical care too soon, it could raise doubts about the severity of your injury.

Handling Pre-Existing Conditions

If you had a pre-existing condition that was aggravated by the accident, you must show that the collision directly worsened your condition. This requires detailed medical evidence comparing your health before and after the accident. Without clear documentation, the insurer might argue that your current symptoms are unrelated to the crash.

Why You Need a Personal Injury Lawyer

Dealing with the complexities of the serious injury threshold can be overwhelming, especially when facing experienced insurance adjusters or legal teams. A personal injury lawyer plays a critical role in helping you navigate the legal process, negotiate with insurers, and gather the evidence necessary to meet the threshold.

Key Benefits of Hiring a Lawyer

  • Comprehensive case evaluation: An attorney can review your medical records, accident reports, and insurance policies to determine the strength of your case.
  • Handling insurance negotiations: Insurers often offer low settlements to unrepresented individuals. An attorney will negotiate on your behalf to secure the maximum compensation.
  • Gathering evidence: Your lawyer can collect medical records, witness statements, and expert testimony to support your case.
  • Meeting legal deadlines: Filing a personal injury lawsuit involves strict deadlines. A lawyer ensures all necessary paperwork is submitted on time.
  • Navigating the no-fault system: If your injury meets the serious injury threshold, your attorney will guide you in pursuing compensation for pain, suffering, and other damages beyond no-fault benefits.

Overcoming Insurance Challenges

Even with a valid claim, insurance companies may still attempt to minimize their liability by arguing that:

  • Your injury does not meet the serious injury threshold.
  • Your medical issues are due to a pre-existing condition and not the accident.
  • Your treatment was excessive or unnecessary.

A skilled personal injury lawyer can anticipate these tactics and build a solid case on your behalf, ensuring you receive the compensation you’re entitled to.

What Compensation Can You Receive If You Meet the Serious Injury Threshold?

If your injury qualifies under the serious injury threshold, you can pursue compensation beyond what your PIP coverage provides. Compensation in personal injury cases often includes:

  • Medical expenses: Current and future medical treatment, rehabilitation, and therapy
  • Lost wages: Income lost due to your inability to work following the accident
  • Pain and suffering: Non-economic damages for physical pain, emotional distress, and diminished quality of life
  • Loss of earning capacity: Compensation if the injury affects your ability to earn a living in the future

Cellino Law Is Here To Help

Proving a serious injury on your own can be a difficult task, especially when dealing with the at-fault party’s insurance or attorneys. Hiring a trusted personal injury attorney can protect you in communications and negotiations and ensure that you do not accept a lowball offer from the insurance company.

With a personal injury attorney, the evidence needed to successfully file a claim, collection of medical records, witness and professional testimonies will all be completed on your behalf while you continue to seek medical treatment for your injuries.

As a victim of a car accident, you deserve compensation for any serious injuries you acquired as a result of another driver’s negligence. A qualified and experienced attorney at Cellino Law is ready to help you. Give our team a call at 888-888-8888 for a free and confidential case consultation with a member or our legal team.

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Content checked by the personal injury attorney Ross Cellino. As a family man and a trial attorney, I pride myself on winning cases and serving the community. With over 35 years of experience, I understand the function of a jury, how juries arrive at conclusions, and the role that the jury plays in administering justice. I know how to win cases. You can find us in Manhattan, Buffalo, Melville, Rochester, Brooklyn, The Bronx, Queens and other locations throughout New York.

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