What is a Serious Injury under NY Insurance Law?
New York operates under a no-fault insurance system for car accidents. This means that if you are injured in a car accident, your Personal Injury Protection (PIP) coverage pays for your medical expenses and lost wages—regardless of who was at fault. However, this system comes with significant limitations, particularly when it comes to suing for pain and suffering.
If your injuries meet the serious injury threshold outlined in Insurance Law § 5102(d), you may be eligible to file a lawsuit for compensation beyond your no-fault benefits. This guide explains what qualifies as a serious injury, how the 90/180-day rule works, what medical evidence is required, and how exceptions allow victims to pursue additional compensation.
What Is a Serious Injury Under New York Insurance Law?
Under New York’s no-fault insurance laws, most minor injuries are covered by PIP benefits, which pay for basic medical expenses and lost wages. However, accident victims who suffer serious injuries can step outside the no-fault system and file a lawsuit for additional damages.
New York Insurance Law § 5102(d): The Legal Definition of Serious Injury
New York defines a serious injury as one that falls into one or more of the following categories:
- Death
- Dismemberment (Loss of a Limb)
- Significant Disfigurement
- Fracture (Broken Bone)
- 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
- An injury or impairment that prevents the victim from performing their usual daily activities for at least 90 of the 180 days immediately following the accident (“90/180-Day Rule”)
Each of these classifications has specific legal and medical criteria that must be met for a victim to be eligible to file a lawsuit beyond New York’s no-fault insurance coverage.
Breaking Down the Key Categories of Serious Injury in New York
While some injuries automatically qualify as serious, others require substantial medical documentation to prove their severity. Below is an in-depth look at how courts determine whether an injury meets the serious injury threshold.
Permanent Loss of Use of a Body Organ or Member
A person qualifies under this category if they suffer a total and permanent loss of function in a body part or organ. This means that the affected area must have no ability to recover function.
Examples of Permanent Loss of Use Injuries:
- A car accident victim suffering paralysis of an arm or leg.
- Severe nerve damage that results in permanent immobility of a hand or foot.
- Complete loss of vision, hearing, or speech.
What Does Not Qualify?
- Partial loss of function or temporary disabilities.
- Injuries that result in chronic pain but do not cause measurable physical limitations.
Significant Disfigurement
New York law defines disfigurement as an injury that permanently alters a person’s appearance in a way that would be obvious to an observer. Courts typically assess whether a reasonable person would consider the disfigurement to be serious.
Examples of Significant Disfigurement:
- Deep facial scars that permanently alter a person’s appearance.
- Severe burns that leave visible scars or skin deformities.
- Amputations of fingers, toes, or other extremities.
What Does Not Qualify?
- Minor scars that are barely visible or can be hidden by clothing.
- Bruises, swelling, or temporary facial injuries.
Fracture Injuries (Broken Bones)
Fractures are one of the few automatic serious injuries under New York law. If a victim suffers a broken bone, they do not need additional proof to file a lawsuit beyond no-fault insurance.
Examples of Fractures That Qualify:
- Broken ribs, arms, legs, collarbones, or skull fractures.
- Complex fractures requiring surgery or long-term rehabilitation.
- Vertebral fractures leading to spinal cord damage.
What Does Not Qualify?
- Hairline fractures that do not require significant medical treatment.
Permanent Consequential Limitation & Substantial Disability
If an injury results in long-term physical limitations, it may qualify as serious. Courts rely on medical records, imaging tests, and physician testimony to determine whether an injury has permanently limited a person’s movement or daily activities.
Examples of Permanent Consequential Limitations:
- A spinal cord injury that prevents bending, lifting, or prolonged standing.
- Severe joint damage that reduces range of motion in the knees, elbows, or shoulders.
- Traumatic brain injuries that impair memory and cognitive function.
What Does Not Qualify?
- Chronic pain that does not substantially limit movement or function.
- Injuries that improve with treatment.
The 90/180-Day Rule (Temporary Disabilities)
If an injury prevents a person from performing their usual daily activities for at least 90 out of the first 180 days after an accident, it may qualify as serious. Courts evaluate medical records, employment records, and witness testimony to determine whether the injury substantially disrupted the victim’s life.
Examples of Qualifying 90/180-Day Rule Injuries:
- A back injury causing three months of missed work.
- A concussion leading to cognitive impairment for over 90 days.
- A leg injury requiring three months of physical therapy and mobility restrictions.
What Does Not Qualify?
- Short-term soreness or minor injuries that do not significantly disrupt daily life.
What Medical Proof Do You Need for a Serious Injury Claim?
To qualify for pain and suffering damages, claimants must provide objective medical evidence proving that their injuries meet New York’s serious injury threshold.
Key Medical Documentation Required
- MRI & CT Scans to diagnose spinal injuries or brain trauma.
- X-Rays to confirm fractures and disfigurements.
- Range-of-Motion Tests to prove functional limitations.
- Surgical Reports documenting permanent impairment.
- Physical Therapy Records showing long-term treatment needs.
Simply stating that an injury is painful is not enough—there must be measurable medical proof demonstrating how the injury affects the victim’s ability to function.
Filing a No-Fault Lawsuit in New York
If you believe your injuries meet the serious injury threshold, follow these steps to file a lawsuit:
- Consult a Personal Injury Lawyer to assess your eligibility.
- Gather Medical Documentation proving the severity of your injuries.
- File a Lawsuit Within the Statute of Limitations:
- Three years from the accident date for personal injury claims.
- Two years for wrongful death claims.
Frequently Asked Questions About Serious Injury Under New York Insurance Law
What qualifies as a serious injury in New York
A serious injury in New York is defined under Insurance Law § 5102(d) and includes conditions such as fractures, significant disfigurement, permanent loss of a body function or system, permanent consequential limitations, and injuries preventing normal daily activities for at least 90 of the first 180 days after an accident. If your injury falls into one of these categories, you may be eligible to pursue compensation beyond no-fault insurance.
Can I sue for pain and suffering under New York’s no-fault insurance law?
Under normal circumstances, New York’s no-fault system does not allow victims to sue for pain and suffering. However, if you meet the serious injury threshold, you can file a personal injury lawsuit against the at-fault driver. This allows you to seek compensation for non-economic damages such as emotional distress, physical pain, and loss of enjoyment of life.
What is the 90/180-day rule, and how does it affect my claim?
The 90/180-day rule applies to injuries that temporarily impair a person’s ability to perform their usual daily activities. If an accident victim is unable to engage in their normal activities for at least 90 out of the 180 days immediately following the accident, they may qualify as having a serious injury. Courts assess medical records, employment documentation, and doctor testimony to determine whether this standard is met.
Do fractures automatically qualify as serious injuries in New York?
Yes. A fracture (broken bone) is considered an automatic serious injury under Insurance Law § 5102(d), meaning that victims with broken bones do not need additional proof of severity to file a lawsuit beyond their no-fault benefits.
What medical proof do I need to prove I have a serious injury?
To establish a serious injury, you need objective medical evidence such as MRI scans, CT scans, X-rays, range-of-motion tests, and surgical records. A doctor’s written evaluation explaining how the injury has impacted your daily activities and long-term health is often required. Courts will also look at whether you have undergone consistent medical treatment.
Contact Marvin A. Cooper, P.C. Today
Navigating New York’s serious injury laws can be challenging, and proving eligibility for pain and suffering damages requires extensive medical documentation and legal expertise. If you believe your injury qualifies under Insurance Law § 5102(d), consulting an experienced personal injury attorney can help you understand your rights and maximize your compensation.
If you or a loved one has suffered a serious injury in a car accident, contact Marvin A. Cooper, P.C. today for a case evaluation.