How To Prove Your Injury Meets The New York Serious Injury Threshold
After a car accident in New York, you may assume that the at-fault driver’s insurance will compensate you for medical expenses, lost wages, and pain and suffering. However, New York’s no-fault insurance laws limit when an injured person can file a lawsuit against the responsible party. To pursue compensation beyond basic no-fault benefits, your injuries must meet the Serious Injury Threshold defined in New York Insurance Law § 5102(d). If your injuries do not meet this legal standard, you may be restricted to only receiving benefits under your Personal Injury Protection (PIP) coverage. Understanding what qualifies as a serious injury and how to prove it can be the difference between securing full compensation or being left with unpaid expenses.
Insurance companies often dispute whether an injury meets the serious injury threshold. Their goal is to minimize payouts, so they frequently argue that an injury is not severe enough to justify additional compensation. That is why strong medical documentation, legal arguments, and clear evidence are critical in these cases. I help my clients establish the severity of their injuries by working with medical professionals, gathering the right records, and building a compelling case that meets New York’s strict legal requirements.
What Qualifies As A Serious Injury Under New York Law?
Under New York Insurance Law § 5102(d), an injury must fit into one of the following categories to qualify as serious:
- Death – If the accident results in the victim’s death, the family may pursue a wrongful death claim.
- Dismemberment – The loss of a limb or other body part automatically qualifies.
- Significant Disfigurement – Permanent scars, burns, or other visible injuries that alter a person’s appearance in a substantial way.
- Fracture – Any broken bone meets the threshold, regardless of its severity.
- Loss of a Fetus – If an accident causes a miscarriage, it qualifies as a serious injury.
- Permanent Loss of Use of a Body Organ, Member, Function, or System – A complete and permanent loss of function of any body part.
- Permanent Consequential Limitation of a Body Organ or Member – A significant and lasting limitation, such as restricted movement or chronic pain, that limits function.
- Significant Limitation of Use of a Body Function or System – This is less severe than permanent loss but still imposes substantial physical restrictions.
- Medically Determined Injury or Impairment Preventing Normal Daily Activities for at least 90 of the First 180 Days Post-Accident – Known as the “90/180 Rule,” this applies to injuries that restrict daily activities for at least 90 days within the first six months after the accident.
If an injury fits into one of these categories, the victim can pursue damages for pain and
suffering, lost income, and other losses beyond what no-fault benefits provide.
How To Prove Your Injury Meets The Serious Injury Threshold
Insurance companies and defense attorneys often challenge whether an injury qualifies as serious under the law. To strengthen a claim, I gather medical evidence, legal documentation, and expert testimony to establish the full extent of an injury.
Comprehensive Medical Documentation
Medical records are the foundation of any serious injury claim. The following types of evidence are essential:
- Emergency room records and hospital reports showing the immediate effects of the injury.
- X-rays, MRIs, and CT scans confirming fractures, disc herniations, or other structural damage.
- Doctor’s evaluations detailing long-term prognosis and treatment.
- Surgical records if an operation was required.
- Physical therapy reports tracking progress and ongoing limitations.
Medical Testimony From Treating Physicians
A treating physician’s statement explaining how an injury affects function is critical. The doctor must:
- Provide an objective diagnosis.
- Show how the injury limits mobility, strength, or daily activity.
- Connect the injury directly to the accident.
Demonstrating Impairment With Functional Tests
If an injury falls under the categories of “significant limitation” or “permanent consequential limitation,” functional tests can demonstrate restricted movement, pain levels, and disability. These tests may include:
- Range of motion measurements.
- Strength and endurance tests.
- Neurological evaluations.
Establishing The 90/180 Rule
For injuries that do not meet the permanent limitation standard, proving that normal activities were restricted for at least 90 out of the first 180 days after an accident is another way to meet the threshold. This requires:
- Statements from doctors confirming the inability to work or perform daily tasks.
- Witness testimony from family, coworkers, or caretakers describing activity limitations.
- Employment records showing work absences due to the injury.
New York Personal Injury Law FAQs
What Happens If My Injury Does Not Meet The Serious Injury Threshold?
If your injury does not qualify under New York Insurance Law § 5102(d), you may be limited to no-fault benefits, which cover medical expenses and a portion of lost wages but do not compensate for pain and suffering. If your injuries are borderline, I can help build a strong case using medical evidence and expert testimony.
How Can I Prove That My Injury Qualifies As A Serious Injury?
Proving a serious injury requires medical records, physician evaluations, and sometimes expert testimony. Objective tests such as MRIs, X-rays, and physical examinations help establish that an injury meets the legal standard. If an insurance company disputes the severity, I work to present clear evidence that supports your claim.
What If The Insurance Company Claims My Injury Is Pre-Existing?
Insurance companies often argue that an injury existed before the accident. If this happens, medical records from before and after the accident can show whether the injury was aggravated by the crash. A doctor’s testimony can also help prove that the accident directly caused the new condition.
Does A Broken Bone Automatically Qualify As A Serious Injury?
Yes, under New York Insurance Law § 5102(d), any fracture meets the serious injury threshold, regardless of whether it requires surgery or extensive treatment.
What If I Was Unable To Work For Several Months Due To My Injury?
If you were unable to perform normal activities, including work, for at least 90 of the first 180 days after the accident, you may meet the serious injury threshold. Employment records, doctor’s statements, and testimony from family members can help prove this claim.
Can A Soft Tissue Injury Meet The Serious Injury Threshold?
Soft tissue injuries, such as whiplash or herniated discs, do not automatically qualify. However, if medical evidence shows a significant limitation of motion or long-term impairment, it may meet the legal standard. Objective tests like MRIs and functional evaluations are crucial in these cases.
What If My Injury Got Worse Over Time?
Some injuries may not appear severe immediately but worsen over weeks or months. If new medical evaluations show a significant limitation that meets the serious injury standard, it may still qualify for compensation.
How Long Do I Have To File A Lawsuit For A Serious Injury Claim?
Under New York Civil Practice Law & Rules (CPLR) § 214, you generally have three years from the date of the accident to file a personal injury lawsuit. However, claims against municipalities or government agencies have shorter deadlines.
The Right Law Firm Is Right Here
If you were injured in a car accident and believe your injuries meet the serious injury threshold, I can help you build a strong case and fight for the compensation you deserve. Insurance companies work hard to deny claims, but I know how to present the right evidence to prove the severity of an injury.
At Jonna Spilbor Law, we fight for injury victims across the Hudson Valley, Dutchess County, Putnam County, and New York City. For a free consultation, contact our Fishkill injury attorney at Jonna Spilbor Law. Call our Fishkill office at (845) 485-2529.
