New York is a “no-fault” state. This means that the legislature has set up a system of rules to ensure that people who are injured in car crashes have medical coverage. In other words, it is health insurance for people who are injured in car accidents.
When they gave us these no fault benefits, the legislature took away our right to sue for every little bump or bruise. The reason is this: Your medical bills have been taken care of; if you are missing time from work, you are going to be re-paid; and your out-of-pocket expenses have been reimbursed.
So in theory you’ve been put back in the same place you were prior to the crash. In reality, that is not often the case but regardless a threshold was created with our no-fault law. In other words, before you can recover any money for pain and suffering after a car crash you must prove that your injuries are “serious” under our law.
This term “serious” has a legal definition under New York law – and the legalese follows: “Serious injury” means a personal injury which results in:
- 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;
- significant limitation of use of a body function or system; or
- a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.
So we have nine different ways that you can be seriously injured. And remember, you can only recover money if you fit into one of these nine categories. Some of the categories are self-explanatory, like death, dismemberment, a significant disfigurement, a fracture or the loss of a fetus, but the rest may leave you scratching your head. It is these remaining categories where the majority of claims fall.
In its simplest form, these categories are all some variation on the same idea. You used to be able to do things one way and now, as a result of the injuries you sustained in the accident, you can’t do things the same. You are limited.
These limitations can come in the form of your everyday tasks, like getting dressed, doing housework, cooking, cleaning and sleeping. Or perhaps your inability to enjoy hobbies, or sports, or exercise. We call these “qualitative” limitations.
Then there are the things you can actually measure; your inability to turn your neck, bend over, raise your arm over your head or straighten out your leg. These things are called “quantitative” limitations.
But how do we go about proving these injuries? There is no set formula, but consistent medical treatment over a course of time, combined with objective evidence of an injury (i.e. an MRI, EMG/nerve test or the like) is a good start.
Each case is different, and each case turns on its own facts but these are some basic ideas that will help you have an understanding of what must be proven.