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New York Car Accident Attorney Discusses No Fault Serious Injury Insurance Law

Each New York car accident attorney should be familiar with New York Insurance Law to represent car accident victims.  A New York car accident attorney will help the injured person claim no fault benefits, which cover up to $50,000 of medical, lost income, and reasonable out of pocket expenses.  Those benefits do not compensate a person beyond $50,000, do not pay a full wage rate, and do not compensate a person for pain, suffering, and lost enjoyment of life.

With few exceptions, people who are injured in a New York car accident must have a “serious injury” in order to recover money damages beyond that $50,000.  Do not take offense.  The phrase “serious injury” appears in the law and has a very specific definition.  People in car accidents can only recover non-economic damages–pain and suffering damages–if they suffered a “serious injury” as that term is defined in New York law.

Insurance Law § 5104 explains: “Notwithstanding any other law, in any action by or on behalf of a covered person against another covered person for personal injuries arising out of negligence in the use or operation of a motor vehicle in this state, there shall be no right of recovery for non-economic loss, except in the case of a serious injury, or for basic economic loss.”

What is a “serious injury” Under New York’s Insurance Law?

Insurance Law § 5102 explains that “Serious injury” means a personal injury which results in:

  1. death;
  2. dismemberment;
  3. significant disfigurement;
  4. a fracture; loss of a fetus;
  5. permanent loss of use of a body organ, member, function or system;
  6. permanent consequential limitation of use of a body organ or member;
  7. significant limitation of use of a body function or system; or
  8. 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.

Certain sections–death, dismemberment, a fracture, and loss of a fetus–are clear cut and rarely lead to vigorous disputes.  But the remaining sections can be hotly disputed before the case ever reaches a jury.  For instance, a New York car accident causes a torn ACL.  Doctors perform surgery to repair the injured person’s knee.   Assume though that the injured person did not lose much time from work because his/her job is mostly sedentary.  A torn ACL is not death, dismemberment, loss of a fetus, or fracture.  It might, or might not, fall into one of the other categories.  I would argue that a torn ACL is more serious than a hairline fracture which requires no surgery or casting, but unlike that fracture, a torn ACL does not fall into a discrete category in Insurance Law 5102.

What Evidence Does a New York Car Accident Attorney Rely on to Meet the “Serious injury” Threshold?

Without delving deeply into the details behind each category, it can be said that Courts have required plaintiffs to establish serious injury through the use of objective medical evidence.  Every New York car accident victim should make a police report and seek medical attention as soon as possible.  Subjective complains of pain do not satisfy the “serious injury” threshold.  Even medical opinion based only upon subjective complaints of pain, by themselves, may not satisfy the “serious injury” threshold.  The medical evidence should include more specific and concrete evidence of harm.  For instance, results from x-ray, MRI, and CT scans can help prove a “serious injury” under the law.

The simple truth is that the injured person will go a long way towards proving a “serious injury” just by getting proper medical care from a knowledgeable doctor or other healthcare provider and making their symptoms clear.

If you have questions about whether your injury is a “serious injury” under New York’s Insurance Law, call a New York  Car Accident Attorney.