A New York car-accident claim can involve two different systems at the same time: no-fault benefits for certain economic losses and a liability claim against the person who caused the crash. The “serious injury” threshold helps determine when an injured person may recover for pain and suffering.
Those systems are related, but they are not interchangeable. Understanding the difference explains why an insurer may pay medical bills even while disputing fault, and why proving another driver's negligence does not automatically establish a right to non-economic damages.
What New York no-fault insurance pays
No-fault coverage, also called Personal Injury Protection or PIP, is designed to pay certain economic losses promptly without first deciding who caused the crash. New York's basic coverage generally provides up to $50,000 per person for combined basic economic loss, including necessary medical expenses, a portion of lost earnings and certain other reasonable and necessary expenses.
Coverage usually follows the vehicle. An injured driver or passenger generally applies to the insurer for the vehicle occupied, while a pedestrian usually applies to the insurer for the vehicle that struck them. Motorcycles and some other situations follow different rules. The New York Department of Financial Services explains the basic coverage and who it protects.
No-fault has short claim deadlines
A no-fault claim is not opened automatically just because the police came to the scene. Written notice generally must reach the appropriate insurer as soon as reasonably practicable and no later than 30 days after the crash, unless the claimant can provide clear and reasonable justification for a delay.
Proof of medical expenses is generally due within 45 days after services are rendered, and proof of lost earnings is generally due within 90 days. These are claim deadlines, not the statute of limitations for a lawsuit. Missing one can affect benefits long before the lawsuit deadline arrives. Current filing guidance is available in the DFS no-fault consumer FAQ.
What the serious injury threshold controls
New York Insurance Law § 5104 generally prevents a covered person from recovering non-economic loss—pain, suffering and similar harm—from another covered person after a motor-vehicle crash unless the injured person proves a “serious injury.” Liability and damages remain separate questions: a driver may have caused the collision, but the injured person still must satisfy the threshold to recover non-economic damages.
Under the current definition in Insurance Law § 5102(d), serious injury includes death, dismemberment, 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, and significant limitation of use of a body function or system.
A major 2026 change removed the 90/180-day category
Articles and claim guides written before May 26, 2026 may describe a category based on being unable to perform substantially all usual daily activities for at least 90 of the first 180 days after the crash. New York removed that category from the statutory definition for actions and proceedings commenced on or after May 26, 2026.
The change matters because older online explanations may no longer state the current law. The Department of Financial Services summarized the amendment in its 2026 motor-vehicle insurance reform guidance. The filing date and facts of a particular matter can affect which rules apply, so the threshold should be evaluated against current law.
A diagnosis alone may not settle the threshold question
Fractures and some other categories can be comparatively direct. Limitation cases are often more contested. Medical records may need to connect the condition to the collision and document its nature and degree with objective findings. Insurers may point to prior injuries, degenerative findings, gaps in treatment or inconsistent measurements to argue that the statutory threshold has not been met.
This is why prompt evaluation and consistent follow-up matter. The purpose of treatment is health, not litigation, but records created during ordinary care often become the best evidence of symptoms, testing, restrictions, improvement and any lasting limitation.
The threshold does not mean no-fault is your only possible recovery
The serious injury rule principally limits recovery for non-economic loss between covered persons. It does not erase every possible claim involving economic loss, and it does not replace the need to prove negligence, causation and damages in a liability case. Coverage questions can also arise when basic no-fault benefits are exhausted, economic losses exceed the statutory definition or an uninsured or underinsured vehicle is involved.
Most negligence claims for personal injury in New York are subject to a three-year limitations period, but shorter deadlines can control particular defendants and benefits. A claim against a municipality or public corporation may require a notice of claim within 90 days. No-fault notice can be due within 30 days. The safest approach is to identify every potentially responsible party and every applicable policy early.
What a lawyer should evaluate at the beginning
An early review should address where the no-fault application belongs, whether required notices were submitted, the available liability and supplementary coverage, how the collision happened, the medical evidence and which current serious-injury category may apply. That review should occur before a broad medical authorization or settlement release is signed.
This article provides general information, not legal advice. New York amended the serious-injury statute in 2026, and the correct analysis depends on the date, coverage, parties, injuries and procedural posture of a particular case. Reading this page does not create an attorney-client relationship.
If you were injured in a Long Island car accident and have questions about no-fault benefits or the serious injury threshold, call (516) 444-1000. The case review is free.