New York Serious Injury Threshold Explained
If you’ve been injured in a car accident in New York City or the surrounding areas, you may have heard that you need a “serious injury” to file a lawsuit. This requirement, known as the serious injury threshold, is one of the most important legal concepts in New York personal injury law. It is also referred to as the “Threshold Rule.” Understanding whether your injury meets “the threshold” can determine your entire path to compensation.
This article explains New York’s serious injury threshold under Article 51 of the state’s Insurance Law, the nine categories that qualify, how insurance companies try to deny claims based on threshold defenses, and what evidence you need to prove your case.
- The nine specific categories of serious injury under New York law
- Why the threshold matters for your ability to recover compensation
- Common defenses insurance companies use to claim you don’t meet the threshold
- The medical evidence required to prove a serious injury and pursue a lawsuit
- How New York’s No-Fault system creates the serious injury threshold requirement
The Nine Categories of Serious Injury
New York Insurance Law Section 5102(d) defines “serious injury” threshold through nine specific categories. If your injury falls into any one of these categories, you meet the threshold and can pursue a lawsuit for all your injuries. Remember, this rule only applies to car accidents.
The Nine Categories
| Category | Description | Key Considerations |
| Death | Fatal injuries resulting from the accident | Applies to wrongful death claims |
| Dismemberment | Loss of a limb or body part | Must be actual loss, not just loss of function |
| Significant Disfigurement | Visible scarring or alteration of appearance | Subjective standard¸Å often requires jury determination |
| Fracture | Any broken bone | Includes teeth; does not need to be compound or comminuted |
| Loss of Fetus | Pregnancy loss caused by the accident | Must be medically documented and causally related |
| Permanent Loss of Use | Total and complete inability to use a body part | Requires 100% loss of function permanently |
| Permanent Consequential Limitation | Permanent injury causing more than minor limitation | Requires objective medical evidence of permanency |
| Significant Limitation | Non-permanent injury causing more than minor limitation | Must be significant, not just inconvenient |
| 90/180 Category | Injury preventing substantially all daily activities for 90 of the first 180 days | Must be medically determined and non-permanent |
Most Commonly Litigated Categories
The “limitation” categories (permanent consequential limitation, significant limitation, and 90/180) are the most heavily disputed because they involve subjective assessments of how much an injury has impacted your life.
The legal standard: Your injury must result in “more than a minor limitation” of function. This vague standard requires strong medical evidence to prove.
Why the Serious Injury Threshold Matters
The threshold requirement has profound implications for motor vehicle accident victims in New York:
Impact on Your Case
| If You Don’t Meet the Threshold: | If You Meet the Threshold: |
| You cannot sue for pain and suffering. | You can file a lawsuit against the at-fault driver. |
| You cannot recover compensation for emotional distress, loss of enjoyment of life, or the daily impact of living with your injuries. | You can seek compensation for all injuries, including pain and suffering. |
| You’re limited to No-Fault benefits ($50,000) and any economic damages that exceed that amount. | You can pursue damages for emotional trauma, diminished quality of life, and permanent impairments. |
One qualifying injury allows you to recover for ALL injuries from the accident, even those that wouldn’t independently meet the threshold.
Real-World Example
Consider two accident victims with neck injuries:
Victim A has documented and provable range-of-motion limitations of 25% compared to normal function, confirmed by objective medical testing. Their doctor states the limitation is permanent and significantly affects daily activities.
Victim B experiences neck pain and discomfort but has only a 10% reduction in range of motion, with medical records showing they returned to work within two weeks.
Victim A likely meets the serious injury threshold under the “permanent consequential limitation” category. Victim B likely does not. The difference determines whether they can pursue a lawsuit for compensation beyond No-Fault benefits.
Common Insurance Company Defenses
Insurance companies aggressively challenge whether injuries meet the serious injury threshold. Understanding their tactics helps you prepare a stronger case.
Threshold Defense Strategies
| Defense Tactic | How It Works | How to Counter It |
| Gaps in Treatment | Arguing you didn’t seek consistent medical care, suggesting injuries weren’t serious | Maintain regular treatment and document reasons for any gaps |
| Pre-Existing Conditions | Claiming your injuries existed before the accident | Prove the accident aggravated or worsened pre-existing conditions |
| Independent Medical Exams (IMEs) | Sending you to their doctor, who often minimizes injuries | Ensure your own doctors provide detailed, objective reports |
| Lack of Objective Evidence | Arguing that your claims are based only on subjective complaints | Obtain MRIs, X-rays, range of motion tests, and other objective data |
| Quick Return to Activities | Showing you returned to work or daily activities quickly | Document ongoing limitations and modifications to activities |
| Minor Accident, Minor Injuries | Suggesting low-impact crashes can’t cause serious harm | Medical evidence proves injury severity, not vehicle damage |
Evidence Required to Prove a Serious Injury
Successfully proving you meet the serious injury threshold requires comprehensive medical documentation. The law requires objective medical evidence, not just your testimony about pain or limitations. Legally, as the the person suing the burden is on you to prove these serious injuries. These create several hurdles for a successful lawsuit.
Essential Medical Evidence
| Quantitative Evidence: | Qualitative Evidence: | Supporting Documentation: |
| Documented range of motion testing with specific percentages of limitation. | Treating physician’s detailed assessment of your limitations. | MRI, CT scan, or X-ray results showing physical damage. |
| Clear documentation of the testing method and instruments used. | Comparison of your current condition to a normal, uninjured person. | Surgical reports if procedures were required. |
| Comparison to normal/uninjured function. | Explanation of how injuries affect your daily life. | Physical therapy records documenting ongoing treatment. |
| Serial testing shows consistency over time. | Prognosis for future limitations. | Work restriction notes or disability documentation. |
The 90/180 Category Requires Specific Proof
If claiming the 90/180 category, you must prove:
- A medically determined injury (not self-reported symptoms).
- The injury prevented you from performing substantially all your usual daily activities.
- This limitation lasted at least 90 days within the first 180 days after the accident.
- The injury is non-permanent in nature.
Critical factor: Courts often require proof that you missed significant work time during this period. If you continued working with minimal interruption, insurance companies will argue you didn’t meet this threshold, even if you experienced pain or difficulty.
The “Range of Motion” Challenge
For limitation categories, insurance companies focus heavily on range-of-motion measurements. Studies have shown that reductions below 20% are often deemed insufficient to meet the threshold, while reductions of 25% or more typically qualify.
Insurance companies will argue:
- Your range-of-motion tests weren’t conducted with proper instruments.
- The reductions aren’t significant enough to constitute “more than minor” limitation.
- Your doctor’s findings are subjective and unreliable.
Understanding New York’s No-Fault Insurance System
New York operates under a No-Fault insurance system designed to reduce the number of minor motor vehicle accident cases clogging court dockets. Under this system, your own insurance company pays for your medical expenses and lost wages up to $50,000, regardless of who caused the accident.
While this provides quick access to basic compensation, there’s a trade-off. You cannot file a lawsuit against the at-fault driver for pain and suffering unless your injuries meet specific legal criteria defined as a “serious injury.” This legal barrier is codified in Section 5104(a) of New York’s Insurance Law and is commonly referred to as the serious injury threshold.
How the Threshold Works
The threshold creates two separate categories of damages in motor vehicle cases:
| Damage Type | Threshold Requirement | What It Means |
| Economic Damages | Must exceed Basic Economic Loss ($50,000) | Medical bills, lost wages, out-of-pocket expenses |
| Non-Economic Damages | Must have a “Serious Injury” | Pain and suffering, loss of enjoyment of life, and emotional distress |
Important note: These two categories are analyzed independently. You can recover economic damages above $50,000 without proving serious injury, and you can pursue pain and suffering damages if you meet the serious injury threshold, even if your bills are under $50,000.
Take Action to Protect Your Rights
Understanding New York’s serious injury threshold is essential, but navigating the legal complexities and building a strong case requires experienced representation. Insurance companies will use every defense available to deny your claim or minimize your compensation.
If you’ve been injured in a motor vehicle accident in New York City or the surrounding areas, don’t let the serious injury threshold prevent you from seeking the compensation you deserve. Contact Eric Richman to discuss your case. We’ll evaluate your injuries, review your medical evidence, and aggressively fight for your right to recovery.
Call (212) 688-3965 or Toll-Free (800) 801-9655, or request a free consultation online.
Sources:
- Hurwitz Fine P.C.: “Article 51 of NYS Insurance Law: Serious Injury Threshold & Basic Economic Loss” – August 30, 2024
- Bell Law Group: “What is Threshold in NY Motor Vehicle Accident Cases?” – by Daniel Johnston, Esq.
- New York State Insurance Law, Section 5102(d): Definition of Serious Injury
- New York State Insurance Law, Section 5104(a): Limitation on Right to Recover
