Serious Injury Threshold

A Short Introduction to the Serious Injury Threshold in New York’s No Fault Insurance Law

New York enacted its no-fault insurance law to ensure that people involved in car accidents would receive compensation within a reasonable time. Prior to the no-fault insurance law, courts were overwhelmed with vehicle injury claims. As a result, many victims’ damage awards were extremely delayed. The Insurance Law addresses this problem.

The Insurance Law requires motor vehicle operators to carry insurance. It also requires those insurance policies to contain certain terms, insure certain people, and cover claims up to a certain limit. Additionally, the insurance law requires insurance policies to cover basic economic losses regardless of who was at fault in certain accidents (with some exceptions). This is known as “no-fault” insurance. It allows accident victims to receive their compensation from their insurance policies, without having to go through the courts.

The amount a victim may be awarded by no-fault insurance is limited. Insurance usually covers medical expenses and lost earnings up to $50,000. Damages beyond this amount, and noneconomic damages, will not be awarded under the no-fault insurance law.

Obviously, however, some accident victims suffer damages beyond this amount. Victims who miss very long periods of work may lose more than $50,000 in earnings. And victims that suffer serious injuries may want compensation for pain and suffering. The law is responsive to these situations, but it does not require insurance policies to provide the compensation. Instead, the insurance law allows victims that suffer “serious injuries” to sue the person at fault in the accident.

“Serious injury” is defined in section 5102 of New York’s Insurance Law:

(d) “Serious injury” means a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system; or a 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 eighty days immediately following the occurrence of the injury or impairment.

Some of these terms may seem rather vague. How much disfigurement is “significant”? How much limitation of the use of a bodily organ or member is “consequential”? Courts agree that these terms are not completely clear, which is why they leave it up to juries – after detailed jury instructions – to decide whether a particular injury is “serious” enough to warrant an award beyond what is provided by the insurance law.

Personal Injury Attorney in Mineola

If you have questions about this or other legal issues, and would like to schedule a free consultation with an attorney at the Law Firm of Vaughn, Weber & Prakope, PLLC, please call 516-858-2620.