New York is a no-fault auto insurance state. This means that if you get into an accident, you and the people in your vehicle should first look to your insurance to cover any “economic loss” related to injury, regardless of who caused the crash. However, there are exceptions to this rule, and victims have the right to sue for additional damages whenever they suffer a “serious injury.”
Because serious injuries create an exception to the no-fault standards, it is important to understand how the state defines them.
9 types of serious injuries
Serious injuries are defined in Section 5102(d) of the New York Insurance Law. The text identifies nine different outcomes that qualify:
- Significant disfigurement
- Loss of a fetus
- Permanent loss of a body part
- Permanent, consequential limitation on a bodily function
- Significant limitation of a body part or function
- Medically determined impairment that substantially blocks normal daily activities for at least 90 of the 180 days immediately following the accident
As you can imagine, some of these standards require more proof or argument than others, but they all allow you to seek compensation from the at-fault driver’s insurance. It is possible, even likely, your insurance will not reimburse you for the full cost of your injury. Suing the responsible driver may force their insurance to cover the rest of your damages.
4 more things to understand about the serious injury threshold
To successfully pursue your compensation from the at-fault driver’s insurance, you need to do more than simply prove you suffered a serious injury. As the New York State Bar Association (NYSBA) notes, you must also:
- Continue with your treatment. If you do not, you must explain any gaps in treatment or risk losing your claim.
- Address any related pre-existing conditions. Pre-existing conditions will not automatically block your claim; failing to address them could get your claim dismissed.
- Quantify your limitations. The example the NYSBA uses is that of a victim who loses movement in her arm. She must not simply say she lost movement. She must compare her limited use to the normal, full range of motion and quantify that difference.
- Provide certified medical results. Because you want certified medical records to support your claim, you want to let your doctor know right away. It can be harder to get the records certified after the fact.
- In most cases, it will not be immediately clear whether you qualify to make a claim or not. An experienced attorney will need to monitor your treatment and obtain all records to determine your eligibility.
Why does it matter if an injury is labeled as “serious”?
No-fault insurance is meant to cover economic loss due to bodily injury. After an accident, it covers your healthcare costs, lost wages and some other expenses with clearly defined dollar amounts, up to your policy limit. No-fault insurance does not cover your auto repairs, nor does it cover things like future therapy, reduced earning potential or pain and suffering.
You can sue to recover some of these additional damages after a serious injury. That’s why you need to understand if the state will recognize your injury as serious.