Last Updated on May 27, 2024

What Is The Serious Injury Threshold in New York?

The New York Insurance Law Section 5102(D) defines what damages qualify as “serious injuries” to pursue further compensation. In this provision, serious injuries are personal injuries that result in:

  • Death;
  • Dismemberment;
  • Significant disfigurement; 
  • A fracture; 
  • 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; or 
  • An injury/impairment that hinders a person from usual daily activities for at least 90 days (within the first 180 days following the accident).

This provision also defines basic economic losses that should be compensated in case of accidents. In which case, both definitions are relevant to vehicular and non-vehicular accidents. 

In the context of vehicular accidents, the New York Insurance Law Section 5104(A) states that economic damages that exceed $50,000 may be compensated for seriously injured individual/s by at-fault negligent drivers.

Unfortunately, fair settlements/compensations are not always guaranteed for seriously injured individuals. It is in their best interest to reach out to personal injury experts so that the case may progress optimally. Personal injury lawyers do not only establish your claim but also ensure that you get the compensation you rightfully deserve.

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What are Basic Economic Losses?

The term “basic economic loss” is defined in the New York Insurance Law Section 5102(A). These losses include:

Medical Expenses– All necessary expenses for medical, hospital, surgical, nursing, dental, ambulance, x-ray, prescription drug, and prosthetic services.
– Psychiatric, physical, and occupational therapy and rehabilitation.
– Non-medical remedial care and treatment rendered in accordance with a religious method of healing recognized by New York law.
– Any other professional health services.
Lost Earnings– Loss of earnings from work which the person would have performed had they not been injured.
– Reasonable and necessary expenses incurred by the person in obtaining services in place of those they would have performed for income.
Other Reasonable and Necessary Expenses– All other reasonable and necessary expenses incurred due to the injury.

In the context of vehicular accidents, these basic economic losses are capped at $50,000 and are typically shouldered by individual insurance providers. Under the New York Insurance Law, individuals suffering from serious injuries after a motor vehicle accident may sue at-fault drivers for subsequent damages. 

Similar economic damages can be pursued in non-vehicular accident cases – such as slip and fall or construction accidents. However, in these contexts, they are not subject to the same statutory definitions and limits.

Contexts and Compensation Figures

Serious injury claims can arise in various contexts where an individual suffers a severe injury due to the negligence or intentional actions of another party. Some common contexts include:

These are just a few examples of the many contexts in which serious injury claims can arise. Essentially, any situation where someone suffers a serious injury due to another party's negligence or intentional actions may give rise to a claim.

Personal injury claims are the most frequently filed and the costliest claims to resolve. In New York City alone, there had been 18,895 personal injury claims throughout 2023 – amounting to $733.3 million in settlements.  The average personal injury claim was compensated with $134,656 in the year 2023.

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What About Injuries that Do Not Pass the Threshold?

If an injury does not meet the serious injury threshold, the injured person is limited to recovering only basic economic losses from their own insurance company. They cannot sue the at-fault party for non-economic damages.

Insurance companies, even your own, often seek to minimize payouts. They may attempt to deny or undervalue your claim, arguing that certain treatments were not necessary or that certain lost earnings are not covered. Document all expenses and losses and be prepared to negotiate with the insurance company (through personal injury lawyers).

Additionally, there are strict time limits for filing a no-fault claim. You must notify your insurance company of the accident within 30 days and submit a proof of claim within 45 days. Failing to meet these deadlines can result in a denial of benefits.

Mandatory Insurance Coverages in New York

In an effort to protect the best interest of the general public, New York law mandates certain insurance coverages for different contexts. Some of the more notable ones include:

Motor Vehicle Insurance

New York is a "no-fault" insurance state, meaning that drivers must carry Personal Injury Protection (PIP) coverage. This covers medical expenses, lost wages, and other reasonable and necessary expenses up to $50,000, regardless of who was at fault in the accident.

Drivers must also carry liability insurance with minimum limits of $25,000 for bodily injury to one person, $50,000 for bodily injury to multiple people, and $10,000 for property damage (25/50/10).

Workers' Compensation Insurance

Most employers in New York are required to carry workers' compensation insurance. This covers medical expenses and a portion of lost wages for employees who are injured on the job, regardless of fault.

Professional Malpractice Insurance

While not always mandatory, many professional organizations, such as those for doctors and lawyers, require their members to carry malpractice insurance. Some hospitals and healthcare facilities also require doctors to have malpractice coverage.

Commercial General Liability Insurance

Many businesses, including property owners and contractors, carry commercial general liability insurance to cover injuries that occur on their premises or as a result of their operations. While not always mandatory, it is often required by lenders, landlords, or clients.

While these insurance coverages are mandatory or commonly carried, they may not always be sufficient to fully compensate an injured person. In cases of serious injury, additional compensation may be sought through a personal injury claim.

Speak to a Personal Injury Lawyer Today

At the Porter Law Group, our team of proven personal injury lawyers delivers ideal results. We take pride in helping families rebuild after unfavorable circumstances. We operate on a contingency basis – meaning you do not need to pay us anything unless we win your case. Through this approach, we can better support families during their times of need.

If you or a loved one is a personal injury victim, please reach out to us for a non-obligatory free case evaluation. You can also contact us at 833-PORTER9 or to schedule a consultation.

Written By
Michael S. Porter
Personal Injury Attorney
Originally from Upstate New York, Mike built a distinguished legal career after graduating from Harvard University and earning his juris doctor degree from Syracuse University College of Law. He served as a Captain in the United States Army Judge Advocate General’s Corps, gaining expertise in trial work, and is now a respected trial attorney known for securing multiple million-dollar results for his clients while actively participating in legal organizations across Upstate NY.
Legally Reviewed on May 27, 2024
Eric C. Nordby
Personal Injury Attorney
Eric, with nearly three decades of experience in personal injury litigation, holds a law degree with honors from the University at Buffalo School of Law and a Bachelor's Degree from Cornell University. His extensive career encompasses diverse state and federal cases, resulting in substantial client recoveries, and he actively engages in legal associations while frequently lecturing on legal topics.
This Article Was Professionally Reviewed
This page was Legally Reviewed by Eric C. Nordby on May 27, 2024. Our experts verify everything you read to make sure it's up to date. For information on our content creation and review process read our editorial guidelines. If you notice an error or have any questions about our content please contact us.
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