Serious Injury Threshold for Personal Injury Cases in New York

Successful Law Firm Achieving Fantastic Results for People Injured in Car, SUV and Truck Collisions in New York who sustained a “Serious Injury.”

It does NOT matter who was at fault for a collision in New York State in order to have your medical bills and lost wages paid after an automobile collision because New York is 1 of 13 States in the U.S. that are considered a “No-Fault State.”

A No-Fault state requires that when you are involved in a motor vehicle collision with a car, SUV, van, taxi cab, Uber or Lyft vehicle or truck, the No-Fault insurance company insuring the vehicle that you are in when the accident occurred pays for your medical bills and a percentage of lost wages.

The 13 U.S. No-Fault states/territories are:

1. Florida;
2. Hawaii;
3. Kansas;
4. Kentucky;
5. Massachusetts;
6. Michigan;
7. Minnesota;
8. New Jersey;
9. New York;
10. North Dakota;
11. Pennsylvania;
12. Utah; and
13. Puerto Rico

To receive more compensation in addition to the basic payment of medical bills and lost wages through No-Fault insurance, you must have sustained :

• A “Serious Injury” as defined in Article 51 of the New York State Insurance Law; or

OR

• An Economic Loss in excess of the basic economic loss, meaning that you have incurred more than $50,000 in combined medical and lost wage payments.

What this “Serious Injury” category really mean though?  Let’s break it down further!

The “Serious Injury” Threshold

It can be very difficult to decide whether a person involved in a car, SUV, van, taxi cab, Uber, Lyft or truck collision has sustained a “serious physical injury.”

We constantly review the New York State Insurance Law to fight for our clients in order to obtain the best possible result and maximize the award they receive.

Section 5102 (d) of the New York State Insurance Law (“No-Fault Law”) defines a “serious injury” as one of the following:

• Death;
• Dismemberment;
• Significant disfigurement;
• A fracture;
• Loss of a fetus;
• Permanent loss of the use of a body organ, member, function or system;
• Permanent consequential limitation of the use of a body organ or member;
• Significant limitation of the use of a body function or system; or
• A medically determined injury or impairment of a non-permanent nature which prevents the injured party from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety (90) days during the one hundred and eighty days (180) immediately following the occurrence of the injury or impairment.

Most of these are self explanatory (ex. death, dismemberment, etc.).  However, let’s explain some of the more ambiguous categories.

Permanent Loss of the Use of a Body Organ, Member, Function, or System :

This category requires a total, permanent loss of use; a substantial limitation is not enough.  For example, permanent muscle damage to one’s eye would satisfy this category as a serious injury;  however, only a moderate loss of use of the lumbar spine would be insufficient.

Permanent Consequential Limitation of the Use of a Body Organ or Member :

Total loss of use is not required under this category.  However, there must be proof of a significant and permanent limitation. For example, a rotator cuff injury that inhibits one’s ability to move his or her arm without pain would constitute a permanent consequential limitation.  In contrast, one experiencing neck issues but only during weather changes would not satisfy this category as a serious injury.

Significant Limitation of a Body Function / System

The difference between this category and the above two categories is that this category does not require a total or permanent limitation.  This category requires that the limitation must be more than just minimal.  For example, a significant limitation of use of a body function or system may be: (i) hearing loss for up to 30 months after a motor vehicle collision; or (ii) carpal tunnel syndrome resulting from a motor vehicle accident causing difficulty driving, opening doors, and sleeping.  However,  a fifteen percent (15%) impairment in the spine is typically not a significant limitation under this category that would qualify as a “serious injury.”

Non Permanent Impairment for 90 days During the First 180 days Following a Collision :

This category focuses on an injury impairing one’s daily activities over the requisite time period.  Many times, this category will involve looking at one’s employment history.  If one is able to return to work, it may provide some indication that one’s daily activities have not been substantially curtailed to satisfy this serious injury category.  However, one’s ability to work after a collision does not prevent a serious injury finding under this category. For example, where one is: (i) not able to engage in significant aspects of his or her job, (ii) prevented from performing his or her household duties, or (iii) cannot sleep undisturbed for 90 out of the first 180 days after the collision, he or she may have a serious injury under this category.

It should also be noted that these limitations do not have to exist for 90 consecutive days.  This category only requires that the limitations exists for a total of 90 days (3 months) out of the first 180 days (6 months).  In other words, if you added up all the days that the limitations existed after a collision, within the first 6 months there should be a total of 3 months with limitations.  For example, one may be in the hospital for 2 weeks following a collision, then put on strict bed rest for another 2 weeks, then go back to work for 2 months, but then returning to the hospital for 2 weeks for surgery, getting released home for more bed rest for another 3 weeks and finally requiring intensive physical therapy / rehabilitation for another 4 weeks.  Basically, this individual was limited for at least 97 days (3 months and 1 week) within the first 5 months and 1 week following the collision.  Even though this individual returned to work for 2 months within that time period, he or she would still qualify as sustaining a serious injury under this category.

Exceptions to the “Serious Injury” Threshold 

Like everything in life, there are exception to every rule.  The serious injury threshold requirement also has some exceptions that would allow additional compensation.

• Motorcycle collision injuries are not limited by the New York “Serious Injury” Threshold requirement because they are not covered by the No-Fault Law and everything is considered an economic loss.
  • What does this mean?  Well, if you were involved in a motorcycle accident, you can sue the person(s) responsible, even if one only sustained  minor injuries and/or damages such as:
    • Medical bills
    • Lost wages
    • Pain and suffering
    • Emotional distress
    • Punitive damages, which act as a punishment for certain behaviors