Wondering if your injuries are serious enough to warrant a lawsuit may seem like a silly question; after all, lawsuits are becoming the norm instead of a last-resort action. You can seek compensation if a hot cup of coffee burns you, and someone even filed a lawsuit for emotional trauma after visiting a theme park’s haunted house. 

While some frivolous lawsuits are tossed out, others result in financial compensation. So, what goes into determining when injuries qualify for legal action? If you don’t want to be laughed out of court for filing a silly claim, your injuries must meet a few specifications.

New York is a No-Fault State

Understanding no-fault laws can be tricky because, in most accidents, there’s an at-fault party. The at-fault party is the individual/s responsible for the accident, so how can a law state no one is to blame?

The law is a little misleading since a no-fault law doesn’t say that no one or everyone is responsible for causing an accident. Instead, each involved party seeks compensation from their insurance provider. All drivers are also required to carry personal injury protection insurance (PIP), and personal injury insurance is typically a rider on your auto policy.

Mandatory Insurance Requirements for Drivers

All drivers in New York must carry at least a $50,000 no-fault insurance policy. This helps ensure a driver involved in a car accident can pay the following:

  • Medical expenses. This includes all necessary and reasonable medical expenses. For example, treatment for a broken rib is covered, but deciding to undergo a tummy tuck is an unnecessary expense that insurance will not pay for.
  • Up to 80% of lost wages. This is capped at $2,000 weekly payments for up to three years.
  • Some necessary and reasonable experiences like transportation costs to and from medical appointments. This is also capped at $25 a day.
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You can also claim up to $2,000 in death benefits if you are the estate holder for the deceased victim. All of these benefits, either individually or combined, cannot exceed $50,000.

Ineligibility for No-Fault Insurance Benefits

Don’t presume that you’re automatically entitled to receive benefits from your insurance provider after an accident, as there are exceptions that can make you ineligible. 

If you’re found to be ineligible, there’s very little recourse. However, it never hurts to consult with a qualified personal injury attorney. Your attorney may be able to find an exception but don’t hold your breath.

If any of the following apply, you probably can’t depend on receiving no-fault insurance benefits:

  • You’re intoxicated (under the influence) at the time of the accident, which can also apply to prescription medications.
  • The accident is a result of you trying to harm yourself
  • The vehicle is stolen by you or someone else, and this exemption applies whether you’re the driver or a passenger in a stolen vehicle. However, if you’re unaware of the vehicle’s origins you may be able to receive compensation.
  • Uninsured vehicles don’t qualify for insurance benefits

If the accident occurs while you’re committing a felony, you’re automatically disqualified from filing a medical and/or property damage claim.

Seeking Compensation for Serious Injuries

If your injuries and/or property damage exceeds $50,000, don’t panic! Just because your damages are over the state’s legal payout amount doesn’t mean you’re on the hook for the rest.

Your injuries and/or economic losses must meet a few basic requirements:

  • Dismemberment
  • Fracture
  • Loss of a fetus or termination of a pregnancy due to injuries sustained in the accident
  • Permanent limited use of a limb or body organ, system, or function
  • Loss of a body organ or limb
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Sustaining an injury that affects your normal quality of life for at least 90 days after the accident may also qualify as a serious injury. Meeting any of the above criteria may mean you’re eligible for additional benefits, which means you can file a lawsuit against the negligent driver.

Applying for Serious Injury Compensation

Before starting negotiations with the at-fault driver’s insurance company, it’s a good idea to consult with an attorney. You have three basic routes you can take, and your attorney can help you decide which option is the best choice for you.

Apply for Additional Insurance

Most accident victims quickly realize that $50,000 doesn’t go very far when they’re dealing with serious injuries. A couple of diagnostic tests can eat up your insurance payout, and this is before you even start treatment. 

You can apply for additional coverage; think of it as a boost to your current PIP plan. There’s no guarantee your request is going to be approved, but it never hurts to ask.

File a Claim Against the Other Driver’s Insurance

All drivers in New York state must carry liability insurance; the at-fault driver’s liability policy can decide to cover your damages but be prepared to go through some lengthy negotiations. You’ll also need to prove the other driver is responsible for causing the accident before the insurance company will even think about awarding you financial compensation.

Go to Court

Hopefully, your attorney is recommending filing a lawsuit in civil court as a last resort since this shouldn’t be your first option. When you can’t make any progress with the at-fault driver’s insurance provider, a lawsuit may be your only option. 

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Your lawsuit can give you some leverage during negotiations. If the court decision is in your favor, you may be awarded enough damages to pay off all of your expenses.

Motorcyclists Have Different Rules

The no-fault law doesn’t apply to motorcyclists, so if you’re in an accident on your bike, you’re automatically ineligible for no-fault insurance benefits. Don’t even try to get around this law, it’s pretty ironclad—however, you’re not totally at a loss. 

Motorcyclists can file a lawsuit against the at-fault driver’s insurance, and best of all, you don’t need to meet the state’s threshold for serious injuries. Pedestrians struck by a motorcycle will file an injury claim against the biker’s insurance provider.

Don’t File a No-Fault Claim Alone

Filing a claim with your insurance provider can be a complex and daunting process, especially if your injuries are serious, as there’s a high risk of making a mistake that could jeopardize your compensation. 

Consulting a personal injury attorney following an accident is crucial; they can guide you through the intricate claims process and advocate on your behalf, significantly increasing your chances of receiving the full, fair compensation you deserve.