Serious Injury Threshold

Serious Injury ThresholdIt may come as a surprise, but not every injury sustained in a car accident or truck accident in the Bronx or New York City can serve as the basis for a successful lawsuit, no matter how negligent a defendant driver may have been in causing an accident. The New York State Legislature, as part of the No-Fault Law and its mandate that no-fault insurance benefits be made universally available to car accident victims in New York, created the “Serious Injury” requirement, memorialized in Section 5102(d) of the New York Insurance Law, to limit the types of injuries that can qualify as the basis for a successful car accident lawsuit. If an injury does not meet the legal tests of the “Serious Injury” requirement that have been developed by the courts, the entire underlying car accident lawsuit will be dismissed regardless of even the most egregious negligence on the part of a defendant driver. It should be noted that the “Serious Injury” requirement does not usually apply to motorcycle accidents because motorcycles are excluded from coverage under the No-Fault Law.

In order to meet the “Serious Injury” requirement, an injured person has to prove that their injuries fall within any one of nine categories of injuries that the legislature has deemed sufficient to form the basis of a car accident lawsuit in the Bronx and New York City. Meeting these requirements is not always easy, as the No-Fault Law’s “Serious Injury” requirement favors negligent drivers and their insurance companies in their fight to deny you fair compensation if you are injured. Our experienced Bronx personal injury lawyers will help you determine whether or not your injuries qualify as “serious injuries” under the No-Fault Law, and will help you properly document and prove the severity of your injuries so that your Bronx car accident case can be successful.

What are the Categories of “Serious Injuries” Under the No-Fault Law?

Section 5104(a) of the New York Insurance law provides that a plaintiff must prove that he or she has either incurred a “basic economic loss” of more than $50,000.00, or has suffered a “Serious Injury” as defined within Section 5102(d), to have a viable personal injury lawsuit arising out of a car accident. Section 5102(d) provides that the following types of injuries qualify as “Serious Injuries”: (i) Death, (ii) dismemberment, (iii) significant disfigurement, (iv) a fracture, (v) loss of a fetus, (vi) the permanent loss of use of a body organ, member, function or system, (vii) a permanent consequential limitation of a body organ or member, (viii) a significant limitation of the use of a body function or system, or (ix) a non-permanent medically-determined injury or impairment that prevents an injured person from performing substantially all of their usual and customary daily activities for not less than 90 of the 180 consecutive days immediately following an accident.

Some of these categories, such as death, a fracture or loss of a fetus, are very easy to understand. Others, such as dismemberment or significant disfigurement, seem simple to understand, but have been complicated by various tests and rules engrafted over the statutory language by New York courts deciding cases involving these types of injuries. For example, with respect to the “significant disfigurement” category, the New York Court of Appeals (the highest court in the State of New York) has ruled that, to qualify as a “significant disfigurement”, an injury must cause a condition visible on the plaintiff’s body that reasonable people would believe to be unattractive, objectionable, or which would subject the plaintiff to pity or scorn from the community.

The last four categories (“permanent loss of use”, “permanent consequential limitation”, “significant limitation” and “90/180”) are much less clear from the statutory text, require quite a bit more medical evidence and documentary proof than other categories of “Serious Injuries”, and are the source of the lions’ share of the litigation that arises from the “Serious Injury” portion of the No-Fault Law. These categories of “Serious Injuries” – especially the “permanent consequential limitation” and “significant limitation” categories – most often feature “soft tissue” injuries (i.e., a spinal cord injury known as a herniated disc, or a torn rotator cuff in the shoulder) that do not fit neatly within any of the other categories of “Serious Injuries”. The effects of these injuries can be of varying impact to the quality of life of an injured person. Courts require that an injured person prove – with reference to objective medical testing such as MRIs and EMGs, objective quantitative measurements of the injury such as through range of motion testing, as well as qualitative aspects of the injury such as complaints of pain, discomfort and disability – that even the most serious of soft-tissue injuries meet the strictures of the No Fault Law in order to even have a chance at obtaining fair compensation.

It should be noted that, even in the case of a soft-tissue injury that requires a major surgery to repair, these types of injuries may not qualify as “Serious Injuries”. If the proper expert opinions regarding not only the nature of the injury and its causal connection to the accident in question, but also the permanent quantitative effects such as percentages of losses of range of motion, are not obtained and put before the court in the proper manner, courts may dismiss the entire case. The complexity of proving that you have sustained a “Serious Injury” under the No-Fault Law cannot be overstated. For this reason, you should always consult with experienced Bronx car accident lawyers with regard to your car accident lawsuit to ensure that your injuries are well-documented, treated properly and the correct medical proof is obtained so that you may be assured of maximum compensation in your case. Our firm’s experience and track record of success in proving Bronx car accident injury claims is second to none, and we offer free consultations to inform you of whether or not your injuries meet the “Serious Injury” test under the No-Fault Law.

How can I Prove That I Have Sustained a “Serious Injury” Entitling me to Compensation in My Car Accident Lawsuit?

The key to proving that you have sustained a “Serious Injury” in an automobile accident is obtaining the right medical treatment and expert opinions from physicians in the appropriate medical specialties. For example, if you are involved in a rear-end accident and you suffer a herniated disc, you will need to seek treatment with an Orthopedist and a Neurologist who will document the extent of your injuries in the proper medical records, provide you with the proper treatment such as MRIs, EMGs, physical therapy, and may even perform surgery in cases of very serious injuries. You will then need to obtain opinions from these physicians (which must be in the proper format required by the courts) stating that your injuries qualify under the specific definitions of “Serious Injury” as outlined in Section 5102(d) of the New York Insurance Law. Our Bronx car accident law firm has developed a network of treating physicians, as well as courtroom expert witnesses, who will accept your no-fault insurance and provide you with the proper treatment and medical documentation to ensure that you not only have the best chance of a full recovery from your injuries, but also will enable you to put forth the proper proof in court if you suffer serious and debilitating injuries due to the negligence of another person on the road. We will work with your doctors and make certain that they write opinions that substantiate your claims of “Serious Injuries” under the No-Fault Law in a manner that will ensure you success in court.

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