New York State Serious Injury Threshold

In New York State if you are injured in an automobile accident you qualify for No-Fault benefits which ensures individuals receive coverage for their medical bills and lost wage if necessary. These benefits can cover medical expenses, lost earnings, and incidental costs, regardless of who was at fault in a crash. The No-Fault coverage received from an accident derives from the vehicle that you, the individual who is injured, were in. You are entitled to medical treatment and out of pocket expenses that are directly related to the accident from No-Fault. However, with a No-Fault claim you are not entitled to compensation from the “pain and suffering” that arose from the damages related to your accident, also known as your injuries. The No-Fault system set in place covers injuries sustained, however, it is important to understand that this does not cover vehicle damage claims.  Typically, most No-Fault agreements allow for up to $50,000.00 in No-Fault benefits, with additional benefits available for an additional price added onto your premium if selected.  Since No-Fault typically covers your medical expenses and lost wages, any type of settlement that one would receive for their injuries would come from the insurance company of the at-fault party or driver.  Typically, a separate insurance company than your No-Fault provider.  In order to eligible for a potential settlement, your injuries must meet the New York State threshold for “Serious Injury”.

New York State has a law called the Serious Injury Threshold. This is defined as “a plaintiff in a personal injury accident that arose out of negligence in the use or operation of a motor vehicle”. This person or “plaintiff” must establish that he or she has suffered a basic economic loss that exceeds $50,000.00 or the plaintiff must establish that he or she has suffered a “serious injury”. Not every injury that one suffers can qualify to meet the New York State’s Serious Injury Threshold.

In order to evaluate someone’s personal injury case, there needs to be certain criteria and loss met caused by the negligence of another person to meet the standards to qualify. Each case has injuries and while many have suffered loss and pain that is serious to them, if they are not within the “serious injury threshold”, they will not fall within the definitions of the statue to pursue the action in court.

In order to meet this “Serious Injury” requirement, an injured person has to prove that the injuries sustained falls into any one of the following nine categories of injuries sated below.

In New York State Insurance law “serious injury” is defined as the following:        

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

Determining Serious Injury

While some of these unfortunate conditions are straight forward and easy to determine, there are some conditions such as the final three that commonly are disputed. In many personal injury cases there are common injuries such as herniated disks, muscle strains, and other “soft tissue” injuries. While these are not specifically laid out in the New York State Serious Threshold Injury, they can but not always qualify for the threshold depending on how the injury effected the individual and how serious it was. It should be understood that even in cases of soft-tissue injury that require major surgery to repair the damage, these injuries may still not qualify as “Serious Injuries”.

The decision on whether or not someone has met the criteria for a Serious Injury Threshold claim will ultimately fall on the court to render a decision concerning the legal sufficiency of someone’s injuries. In doing so, the court will look at many different factors.  Specifically, the court will examine medical records, opinions of the physician treating, if there were pre-existing injuries and how they may have affected this current injury, gaps in treatment, and how long the person was unable to perform their daily activities. It is imperative that the person makes immediate complaints about the injuries and pain at the time of the accident, get emergency care treatment the same day as the crash or within the next few days, miss time from work related to the injury, consistent treatments over a long period of time, and receive a specific diagnosis related directly to your injuries.

Exceptions

There are exceptions to the “Serious Injury” Threshold. For example, motorcycle accident injuries are not covered by the New York State Serious Injury Threshold. This means that if you have been involved in a motorcycle accident, you are allowed to sue the at-fault party for injuries and damages such as medical bills, lost wages, pain and suffering, and emotional distress.

The Serious Injury Threshold is very difficult and complicated to understand. If you believe you have a case that can meet this threshold, it is very important to contact an attorney. This is where Ramos and Ramos can step in and help. Our team has numerous prestige and experienced Personal Injury attorneys that can help you determine the seriousness of your injuries and how to proceed. Our team works diligently to make sure we evaluate every case to the fullest and help you receive the compensation you are entitled to and deserve.