NY “Serious Injury” Threshold Explained

In New York State, if you have a serious injury, as defined by law, it can have a significant impact on your car accident claim. It may qualify you to step outside of NY’s no-fault car insurance system and seek damages from an at-fault driver.

Auto accident cases involving serious injuries are often complex, and the large amount of compensation victims could recover usually means that insurance companies push back against these claims. A car accident lawyer with O’Brien & Ford PC could help you understand your rights and fight for the money you need to heal.

How does having a serious injury affect a car accident claim?

New York is a no-fault insurance state. This means that New York vehicle owners generally must carry personal injury protection (PIP) insurance, which pays for your medical expenses and some other damages after an accident, whether the crash was your fault or someone else’s. You usually must seek compensation from your PIP first, and you can’t seek damages from another driver unless you have a serious injury (according to the legal definition) or economic damages that exceed basic economic loss. You must also be able to prove that another driver was liable for the crash, and your share of fault cannot exceed 50%.

According to the New York Department of Financial Services, New York auto policies generally must include at least $50,000 in PIP. They must also include liability insurance to pay for an accident if an injured party has the right to seek compensation from the insured. Mandatory liability insurance minimums include:

• $25,000 for bodily injury and $50,000 for death to one person
• $50,000 for bodily injury and $100,000 for death to two or more people
• $10,000 in property damage coverage

What is the legal definition of a serious injury?

For actions and proceedings commenced on or after May 26, 2026, N.Y. Ins. Law § 5102 defines a “serious injury” as a personal injury that results 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; or significant limitation of use of a body function or system.”

So, to meet the serious injury threshold and be eligible to seek compensation from an at-fault driver, your injury must meet one of the above qualifications. You may also be able to seek certain damages from a liable party if your economic losses exceed basic economic loss.

Damages you could recover

You likely have PIP coverage through the vehicle you occupied or, in some situations, through your own or a household member’s policy. Basic PIP typically includes the following benefits:

• Medical expenses for injuries resulting from your crash
• Eighty percent of your lost wages from work (capped at $2,000 per month for up to three years)
• Up to $25 per day for necessary expenses, including household services and transportation assistance
• A $2,000 death benefit (in addition to the $50,000 no-fault PIP limit) for a fatally injured party

Remember, you can file a claim with your PIP provider for these damages, no matter who was at fault for the accident and regardless of whether you have a serious injury. However, if you do have a serious injury under the law, you can seek additional compensation if you can prove the other driver was liable and your share of fault does not exceed 50%. In general, you may be able to recover the following:

• Economic damages – These are your actual expenses after a car accident. They include many of the same damages that PIP covers (i.e., medical expenses, lost wages, and household expenses), but with a liability claim or personal injury lawsuit against an at-fault party, you can seek economic losses that exceed basic economic loss.
• Non-economic damages – These are damages for your physical, mental, and emotional pain and suffering, which PIP doesn’t pay. The only way you can pursue them is if you have a serious injury and the right to step outside the no-fault system. Non-economic damages include monetary awards for intangible losses, such as scarring, disabling injuries, chronic pain, stress, depression, and reduced quality of life.

Note that if you have economic damages that exceed basic economic loss but do not have a serious injury, you can also seek compensation from an at-fault driver. In this scenario, you can’t recover non-economic damages, but you can recover economic loss that exceeds basic economic loss.

What to do after an auto accident in NY

Taking some simple steps after an auto accident can help you protect your health and any claims you may decide to file.

Tending to your injuries is priority number one. If you didn’t get emergency treatment at the scene of the crash or immediately after, see your doctor. Getting treated is not only important for preventing undiagnosed or worsening injuries, but it also creates an official medical record for your claim.

If you can, gather as much information as possible while still at the accident site. This includes the name, contact information, insurance information, and driver’s license number of the other involved motorist. You should also get the name and contact information for any passengers or eyewitnesses. Additionally, note the other vehicle’s make, model, and license plate number, and any other relevant details, such as the location of the crash, time of day, and weather conditions.

According to the New York State Department of Motor Vehicles (DMV), state law requires that you immediately notify the police if an accident involves injury or death. You must also file a crash report with the DMV within 10 days if an accident involves injury, death, or more than $1,000 in damage to the property of any one person.

Finally, you’ll want to notify your PIP insurer about the accident right away and file a claim with the other driver’s liability insurer if you meet the serious injury or economic damage thresholds.

When should you hire legal help?

If you have a serious injury, you should consider hiring our firm’s car accident attorneys. These cases can be complex because you’ll have to show that your injury qualifies as serious under the law, as well as establish that another driver is legally liable for the collision. And you must do all this while recovering from severe bodily harm.

Our lawyers can answer any questions you have about car accident claims and explain NY’s serious injury threshold in more detail. If you meet it, we can help you prove it using medical records and expert testimony from healthcare professionals. We can also conduct a crash investigation to prove fault. We will present the strongest case possible to the insurance companies and demand maximum compensation.

Contact O’Brien & Ford PC

O’Brien & Ford PC has helped clients in Western New York recover over $275 million in personal injury settlements and verdicts. If you have a severe car accident injury, we can help you prove that you have a serious injury and the right to seek damages from a liable party. Our goal is to secure every cent you need to get your life back on track.

To learn more, contact us today. We take calls 24/7 and don’t charge attorney fees unless and until we win your case.