NY Insurance Law § 5102(d)
NY Serious Injury Threshold
New York's no-fault insurance system limits when you can sue the at-fault driver. Understanding the serious injury threshold is critical to knowing whether you have the right to pursue additional compensation beyond basic no-fault benefits.
What Is the NY Serious Injury Threshold?
New York is a "no-fault" state. This means after a car accident, your own auto insurance pays for basic medical expenses and a portion of lost wages — regardless of who caused the crash. In exchange, your right to sue the at-fault driver for pain and suffering is restricted.
To step outside the no-fault system and pursue a claim against the at-fault driver for non-economic damages (like pain and suffering), your injuries must meet New York's "serious injury" threshold as defined under Insurance Law § 5102(d).
This threshold was created to prevent the courts from being flooded with minor accident claims. But it also means that accident victims with legitimately serious injuries need to properly document and prove those injuries to receive full compensation.
What Injuries Qualify?
Under § 5102(d), a serious injury includes any of the following:
- Death
- Dismemberment
- 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
- A medically determined injury or impairment of a non-permanent nature that prevents the injured person from performing substantially all of the material acts that constitute such person's usual and customary daily activities for not less than 90 days during the 180 days immediately following the occurrence of the injury or impairment (the "90/180-day rule")
Note: Whether your specific injury meets one of these categories is a legal and medical determination. Only a licensed attorney — in consultation with medical professionals — can evaluate your case. This page is for general information only.
Why Medical Documentation Matters
Courts and insurance companies require objective medical evidence — not just your word — to establish that your injury meets the serious injury threshold. This means you need:
- Consistent medical treatment starting as soon as possible after the accident
- Clinical findings — MRI results, X-rays, orthopedic evaluations, nerve conduction studies
- A documented connection between the accident and your injuries
- Treatment records that show the ongoing nature and extent of your limitations
- For the 90/180-day rule: detailed records of how your injury prevented normal daily activities
Insurance companies aggressively challenge serious injury claims. Gaps in treatment or subjective complaints without clinical backup are common defenses used to argue your injury does not qualify.
Common Mistakes That Can Hurt Your Case
Delaying Medical Treatment
Waiting days or weeks to see a doctor after your accident can make it harder to prove your injury is accident-related. See a doctor as soon as possible, even if you feel okay.
Stopping Treatment Too Early
Gaps in treatment are one of the most common reasons insurance companies argue an injury is not serious. Keep attending all scheduled appointments and follow your doctor's recommendations.
Relying on Subjective Complaints Alone
Pain is real, but courts need objective clinical evidence. Make sure your doctors are ordering appropriate diagnostic tests (MRI, X-ray, EMG/NCV) and documenting their findings.
Settling Too Soon
Settling before you understand the full extent of your injuries — or before reaching maximum medical improvement — can leave significant compensation on the table. Consult an attorney before accepting any offer.
Not Consulting an Attorney
Serious injury threshold disputes are complex legal and medical matters. An experienced personal injury attorney can help build the strongest possible case and protect your right to full compensation.
Timeline After Your Injury
Immediately
Seek emergency medical attention. Call 911. Document the scene.
Within 24–48 hours
Follow up with your primary care doctor or a specialist. File your no-fault (PIP) claim with your own auto insurer — you typically have 30 days.
Within 1–2 weeks
Consult a personal injury attorney. Obtain all accident-related records: police report, insurance correspondence, medical bills.
Ongoing (30–90 days)
Attend all medical appointments. Follow treatment plans. Keep a daily journal of how your injuries affect your daily activities — critical for the 90/180-day rule.
At or near maximum medical improvement
Work with your attorney to evaluate the full value of your claim before considering any settlement.
Within 3 years of the accident
New York's general statute of limitations for personal injury claims. Certain cases involving government entities may have much shorter deadlines (90 days to file a Notice of Claim).
Frequently Asked Questions
Get answers to the most common questions about our intake process.
Sources & References
- NY Insurance Law § 5102(d) — Serious Injury Definition
- NY Insurance Law § 5103 — No-Fault Benefits
- NY CPLR § 214 — Statute of Limitations (3 years)
- General Municipal Law § 50-e — Notice of Claim (Government)
- NY Courts — Civil Court Personal Injury Resources
External links are provided for informational purposes only. InjuryCaseHub does not control or endorse the content of external websites.
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