Explaining New York's 'Serious Injury' Threshold: Do I Have a Case? by Keetick L. Sanchez

Описание: Explaining New York's 'Serious Injury' Threshold: Do I Have a Case? by Keetick L. Sanchez

Understanding the New York serious injury threshold is one of the most important steps after a crash. Many accident victims assume they can immediately file a lawsuit for pain and suffering, but New York’s No-Fault insurance system creates strict limits. A Queens car accident lawyer can help injured individuals understand how the serious injury rule works and what evidence is required before stepping outside the No-Fault framework.

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New York requires every driver to carry Personal Injury Protection (PIP), also known as No-Fault insurance. This coverage pays up to $50,000 for basic economic loss, including necessary medical expenses such as hospital care, surgery, nursing, prescriptions, psychiatric care, physical therapy, and occupational therapy. It also covers lost earnings at 80 percent of wages, up to $2,000 per month, as well as other reasonable expenses like transportation to treatment.

Under New York Insurance Law § 5104(a), there are only two gateways to a lawsuit. The first is when basic economic loss exceeds the No-Fault cap. The second is when the injured person can prove a serious injury as defined under New York Insurance Law § 5102(d). Serious injury categories include death, dismemberment, loss of a fetus, and fracture.

Other serious injury claims require strong objective medical evidence. These include permanent loss of use of a body organ or member, permanent consequential limitation, and significant limitation of use of a body function or system. Courts often require MRIs, CT scans, diagnostic imaging, and range-of-motion measurements rather than subjective complaints. Conditions such as herniated discs, torn ligaments, and chronic pain conditions must be supported with medical proof from specialists such as orthopedic surgeons, neurologists, and radiologists.

Significant disfigurement can also qualify when scars or deformities affect appearance. Another common category involves the 90/180-day rule, which applies when a medically determined injury prevents a person from performing substantially all normal daily activities for at least 90 days within the first 180 days after the accident.

Insurance companies and defense attorneys often challenge these cases by pointing to gaps in treatment, claiming pre-existing conditions, or questioning the consistency of care. Strong documentation from the beginning is critical.

Keetick L. Sanchez, Esq., of K L Sanchez Law Office, P.C., has extensive experience handling serious injury cases, motor vehicle accidents, construction accidents, and slip and fall claims. She understands insurance company tactics and the evidence needed to protect the rights of injured clients.

Motorcycle accident claims are an important exception because motorcycles are excluded from the No-Fault system. This means riders can pursue a lawsuit without proving the serious injury threshold, as long as negligence is established.

If you were injured in a crash, a Queens car accident lawyer can guide you through the No-Fault system, build strong medical support, and help you pursue compensation. Contact K L Sanchez Law Office, P.C. at (646) 701-7990 for a free consultation and take the next step toward protecting your rights.

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