Serious Injuries and the 90/180-Day Rule

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New York is among a dozen states in the U.S. that operate on a “no-fault” basis for auto insurance. In most states, a car accident victim files an insurance claim or personal injury lawsuit against the person who caused the crash. In a “no-fault” state like New York, car accident victims usually turn to their own insurance policy for coverage regardless of who was at-fault for an accident.

New York requires all motorists to purchase and carry a personal injury protection (PIP) policy worth at least $50,000. PIP covers medical expenses and replaces some lost income for New Yorkers who have been hurt in auto accidents.

However, there are certain exceptions to the no-fault system that allow New York car accident victims to pursue a claim or lawsuit against the at-fault party, just as they would in states that don’t follow a no-fault regime. Below, we will discuss the circumstances in which an injured auto accident victim can step outside New York’s no-fault auto insurance system to seek compensation from the negligent party.

What Are the Requirements for Stepping Outside the No-Fault System in New York?

The idea behind the no-fault system in New York is to make it faster and easier for car accident victims to get the coverage they need for medical expenses and lost income, without having to prove liability or build a case against the other driver.

While PIP coverage is often sufficient for minor injuries, individuals who suffer serious injuries may incur expenses that far exceed their PIP coverage limits. PIP also does not cover non-economic damages like physical and emotional pain and suffering, nor does it cover loss of quality of life, loss of consortium, and other non-financial losses. These types of damages are recoverable through a third-party insurance claim or lawsuit, in addition to financial losses.

You might be entitled to step outside the no-fault system and bring a claim or lawsuit directly against the at-fault party if you suffered a “serious injury” as defined by state law.

What Counts as a Serious Injury?

The state defines the following injuries as “serious” in New York Insurance Law Section 5102(d):

  • Death
  • Significant disfigurement
  • Dismemberment
  • Loss of a fetus
  • Fractures
  • Permanent loss of a body member, organ, system, or function
  • Permanent consequential limitation of a body member or organ
  • Significant limitation of use of a body system or function
  • A medically determined injury or impairment of a temporary nature which inhibits the injured individual from carrying out “substantially all” of the material acts which constitute that person’s typical daily activities for at least 90 days during the 180 day period after they first suffered the injury or impairment

The final type of “serious injury” is commonly referred to as the 90/180-day rule. Many individuals who step outside of the no-fault system do so on the basis of this rule.

How Does the 90/180-Day Rule Work?

To successfully prove that you suffered a serious injury in a car accident based on the 90/180-day rule, you will need to be able to demonstrate that the injury caused a major disruption in your life and prevented you from performing everyday activities.

The “substantially all” language is critical, as it makes clear that your injury must have significantly impeded your ability to go about your life as you normally would. If your injury or impairment only slightly hindered your ability to perform your customary activities, your condition would probably not qualify as “serious” under the 90/180-day rule.

For example, if you need help performing some tasks but can still complete others without assistance, your condition likely would not fulfill the “substantially all material acts” qualification. But if your physical condition prevents you from returning to work for at least 90 days and hinders your ability to do most or all of your routine daily tasks, your injury is much more likely to meet the standard required by law.

How to Prove a Serious Injury Under the 90/180-Day Rule

To bring a successful claim or lawsuit under the 90/180-day rule, you will need to obtain and present medical records showing that your injury significantly impacted your ability to work or carry out other tasks for the specified number of days. While you can personally attest to the nature of your injury, you will need more evidence to demonstrate the veracity of your claims. For instance, you could present testimony or reports from your medical provider, results from imaging tests, and other medical evidence to prove your case.

If you are severely injured in an accident that you didn’t cause, you should seek prompt medical attention. The longer you delay medical treatment, the more likely it is that the at-fault party’s insurance company will contest your claim. They could argue that your injuries were sustained in a completely different accident if you wait more than 72 hours to see a doctor. By getting your injuries diagnosed right away, you can effectively show that the accident left you temporarily disabled.

Contact a New York Car Accident Attorney Today

Were you seriously injured in a car accident in New York? Was someone else to blame? If your injury has prevented you from functioning normally for a period of at least 90 days, or you suffered another type of serious injury as defined by New York state insurance law, you might be entitled to seek compensation from the person who caused the accident. However, you will benefit from having an experienced New York car accident attorney’s help to determine your eligibility and successfully prove your case.

The New York car accident lawyers at Finz & Finz, P.C. have extensive experience helping victims of car accidents seek the financial relief they need to get their lives back on track after a motor vehicle crash. We understand how an auto accident can completely upend your life, physically, emotionally, and financially. If you were seriously hurt and you didn’t cause the accident, then you shouldn’t be responsible for your medical costs, lost income, and non-financial losses. We will work tirelessly to help you hold the at-fault party accountable for their negligence.

Contact us today for a free consultation by calling us at 855-TOP-FIRM.

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Finz & Finz, P.C. is a New York and Long Island personal injury law firm based out of Mineola, NY. It was founded in 1984 and is highly rated, with many honors and awards of excellence.