The Serious Injury Threshold: What You Need to Know in a No-Fault State

If you were injured in a car accident in New York or New Jersey, the no-fault system establishes a “serious injury” threshold that you must cross in order to sue the other party and their insurance company for full damages, including “pain and suffering” and other non-economic damages. If you do not meet the “serious injury” criteria as established by your state’s law, you can still collect a limited amount of compensation from your own insurance company, regardless of who was at fault for the accident. However, this “no-fault” insurance may not be enough to fully compensate you for your medical bills, lost wages, and reduced earning capacity. Furthermore, you cannot make a “no fault” insurance claim for the type of damages that are more difficult to quantify in a dollar amount, such as mental anguish and loss of quality of life. For this reason, if you have sustained major injuries in a car crash caused by another driver’s negligence, it is crucial to work with a knowledgeable lawyer who can prove definitively that your injuries meet the official “serious injury” designation.

State laws determine what injuries qualify as “serious” and an experienced car accident lawyer can help you understand your options. The attorneys at Kantrowitz, Goldhamer, Graifman, Perlmutter & Carballo, P.C. know the many ways that an auto accident can disrupt your life, and we are committed to fighting for full compensation.

Why is there a “serious injury” threshold?

In the dozen states with no-fault insurance requirements, the lawmakers often had well-meaning intentions. By requiring drivers to buy personal injury protection (PIP) insurance policies, very minor injuries can be settled quickly and, theoretically, without much fight over who was to blame, with the injured party’s own insurance carrier. As a trade-off, injured individuals cannot recover non-economic damages like pain and suffering, and the compensation is limited.

While no-fault laws might lead to the quick settlement of the smallest claims, they are an unfair restriction for those who sustain major injuries. The “serious injury” threshold is meant to balance these interests. However, if you do not thoroughly document and prove that your injury qualifies for a lawsuit, the insurance company of the defendant you sue will attempt to have your lawsuit dismissed. Having an experienced lawyer on your side can help.

What is a serious injury?

Each no-fault state has its own definition of a “serious injury” so you need to choose a lawyer who knows the laws of the state where the injury occurred.

Under the New York no-fault law, the following qualify as serious injuries:

• Losses causing more than $50,000 in damages
• Death
• Dismemberment
• Significant disfigurement
• Permanent loss or significant limitation of use of a body party, function, or system
• Fracture
• Loss of a fetus
• A non-permanent medically-determined injury that causes a qualifying disability

Under New Jersey law, when drivers obtain their auto insurance policies, they must choose between two coverage options. Under the more expense “no limitation on lawsuits” option, they may sue an at-fault party for injuries without meeting a threshold. Under the “limitation on lawsuits” option, the injuries must be “serious.” Serious injury, in NJ, is defined as:

• Death
• Dismemberment
• Significant disfigurement or scarring
• Loss of a fetus
• Fracture
• Medically probable permanent injury

Once an accident occurs, it is too late for a New Jersey driver to change their insurance selection. However, even if you have selected the “limitation on lawsuits” option, our car accident attorneys can help you determine whether your injuries meet the threshold to sue.

Determining whether an injury qualifies as “serious”

If you have lost a loved one in a car accident or endured the amputation of a limb, it is pretty clear that you can meet the “serious injury” definition. However, other serious injuries are more difficult to prove.

You may have suffered scarring or disfigurement, but is it “significant” in a way that meets the law’s requirement for filing a lawsuit? You may not be able to do everything that you could before the accident, but is this a disability that a court would deem “medically determined” or “medically probable”? For questions like these, your attorney will arrange for the necessary professionals who can attest to the severity of your injury.

The difference that a “serious injury” makes

Except in the case of the most minor injuries, no-fault coverage does not provide complete compensation. In both New York and New Jersey, a no-fault claimant making a personal injury policy claim is barred from collecting non-economic damages. This means that pain and suffering, which is often a significant portion of a personal injury settlement and can total between two and five times the medical bills, cannot be claimed.

The maximum compensation for medical bills and lost wages varies by state. In New York, these economic damages are capped at $50,000. In New Jersey, the cap is based on your personal injury policy limits, as low as $15,000 but potentially as high as $250,000. However, someone who chooses a policy that limits lawsuits in order to save money is unlikely to pay for the highest coverage limits.

If you can successfully prove that your injury was “serious” as defined by state statute, your right to full compensation may be restored. You can then sue and be eligible to receive compensation for non-economic losses like pain and suffering, emotional distress, impaired relationships, and other intangibles that can impact your life.

Speak with a no-fault accident attorney

Though no-fault laws were meant to simplify the process of accident compensation, they can also make receiving complete compensation more complicated. If you were injured in New York or New Jersey, speak with a personal injury lawyer today to find out how to maximize your compensation.

At Kantrowitz, Goldhamer, Graifman, Perlmutter & Carballo, P.C., our attorneys represent car accident injury victims in Rockland County, Bergen County, and throughout NY and NJ. To find out how the serious injury requirement may affect your case, call today to schedule a free, no-obligation consultation.