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No Fault Auto Insurance and Serious Injury

Auto Accident Lawyers

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Posted on: March 15, 2021

serious injuryIn last month’s column, the White Plains accident lawyers at Worby Vecchio Edelman covered No Fault Insurance from the perspective of payment of medical bills and lost wages.  As mentioned, the insurance company of the vehicle occupied by the injured party will cover medical bills, as well as a portion of lost wages, all regardless of fault.  However, the payment of accident related bills and lost wages is only one aspect of No Fault.  Yes, your medical bills are covered.  But the question then becomes whether you can sue an at fault vehicle owner or operator for personal injuries sustained as a result of that accident.

So we now reprise the factual scenario presented last month.  You are driving to the local supermarket, and are fully stopped at a red light.  There are a few vehicles in front of you, with a good amount of distance separating you from the vehicle directly ahead.  You are wearing your seat belt, your hands are on the steering wheel, and you are paying full attention to the situation around you.  Before the light turns green, you see a vehicle coming directly at you from behind, its driver seemingly oblivious to your presence.  You have nowhere to go, so you brace yourself for the imminent heavy impact.

You have sustained injuries as a result of the impact.  You are now at the crossroads of the New York No Fault Insurance law.  The idea underlying No Fault was to remove the necessity of a lawsuit to recover medical basic expenses, and that is why your own insurance company pays those expenses, even if another vehicle caused the accident.  At the same time, the No Fault law requires proof that an accident victim has sustained a “Serious Injury” in order to sue an at fault vehicle owner or operator for the pain and suffering caused by those injuries. 

Does Your Auto Accident Injury Meet the Definition of “Serious Injury”?

The term “Serious Injury” is defined in the Insurance Law.  Some definitions of “Serious Injury”, such as “death”, or “fracture”, are very specific, and easy enough to apply.  Other definitions, such as “significant limitation of use of a body function or system”, or “permanent loss of use of a body organ, member, function or system” are obviously (and probably purposely) vague, and the subject of thousands of pages of appellate decisions.

The best advice we can offer here is to listen to your body, and pay attention to your symptoms.  While immediate medical treatment may be called for, follow up care and objective testing are usually required to determine whether your injury qualifies as a “Serious Injury”.  The question of whether you have sustained a fractured leg may be obvious from your presentation in the Emergency Room, and can be diagnosed on the spot by x-rays.  However, more advanced radiological testing, not generally provided during an ER consult, is generally required to determine whether you have sustained an injury that cannot be diagnosed by a simple X-ray.

If your symptoms do not subside within a reasonable amount of time, it is important to obtain prompt follow-up care.  As an example, pain in the lower back which prevents full rotation, especially where that pain radiates to the leg, can be signs of a neurological injury.  An inability to fully rotate the shoulder area could be a sign of a torn rotator cuff.  In some cases, injuries of this type will include surgery as a treatment option.

The issue of whether an accident victim has sustained a “Serious Injury” has confounded both trial level and appellate courts throughout the State, including New York’s highest Court, the Court of Appeals.  We can state with certainty that the lack of a firm diagnosis will ultimately result in an unsuccessful lawsuit, regardless of how painful the injury might be.  Pain itself is not a diagnosis.  Rather, objective testing which can show an injury, and objective range of motion restrictions directly caused by that injury can get you over the Serious Injury threshold.

Contact Our White Plains Auto Accident Lawyers

The motor vehicle accident lawyers at Worby Vecchio Edelman do not offer medical advice; only a qualified medical professional can diagnose your injury, and suggest a treatment plan.  Our area of expertise involves how your injuries, diagnosis, and treatment affect your legal rights.  We have access to the latest judicial decisions which can help us offer an opinion whether you have sustained the required “Serious Injury”.  We have over 150 years of combined experience in the field.  Call us if you are the victim of a motor vehicle accident.  We can help you navigate your way through the complicated area of No Fault Insurance.

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Worby Vecchio Edelman, LLP White Plains Office 11 Martine Ave, Penthouse
White Plains, NY 10606
(914) 686-3700

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