Going Outside No-Fault Insurance for Car Accident Legal Claims
No-fault car insurance does not account for non-economic damages like pain and suffering. However, no-fault states (Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania, and Utah) allow a victim to go outside the no-fault system and sue an at-fault driver for non-economic damages if they have suffered serious injuries. Some no-fault states also allow a victim to sue if they have incurred more than a certain amount in medical bills. In Kentucky, New Jersey, and Pennsylvania, moreover, a driver can avoid the non-economic damages limitation in advance by opting out of the no-fault system and preserving their right to sue under traditional fault rules.
Serious Injury Thresholds
"Serious injuries" are defined slightly differently and very specifically in each state (except Pennsylvania, which simply uses the phrase “serious injury”). Some common categories of serious injuries include permanent injuries, fractures, disfigurement, disabilities, or the loss or limitation of a body part or function. In some states, an injury that is permanent may not need to be severe to meet the serious injury threshold, and it may not even need to have a significant impact on your work or daily life. A disability similarly may not need to involve a total loss of function to qualify. Meanwhile, a fracture does not necessarily require that the bone is completely broken. A chipped or cracked bone may be enough to qualify.
However, other states require a permanent injury, disability, or fracture to be significant. What this means can be very fact-specific, and the vagueness of the law often gives rise to disputes with insurers over the value of a claim. Even if you are not sure whether you meet the requirements for going outside the no-fault system, you can file a claim against the at-fault driver’s insurer and address the threshold in your negotiations. You may be able to convince the insurer to offer a settlement without going to court to get a legal finding that your injuries qualify.
Monetary Thresholds
Hawaii, Kansas, Kentucky, Massachusetts, Minnesota, North Dakota, and Utah allow a victim to go outside the no-fault system and pursue non-economic damages if their medical costs exceed a certain amount, which varies depending on the state. (For example, Kansas and Massachusetts impose a $2,000 threshold, while Utah imposes a $3,000 threshold.) Only necessary medical expenses will qualify toward the threshold in these states. As a result, an insurer may argue that a certain type of procedure or treatment either was not necessary or was not relevant to the injuries arising from the accident. However, a procedure or treatment is not unnecessary just because you could choose to forego it. As long as it serves a reasonable diagnostic or therapeutic purpose, it should qualify as a necessary medical expense.
