A threshold, not a description
Under New York's no-fault system, the policy on the vehicle you were driving or riding in, or on the vehicle that struck you, usually pays basic medical expenses and part of lost earnings after a car accident, regardless of who caused it. To sue the at-fault driver for pain and suffering, an injured person usually must show a serious injury as New York law defines it. The definition is built from categories of injury, such as fractures and significant limitations of a body function, and what fits those categories is often litigated. Insurers frequently challenge whether an injury meets the threshold, and courts sometimes dismiss cases on that basis before trial. Other states use different systems, so the phrase can mean something else outside New York.
How medical evidence carries the claim
Because the threshold is contested, the medical record carries more weight in serious injury claims than in many other cases. Consistent treatment, objective findings such as imaging and measured range of motion, and a doctor's explanation of how the injury relates to the accident usually matter. Insurers often point to gaps in treatment as a sign that the injury resolved or was never serious, so if treatment stopped because benefits were cut off or you could not afford it, make sure your lawyer knows. Pre-existing conditions are another common battleground, especially with spine and joint injuries. Keep every medical record, prescription, and bill, along with proof of missed work.
Coverage, examinations, and timing
We look at the accident, the injuries, and the treatment so far to judge how the threshold question may play out. We review the status of your no-fault claim and any examinations requested by the insurer's doctors. We also check the other driver's policy limits and whether your own policy includes supplementary coverage for underinsured drivers. Deadlines for no-fault applications can be short, and lawsuit deadlines apply as well, so timing is reviewed at the start. If the injury did not come from a car accident, the threshold generally does not apply, and we explain how the analysis changes.
