New York is a no-fault insurance state. After a car accident, your own Personal Injury Protection coverage pays for your medical bills and lost wages, regardless of who caused the crash. The no-fault system exists to reduce litigation over minor accidents. But it also creates a barrier that stops many legitimately injured people from pursuing the full compensation they deserve. Understanding how to break through that barrier is one of the most important decisions you will make after a serious accident.
How the No-Fault System Works in New York
Under New York’s no-fault law, your own insurer covers up to $50,000 in medical expenses and 80 percent of lost wages up to $2,000 per month after an accident. These benefits apply regardless of fault. The tradeoff is that in exchange for guaranteed basic coverage, New York limits your right to sue. You can only pursue a personal injury lawsuit against the at-fault driver if your injuries meet the serious injury threshold defined by state law.
What Qualifies as a Serious Injury Under New York Law
New York Insurance Law Section 5102(d) defines serious injury. The most commonly used categories in litigation are significant limitation of use of a body function or system, permanent consequential limitation of a body organ or member, permanent loss of use of a body organ or function, and a medically determined injury preventing you from performing your usual and customary daily activities for not less than 90 of the first 180 days following the accident. This last category, the 90/180 rule, is critical for cases involving soft-tissue injuries, disc herniations, and psychological trauma that may not be immediately visible on imaging.
Why Insurance Companies Fight the Threshold Hard
Insurers know that if they can argue your injury does not meet the threshold, your case is over. They use tactics including citing gaps in your medical treatment as evidence the injury was not serious, claiming pre-existing conditions caused your limitations, and disputing the significance of MRI findings with their own hired medical examiners. Attorney Keith Silverstein spent 25 years on the defense side building exactly these arguments. He now uses that knowledge to dismantle them. Proper documentation of treatment, objective medical evidence, and a clear timeline of how the injury has affected daily life are what determine whether a case crosses the threshold.
Contact KDS Today
If you have been injured in a New York car accident, do not assume no-fault benefits are all you are entitled to. A serious injury may open the door to full compensation, including pain and suffering.
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