New York No-Fault Law: Serious Injury Threshold for Damages

By Jonathan B. Nelson, Attorney at Law

New York’s No-Fault Law was enacted to make certain that legitimate accident related medical expenses, lost earnings and incidental costs were paid by the insurance companies. (See, New York Automobile No Fault Law)

However, as the legislature often does – when it gives you something with one hand, it takes something away with the other. Under New York No-Fault Law, you cannot recover for personal injury unless you have sustained Serious Injury under the law.

Under New York State Insurance Law, Serious Injury Threshold is defined as:

  • A permanent loss of use of a body organ, member, function and symptom.
  • A permanent consequential limitation of a use of a body organ or member.
  • Significant limitation of a use of a body function or system.
  • A medically determined injury or impairment of a non-permanent nature which has prevented the Plaintiffs from performing substantially all the material acts which constitute the Plaintiffs usual and customary daily activities for not less than 90 days during the 180 days immediately following the accident.

In explaining the serious injury, I often remark to my clients, “It’s somewhere between a bump on the arm and a broken arm. A bump, clearly not meeting the threshold and a broken arm routinely satisfying the requirement.” It is the injuries “in the middle” that can be the most problematic under New York No-Fault Law.

The New York Court of Appeals has noted, “In the context of soft-tissue injuries involving complains of pain that may be difficult to observe or quantify, deciding what is a ‘serious injury’ can be particularly vexing.” Soft tissue injuries can involve injuries such a bulging or herniated disc, shoulder rotator cuff tears, tears in the meniscus of the knees and other injuries. In other words, soft tissue injuries involve the “soft tissues” of our bodies as opposed to bones or injuries to organs.

As a general rule, insurance companies first inquiry is the extent of medical treatment. Insurance companies pay particular attention to the onset of medical treatment in relation to the date of the accident. They generally will be skeptical if a person is claiming serious injury yet they did not seek medical attention for an extended period of time after the accident. Insurance companies will also focus on the length of medical treatment. Again, relying upon New York State No-Fault Law, they generally want to see that the person has treated for at least 90 days. Many insurance companies will deny a claim outright if the accident victim has sought medical treatment for less than ninety days. Additionally, insurance companies will most always question a “gap” in treatment. If a person is claiming serious injury, an insurance company will be dubious about a cessation or gap in medical treatment.

In determining whether an injury meets the requirements under New York State No-Fault Law, insurance companies will also look to the actual medical records and diagnostic tests. Insurance companies often rely upon MRI’s (magnetic resonant imaging). Unlike x-rays which show injuries to bones, MRI’s show injuries to soft tissues. Insurance companies often have their own radiologists read the MRI’s. MRI interpretation can differ from doctor to doctor and oftentimes, the insurance company doctor will disagree with your doctor’s findings. More doctors have been relying upon nerve conduction studies and other objective tests to help satisfy the New York State No-Fault requirements.

Additionally, insurance companies will inquire about lost time from work, inability to perform daily tasks, restriction of range of motion and other areas that the particular insurance company finds probative. In other words, there is no easy answer and the conclusion may differ from insurance company to insurance company, attorney to attorney and judge to judge.

The best course of action that a person who has been injured in a car accident in New York can follow is to seek medical attention right away if needed and follow the advice of the doctor. Next call an attorney. Let the attorney handle the legal aspects of your car accident so that you can concentrate on getting better!

Your lawyer will be able to help guide you through the New York State No Fault process. If you have any questions, you may always call The Law Offices of Jonathan B. Nelson, PC at (212) 791-0441 or 1-888-9-ATTORNEY. We are here to help. “Let our family help your family.”

About the Author:

The Law Offices of Jonathan B. Nelson, P.C.
Personal Injury Attorney in New York
225 Broadway, Suite 2400
New York, NY 10007

Phone: (212) 791-0441
Email: law@nelson-law.com
Website: www.nelson-law.com

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