What is the 90/180-day rule under New York insurance law?

The 90/180-day rule is a serious injury category defined under New York Insurance Law Section 5102(d). This rule allows an accident victim to pursue non-economic damages like pain and suffering if their injuries meet specific criteria. To qualify, a medically determined injury must prevent the individual from performing substantially all of their customary daily activities for at least 90 of the first 180 days following the accident.

How do New York courts define the standard of substantially all daily activities?

New York courts interpret the phrase substantially all to mean that a person's usual activities must be curtailed to a great extent rather than slightly limited. This standard was established by the Court of Appeals in the case of Licari against Elliott. A plaintiff must show a significant disruption in their pre-accident routine, which can include employment, household chores, childcare, and social activities. Vague claims of pain without objective medical proof connecting the injury to specific curtailed activities are generally insufficient in court.

What types of medical records are required to support a claim under this rule?

Proving a claim under this category requires medical documentation created during the 180-day period immediately following the accident. Useful records include treating physician notes that describe specific functional limitations and narrative reports explaining how the injuries affected daily activities. Functional capacity evaluations can also provide valuable objective evidence of physical restrictions. A physician affirmation or other competent medical proof must directly connect the diagnosed injury to the functional limitations. Records created long after the 180-day window are more vulnerable to challenges if earlier documentation does not support the claimed limitations.

What non-medical evidence can be used to support a 90/180-day claim?

Several types of non-medical documentation can help substantiate the daily limitations claimed by an accident victim. Employer leave records or termination notices can document the exact amount of time missed from work. School absence records are useful for students who were unable to attend classes due to their injuries. Additionally, testimony from family members or caregivers can describe the day-to-day limitations they witnessed firsthand.

Can a 90/180-day claim be dismissed before reaching a trial?

Defendants can file a motion for summary judgment under Civil Practice Law and Rules Section 3212 to dismiss the case before trial. To succeed, the defense must first establish a prima facie case showing that the plaintiff did not suffer a serious injury. If the defense meets this burden, the plaintiff must submit competent medical proof to raise a triable issue of fact and keep the case alive.

How does the 90/180-day rule differ from other serious injury categories?

Unlike other serious injury categories under New York law, the 90/180-day rule is based on function and time rather than permanence. Some categories require a specific diagnosis like a fracture or a permanent loss of use of a body organ. The 90/180-day rule focuses instead on what the injured person could not do and the duration of those limitations. Because of this distinction, plaintiffs often plead this rule alongside other categories when the facts support multiple legal theories.

Does no-fault insurance cover medical expenses while a victim proves the serious injury threshold?

Eligibility for basic no-fault insurance benefits is separate from the serious injury threshold required for a lawsuit. Under New York law, basic economic loss covers up to 50,000 dollars per person for medical expenses and lost earnings. An injured person can receive these first-party benefits even if they have not established a serious injury. The 90/180-day rule only becomes relevant when the victim seeks non-economic damages such as pain and suffering. Therefore, a person may receive medical coverage while simultaneously preparing a pain and suffering claim.

How can K L Sanchez Law Office, P.C. help accident victims with a 90/180-day claim?

K L Sanchez Law Office, P.C. can assist you by thoroughly evaluating your medical records, treatment history, and daily activity limitations to determine if they support a serious injury claim. Our team works to gather treating physician notes, employer leave records, and other essential documentation during the critical 180-day window. We also help address potential challenges from the defense, such as treatment gaps or unfavorable independent medical examination reports. By building a well-documented record early in your case, we aim to protect your right to pursue pain and suffering damages.

How can individuals contact K L Sanchez Law Office, P.C. for a consultation?

You can contact K L Sanchez Law Office, P.C. by calling our office at (646) 701-7990 to schedule a free consultation regarding your accident claim. Our physical office is located at 37-06 82nd Street, Suite 304, in Jackson Heights. We represent injured victims throughout Queens and nearby communities, including Jackson Heights, Elmhurst, Woodside, and Corona. You can also reach out to us online to discuss how New York's serious injury threshold rules may apply to your specific situation.

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K L Sanchez Law Office

What’s the 90/180-Day Rule Under NY Insurance Law § 5102(d)?

Q: How do treatment gaps affect a 90/180-day claim under New York law?

Gaps or a complete cessation in medical treatment can significantly weaken a 90/180-day claim. Defense attorneys frequently use these interruptions to argue that the injury resolved quickly or was not serious. According to the Court of Appeals ruling in Pommells against Perez, a plaintiff who stops treatment must offer a reasonable explanation for the gap. Acceptable explanations may include a doctor's determination that further therapy is only palliative, the termination of no-fault benefits, or an inability to afford care. Clear documentation of the reason for any treatment interruption is necessary to counter defense arguments.

Posted on June 30, 2026

The 90/180-day rule is one of the “serious injury” categories under NY Insurance Law § 5102(d). It may allow an accident victim to pursue pain and suffering damages when an injury significantly disrupts their usual daily activities during the months after an accident. Because this category depends on medical proof, activity limitations, and the timing of treatment records, careful documentation can play an important role in protecting the claim.

At K L Sanchez Law Office, P.C., Queens personal injury attorney Keetick L. Sanchez helps accident victims evaluate whether their medical records, treatment history, and daily activity limitations may support a serious injury claim under the 90/180-day rule. For motor vehicle accident victims, our car accident lawyer can review how New York’s no-fault serious injury threshold may affect a claim for pain and suffering damages.

This guide explains what the 90/180-day rule requires, how courts interpret the “substantially all” standard, and why defense attorneys target treatment gaps to challenge this category. You will also learn what documentation may help support the claim if the defense files a summary judgment motion and how a Queens personal injury attorney can help preserve the record early in the case. Call (646) 701-7990 for a free consultation.

What Is the 90/180-Day Rule in NY No-Fault Law?

NY Insurance Law § 5102(d) defines “serious injury,” and § 5104 limits recovery for non-economic loss, including pain and suffering, unless the serious injury threshold is met. The 90/180-day rule is one of the qualifying categories and focuses on how the injury affected the person’s daily activities during the 180 days immediately following the accident.

This category applies when an accident victim has a medically determined injury or impairment that prevents them from performing substantially all of their customary daily activities for at least 90 of those 180 days. The injury does not need to be permanent, but the records should connect the diagnosed injury, the functional limitations, and the relevant timeframe.

Key Takeaway: The 90/180-day rule focuses on whether a medically determined injury kept the accident victim from performing all customary daily activities substantially for at least 90 of the first 180 days after the accident.

What Does “Substantially All” Daily Activities Mean?

“Substantially all” is the most contested phrase in the 90/180-day category. Courts do not interpret it to mean just “some” limitation. The plaintiff must show their usual activities were curtailed to a great extent, not merely reduced slightly.

How Do Courts Define the Standard?

The Court of Appeals addressed this standard in Licari v. Elliott, 57 N.Y.2d 230 (1982), establishing that the plaintiff’s usual activities must be curtailed to a great extent, not just slightly limited. Medical proof should connect the injury to specific functional restrictions during the relevant 180-day period. Quantified range-of-motion findings can help, but a qualitative medical assessment may also support the claim when it has an objective basis and compares the plaintiff’s limitations to normal function.

What Counts as a “Usual Daily Activity”?

Courts may consider the person’s pre-accident activities, including their job, household responsibilities, childcare duties, exercise routines, and social activities. The key is comparison between what the plaintiff could do before the accident and what they could do during the 180-day window. Vague claims like ‘I was in pain and couldn’t do normal things’ may be vulnerable without medical proof tying the injury to specific curtailed activities. The record must show specific curtailed activities and the medical reason why.

Key Takeaway: “Substantially all” requires more than minor disruption. The record should show that the plaintiff’s usual activities were curtailed to a great extent and tied to medically supported limitations.

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How Do You Prove the 90/180-Day Rule After an Accident?

Proving this threshold requires more than a diagnosis. The record should show how the injury limited specific daily activities during the first 180 days after the accident.

What Medical Records Are Required?

Helpful evidence often includes medical documentation created during the 180-day period. Useful records may include treating physician notes describing functional limitations, narrative reports explaining how the injuries affected daily activities, and functional capacity evaluations when available. Later reports may still help, but they are more vulnerable when earlier records do not support the claimed limitations.

A physician’s affirmation or other competent medical proof should connect the diagnosed injury to specific functional restrictions. For example, a report explaining that the patient has a herniated disc at L4-L5 and has documented limits with sitting, lifting, or household chores may be more useful than a record that simply notes back pain without explaining how the injury affects daily function.

What Non-Medical Evidence Supports This Claim?

Employer leave records or termination notices may help document time away from work. School absence records can matter if the plaintiff is a student. Caregiver testimony from family members can describe day-to-day limitations they witnessed firsthand. A personal activity journal started as close to the accident date as possible can also help document what the injured person could not do each day.

Key Takeaway: A strong 90/180-day claim ties the diagnosed injury to specific activity limits during the first 180 days, with medical records created as close in time to the accident as possible.

How Treatment Gaps Can Affect a 90/180-Day Claim

Gaps or a complete stop in medical treatment can create problems in a 90/180-day claim. The record should document both the person’s functional limitations and the reason for any interruption in care. A treatment gap does not automatically defeat the claim, but an unexplained gap can give the defense an argument against the seriousness, duration, or cause of the claimed injury.

Common Treatment-Gap Issues Defendants May Raise

Defense attorneys often focus on gaps or weaknesses in the record. The table below shows common issues that may be used to challenge a 90/180-day claim and the types of documentation that may help address them.

Issue in the Record	How the Defense May Use It	What May Help Address It
Missed treatment appointments	Argue the injury resolved before 90 days	A documented reason for the gap, such as insurance, cost, or doctor instructions
Vague medical notes	Argue there is no proof of specific daily limits	Records describing limits with sitting, lifting, walking, work, or household tasks
Late-created reports	Argue the limitations were reconstructed after the fact	Medical records created during the first 180 days
Unfavorable IME report	Argue the injuries were minor or resolved	Treating physician records with objective findings and activity restrictions
Plaintiff testimony only	Argue the claim relies on subjective complaints	Medical proof connecting the injury to daily functional limits

How Have Courts Ruled on Treatment Gaps?

The Court of Appeals addressed treatment gaps directly in Pommells v. Perez, 4 N.Y.3d 566 (2005). An unexplained cessation of treatment can support dismissal of a serious injury claim in some cases, but a gap is not automatically dispositive. A plaintiff who stops treatment must offer a reasonable explanation. Depending on the record, that explanation may include a physician’s decision that further therapy would be only palliative, termination of no-fault benefits, lack of medical insurance, or inability to afford continued care. The stronger the documentation, the harder it may be for the defense to use the gap as proof that the injury resolved or was not serious.

Key Takeaway: A treatment gap does not automatically defeat a 90/180-day claim, but the record should explain why treatment stopped or became inconsistent. A documented reason, such as a doctor-directed end to therapy, terminated no-fault benefits, or financial barriers, may help address the defense argument.

Personal Injury Attorney in Queens, K L Sanchez Law Office, P.C.

Can the Defense Dismiss Your Case Before Trial?

It can happen. Defendants may file summary judgment motions under CPLR § 3212 arguing that the plaintiff cannot meet the 90/180-day threshold as a matter of law. If the court grants the motion, the case may be dismissed before it reaches a jury.

What May the Defense Need to Show in a Summary Judgment Motion?

The defense must first establish a prima facie case that the plaintiff did not suffer a serious injury. Defendants may submit IME reports, defense medical evidence, or portions of the plaintiff’s own medical records showing treatment gaps, resolved injuries, or a lack of documented functional limitations. Once the defense meets this initial burden, the burden shifts to the plaintiff to raise a triable issue of fact.

What Must the Plaintiff Show to Survive the Motion?

The plaintiff must submit competent medical proof in admissible form, such as a physician affirmation, affidavit, or properly supported medical records. The proof should raise a triable issue on the serious injury threshold by tying objective medical support to the claimed limitations during the required period. Cases that rely only on the plaintiff’s own testimony about pain or limitations remain vulnerable at summary judgment.

How Is the 90/180-Day Rule Different from Other Serious Injury Categories?

The 90/180-day rule is different from the other serious injury categories under § 5102(d) because it is based on function and time rather than permanence alone. Some categories focus on a specific injury or result, such as a fracture or permanent loss of use. The 90/180-day rule asks a different question: what could this person not do, and for how long?

A permanent injury or fracture diagnosis is not required. Because this category is based on function and time, there is no single diagnostic test that confirms the standard is met. Many plaintiffs plead the 90/180-day rule alongside other categories, such as “significant limitation of use” or “permanent consequential limitation,” when the facts support more than one serious injury theory.

Does No-Fault Insurance Cover You While You Prove This Threshold?

In many covered cases, the serious injury threshold is separate from eligibility for no-fault first-party benefits. Under Insurance Law § 5102(a), basic economic loss includes up to $50,000 per person for covered losses, including medical expenses and a portion of lost earnings. A covered person may be able to receive eligible no-fault benefits even if they have not established a serious injury for a pain and suffering lawsuit.

The 90/180-day rule generally becomes important when the claim includes non-economic damages, such as pain and suffering. Eligible no-fault benefits and a serious injury lawsuit are separate issues, so a person may receive first-party benefits while also pursuing a pain and suffering claim when the facts support it.

What Should You Do After an Accident to Protect This Claim?

The 180-day window begins on the day of the accident. Early treatment, consistent records, and clear documentation of daily limitations can help protect the claim.

The following steps can help protect a 90/180-day claim:

Seek medical treatment immediately and attend every follow-up appointment.
File a written notice of a no-fault claim as soon as possible and, in most cases, no later than 30 calendar days after the accident unless a clear and reasonable late-filing reason exists.
Keep a daily activity journal starting on day one, noting specific tasks you cannot perform.
When work is affected, notify your employer in writing when appropriate and preserve available absence records, leave requests, and pay stubs.
Follow your physician’s instructions, and do not “push through” pain without documentation.
Tell your doctor specifically how your injuries limit daily activities at every visit, so it is recorded in your chart.
Consider contacting a Queens personal injury attorney early, especially while records from the 180-day period can still be preserved.

Legal Guidance After a Car Accident Under New York’s 90/180-Day Rule

If you have been told your injuries may not qualify under the serious injury threshold, or if a treatment gap or unfavorable IME report concerns you, legal guidance may help clarify the strength of your claim.

K L Sanchez Law Office, P.C. can review the medical records, treatment history, activity limitations, and treatment gaps that may affect a serious injury threshold claim under New York’s no-fault system. We represent injured victims in Queens and nearby communities, including Jackson Heights, Elmhurst, Woodside, and Corona.

Call K L Sanchez Law Office, P.C. at (646) 701-7990. Our office is located at 37-06 82nd Street, Suite 304, in Jackson Heights.

Frequently Asked Questions About the 90/180-Day Rule

What types of injuries may support a 90/180-day claim?

Soft tissue injuries, herniated discs, torn ligaments, and other non-permanent conditions may support a 90/180-day claim when medical records connect the injury to significant limits on the person’s usual daily activities during the required period.

How does an IME affect my 90/180-day claim?

An IME can give the defense medical evidence to challenge the seriousness, duration, or cause of the claimed injuries. If the IME report is unfavorable, treating physician records with objective findings, documented restrictions, and clear activity limitations can help respond to those arguments.

Can I still qualify if I missed some treatment during the 180 days?

It depends on the reason for the missed treatment and how well that reason is documented. An unexplained gap can weaken a serious injury claim, but a supported explanation, such as a doctor-directed end to therapy, terminated no-fault benefits, or a financial barrier to continued care, may help address the issue.

What if my doctor never documented my functional limitations?

Without medical records from the 180-day period describing specific functional restrictions, the 90/180-day category becomes harder to prove. A later physician affirmation may help in some cases, but records created during the relevant period usually provide stronger support than limitations reconstructed after the fact.

Does the 90/180-day rule apply to passengers and pedestrians?

The 90/180-day category may apply to covered people under New York’s no-fault system, including many drivers, passengers, pedestrians, and cyclists injured in motor vehicle accidents. When a covered person seeks non-economic damages, such as pain and suffering, the serious injury threshold generally applies.

How long do I have to file a lawsuit based on the 90/180-day rule?

In many New York personal injury negligence cases, the deadline to file a lawsuit is three years. Some cases have shorter notice or filing requirements, especially when a public entity is involved. The 180-day period for documenting a 90/180-day claim is much shorter, so delays in treatment or documentation can still affect the claim even when the lawsuit deadline has not passed.

Can I claim multiple serious injury categories at once?

A plaintiff may rely on more than one serious injury category when the facts support it. The 90/180-day category may be pleaded alongside categories such as significant limitation of use or permanent consequential limitation, giving the claim more than one possible basis for meeting the serious injury threshold.