When you're injured in a car accident in one of the dozen or so states that follow some form of "no-fault" car insurance, you can step outside the confines of no-fault and make a claim against the at-fault driver, but only if your injury claim meets certain thresholds set out under state law. (Get the basics on how no-fault car insurance works.)
Some states have monetary thresholds (medical expenses related to the accident must be over a certain dollar amount), other states have a "serious injury" threshold, and some states use both kinds of thresholds (letting an injured person file a claim when either threshold is met.)
In this article, we'll discuss the "serious injury" threshold in place in a number of no-fault states. How do these thresholds work? When your car accident injuries meet the definition set out in your state, you're not limited to making a no-fault car insurance claim under your own "personal injury protection" coverage. Instead, you're free to file a third-party claim with the at-fault driver's insurance company, or even a personal injury lawsuit against the other driver. The key here is that in these kinds of liability claims, you're able to recover compensation for your non-economic damages (including pain and suffering), which aren't available in a no-fault/PIP claim (For a discussion of the monetary threshold, see our companion article No Fault Car Insurance: States with Monetary Thresholds.)
District of Columbia: Substantial permanent scarring or disfigurement, substantial permanent impairment, or substantially total impairment lasting 180 days.
Florida: Permanent injury or significant and permanent scarring or disfigurement.
Hawaii: Significant permanent loss of use of a body part or function, or permanent and serious disfigurement resulting in mental or emotional distress.
Kansas: Permanent disfigurement, fracture of weight-bearing bone or compound, comminuted, compressed, or displaced fracture of any bone, permanent injury, or permanent loss of a body function.
Kentucky: Permanent disfigurement, fracture of weight-bearing bone or compound, comminuted, compressed, or displaced fracture of any bone, permanent injury, or permanent loss of a body function.
Massachusetts: Permanent and serious disfigurement, fractured bone, substantial loss of hearing or sight.
Michigan: Serious impairment of a body function or permanent and serious disfigurement.
Minnesota: Sixty days disability, permanent injury, or permanent disfigurement.
New Jersey: Dismemberment; significant disfigurement or significant scarring; displaced fractures; loss of a fetus; permanent injury (other than scarring or disfigurement).
New York: Significant disfigurement, bone fracture, permanent limitation of use of body organ or member, significant limitation of body function or system, or substantially full disability for 90 days.
North Dakota: Serious and permanent disfigurement or disability of more than 60 days.
Pennsylvania: Serious injury.
Utah: Bone fracture, permanent disability, or permanent disfigurement.
The categories of injuries legally considered "serious" by the various state no-fault laws are explained below.
Bone fracture: The probable fracture of any bone, as shown by X-rays and a doctor's statement, that was the result of the accident -- that is, was not an old fracture. Some PIP laws require that the fracture be of a "weight-bearing bone" -- large bones of arm or leg, or a vertebra. Some also define serious injury as the compound, "comminuted" (meaning crushed or splintered), displaced, or compressed fracture of any bone. And other state laws merely mention "fracture," which would include chipped or cracked bones or vertebrae as well as full breaks.
Permanent injury: In some states, a "permanent" injury (if the term "disabling" is not included) can permit a liability claim even if the injury is not a severe one. For example, a broken bone that will remain crooked can be a permanent injury even though it is a small bone like a finger or toe and its crookedness does not affect the use of hand or foot. Similarly, a joint that suffers ligament, cartilage, or other damage may be permanently injured if the joint is not as strong or as flexible after healing as it was before the injury. Neck and back injuries are common in automobile accidents, and any injury to the spine that cannot be corrected without surgery might be considered a permanent injury, even though it may not prevent you from working or performing other normal daily life functions.
Laws using the word "significant" to describe a threshold permanent injury require that the injury be more serious than in states that do not use that term.
Disabling injury: Some state no-fault laws speak in terms of "disabling" injuries rather than "permanent" ones. In these states, your medical records must show that you have suffered some loss, though not necessarily total loss, of the function of a part of your body. For example, if you cannot straighten your arm all the way out because of an elbow injury, or you can no longer bend and pick up heavy things because of a back injury, your injury may be disabling even though you still have most of the use of your arm or back.
In some states the loss of function has to be "significant," while in others it does not. Under some rules, the injury has to be "permanent" as well as disabling, while other rules require only that the disability last more than 60 days.
Because of the sometimes vague definitions of the threshold injury categories under PIP laws -- and the subjective nature of many medical evaluations -- it may not be clear whether your injuries qualify under your state's no-fault threshold. But you don't have to have a surefire qualified injury to pursue a liability claim. The issue of whether your injury qualifies is something to negotiate with the insurance company.
File your liability claim against the person at fault and include the no-fault threshold question among the other issues you will be negotiating with the insurance company.
To learn more about how insurance coverage works after a car accident -- and everything you'll need to navigate your claim -- get How to Win Your Personal Injury Claim by Joseph L. Matthews (Nolo).