The Law Defines "Serious." Not the Insurance Adjuster.

New York's no-fault system pays your medical bills and lost wages after a crash regardless of who caused it — but whether you can sue for pain and suffering is a separate question, and the answer comes from a specific statutory list, not from what an adjuster tells you over the phone. I've spent 35 years helping Nassau and Suffolk County crash victims understand exactly where they stand under Insurance Law §5102(d), and I can give you a straight answer in a single conversation.

What No-Fault Insurance Actually Covers — and What It Doesn't

New York is a no-fault state, which means your own auto insurance pays your medical expenses and a portion of lost wages after a car accident, regardless of fault. You file with your own insurer, and that claim is separate from any lawsuit against the driver who hit you.

 

No-fault covers reasonable and necessary medical treatment up to $50,000 per person, and up to 80% of lost earnings (capped at $2,000 per month). What it does not cover is pain and suffering, permanent limitations, or the full economic impact of a serious injury. To pursue those damages, you must clear the serious injury threshold.

 

One critical deadline: you must file your no-fault claim within 30 days of the accident. Missing that window can forfeit your benefits entirely. If you haven't filed yet, that's the first call to make.

What Counts as a Serious Injury Under New York Law

Insurance Law §5102(d) defines "serious injury" as a specific list of injury categories. An adjuster's opinion that your injury "isn't serious enough" is not a legal determination — the statute is. The categories that qualify are:

 

  • Fracture — any broken bone
  • Significant disfigurement — a permanent, visible scar or deformity that a reasonable person would find objectionable
  • Dismemberment — loss of a limb or body part
  • Permanent loss of use — complete and permanent loss of a body organ, member, function, or system
  • Permanent consequential limitation — a permanent limitation of a body organ or member that is medically significant, not minor
  • Significant limitation of use — a significant limitation of a body function or system, documented by objective medical evidence
  • 90/180-day rule — a medically determined injury that prevents you from performing substantially all of your usual daily activities for at least 90 of the first 180 days after the accident

 

Each category has its own legal standards and documentation requirements. Meeting the threshold on paper isn't enough — the injury has to be supported by objective medical evidence, not just subjective complaints of pain.

The 90/180-Day Rule: When Months of Limitation Becomes a Legal Claim

The 90/180-day category is the most commonly misunderstood — and the most commonly underestimated. If a medically documented injury has prevented you from performing substantially all of your usual daily activities for 90 out of the first 180 days following the accident, you may qualify to sue even without a fracture or permanent condition.

 

"Substantially all" doesn't mean every single activity. It means the injury has meaningfully curtailed your normal routine — work, household responsibilities, physical activity — for the required period. The key word is "medically determined": the limitation must be connected to an objective diagnosis, not self-reported pain alone.

 

If you're still struggling months after a crash and your doctor has been documenting your condition, that treatment record may be exactly what establishes this category. Don't assume your case doesn't qualify before speaking with an attorney.

Why Honest Assessment Matters More Than a Promising Pitch

Not every crash injury clears the threshold. Soft-tissue injuries — sprains, strains, and minor whiplash — frequently do not, especially when they resolve within weeks and lack objective diagnostic support. I'll tell you that directly, because taking a case that can't survive a threshold motion wastes your time and mine.

 

What I look for in an initial review: the type of injury, the diagnostic record, the duration of treatment, how the injury has affected your daily life, and whether there's objective evidence — imaging, range-of-motion measurements, specialist findings — to support a threshold argument. If the evidence is there, I'll build the case on it. If it isn't, I'll tell you that too, and explain what options remain through no-fault alone.

 

That kind of straight talk is what builds a practice over 35 years. You deserve an accurate picture of where you stand, not a promise designed to get you to sign a retainer.

How the Threshold Connects to Your Right to Sue

Clearing the serious injury threshold is what unlocks a lawsuit against the at-fault driver. Once you qualify, you can pursue compensation for pain and suffering, permanent disability, loss of enjoyment of life, and economic damages beyond what no-fault covers.

 

In a threshold case, the defense will often challenge whether your injury truly meets the statutory definition — it's one of the most litigated issues in New York personal injury law. That's why documentation from the beginning matters. Gaps in treatment, delayed care, and missing objective findings are the arguments insurance defense attorneys rely on. I've been on the other side of those arguments for decades, and I know how to build a record that holds up.

 

If your case involves a car accident with serious injuries, the no-fault and threshold issues are part of the same conversation. I handle both.

Courts and Counties Where I Handle These Cases

I represent injury clients in Nassau County and Suffolk County courts, and I'm familiar with the procedural landscape across Long Island's court system. For clients in Great Neck, Garden City, Lake Success, Lynbrook, and the surrounding North Shore and South Shore communities, my office is close by and easy to reach.

What to Do After a Crash That May Have Caused a Serious Injury

The steps you take in the days and weeks after an accident directly affect whether a threshold claim can be built. Here's what matters most:

 

  • File your no-fault claim within 30 days. Your insurer requires prompt notice. Missing this deadline puts your benefits at risk.
  • Get medical attention immediately and continue treatment. Gaps in your treatment record are used by defense attorneys to argue your injury wasn't serious or wasn't caused by the accident.
  • Follow your doctor's recommendations. Documented compliance with a prescribed treatment plan strengthens a threshold argument.
  • Keep records of how the injury affects your daily life. A written log of activities you can no longer perform, or can only perform with difficulty, supports the 90/180-day category if it applies.
  • Don't give a recorded statement to the other driver's insurer without speaking to an attorney first.
  • Contact a personal injury attorney early. The sooner I can review the facts, the better positioned you are — both on the no-fault side and on any potential lawsuit.

Frequently Asked Questions About New York's No-Fault and Serious Injury Rules

  • Can I sue the driver who hit me if I live in New York?

    Yes, but only if your injury meets the serious injury threshold defined under Insurance Law §5102(d). New York's no-fault system limits lawsuits to cases involving qualifying injuries — fractures, significant disfigurement, permanent limitations, or injuries that prevented normal activity for 90 of the first 180 days. If your injury falls within one of those categories and is supported by objective medical evidence, you can pursue a claim against the at-fault driver.

  • My injury isn't a broken bone. Can I still have a case?

    Possibly. Fractures are only one of several threshold categories. Permanent or significant limitations of a body organ, function, or system — documented by objective medical findings — can also qualify. The 90/180-day rule is another path for injuries that aren't permanent but have meaningfully disrupted your life for an extended period. The answer depends on your specific diagnosis and medical record, which is why a case review matters.

  • Why is my own insurance paying my medical bills when the accident wasn't my fault?

    New York's no-fault system is designed to pay medical expenses and lost wages quickly, regardless of who caused the accident. Your insurer pays first, up to the policy limit, and that process is separate from any claim against the at-fault driver. No-fault covers immediate costs — a lawsuit, if your injury qualifies, pursues compensation for pain, suffering, and damages beyond what no-fault provides.

  • What happens if the insurance company says my injury isn't serious enough to sue?

    That determination belongs to the court, not the adjuster. "Serious injury" is a legal standard defined by statute, and whether your injury meets it is a question of law and medical evidence — not the insurer's claims decision. If an adjuster has told you your injury doesn't qualify, that's their position, not a final legal ruling. An attorney can evaluate the actual evidence against the statutory categories.

  • How long do I have to file a personal injury lawsuit in New York?

    In most motor vehicle accident cases in New York, the statute of limitations is three years from the date of the accident. However, no-fault benefits must be claimed within 30 days of the accident — that deadline is much shorter and separate from the lawsuit deadline. If a government entity is involved, a notice of claim may be required within 90 days. Don't rely on having time to spare — earlier review means better evidence preservation.

Ready to Find Out Whether Your Injury Qualifies?

The threshold question is one I can address quickly once I understand the facts of your case. If your injury is serious and the evidence supports it, I'll tell you what a claim looks like and what to expect. If it doesn't qualify, I'll tell you that too — and explain what no-fault still provides.

Attorney advertising. Prior results do not guarantee a similar outcome. This page is for general informational purposes only and does not constitute legal advice. Contacting this office does not create an attorney-client relationship.