Comparing No Fault and Serious Injury Liability

New York is one of 12 states that impose a “no-fault” liability system with respect to vehicle insurance. What does “no-fault” mean? Basically, it means that for most accidents, your own insurance carrier is liable for paying your medical bills. This eliminates the need to apportion fault between yourself and the other parties (and insurers) involved in the accident, and results in quicker compensation to cover a party's medical bills.

The no-fault rule does not apply to every accident. Under New York law, an accident victim who suffers a “serious injury” can still bring a personal injury lawsuit against another responsible party or parties. What constitutes a “serious injury”? New York law offers several examples:

  • Death;

  • Dismemberment;

  • Significant disfigurement;

  • Bone 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;

  • Significant limitation of use of a body function or system;

  • A non-permanent disability lasting more than 90 days.

Beyond personal injury claims, a victim can always sue a responsible party for any property damage arising from an accident. The no-fault and serious injury rules do not apply to property damage claims.

Demonstrating a “Serious Injury”

Here is a recent example of how the “serious injury” threshold works in practice. This is a case currently pending before Queens Supreme Court. The plaintiff, a female pedestrian, was struck by a car in 2012. As a result of the accident, she suffered serious shoulder and knee damage. She required surgery on her left knee and, according to a medical report prepared by her physicians, is now permanently limited in her movement of the affected knee and shoulder.

The plaintiff said her no-fault benefits would not be enough to cover the cost of her continued medical treatment. She sued the drivers of the two vehicles involved in the accident, arguing she suffered “substantial injury” as defined by New York law. The defendants opposed this and filed a motion for summary judgment. On August 8th of this year, Queens Supreme Court Justice Robert J. McDonald denied the motion, saying the plaintiff's case could proceed to trial. Justice McDonald did not rule the plaintiff suffered a “substantial injury,” merely that the expert evidence offered by her doctors was sufficient to allow a jury to make that determination. Justice McDonald also pointed to significantly differing accounts of the circumstances surrounding the accident, which a jury would also need to sort out.

As this case demonstrates, it is not enough for a victim to simply allege he or she suffered a “serious injury.” A New York court requires an expert affidavit or physician’s report to confirm the diagnosis. In the case of an alleged loss of function, the expert must objectively compare the victim's present condition with his or her pre-injury state. The need for adequate expert testimony is just one reason to work with an experienced New York personal injury lawyer when you are considering a lawsuit.