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Guidance on how to defeat a lack of causation motion regarding injury to a knee
Causation

Guidance on how to defeat a lack of causation motion regarding injury to a knee

By Jason Tenenbaum 8 min read

Key Takeaway

Learn how to defeat lack of causation motions in knee injury cases. Expert guidance on establishing causal relationship between accidents and injuries in NY.

This article is part of our ongoing causation coverage, with 177 published articles analyzing causation issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.

With the uptick in surgeries that are taking place in no-fault practice, the question that every claims representative or defense attorney evaluating these types of cases needs to ask is: “was this injury causally related to the accident?”

As a Plaintiff’s attorney, the question you need to ask, in response to this, is how do you at least raise a triable issue of fact when faced with what should be the inevitable summary judgment motion from the defense attorney.

This is a case from the First Department, where in my opinion, they lay out how a plaintiff needs to address this type of defense.

Malloy v Matute, 2010 NY Slip Op 09383 (1st Dept. 2010)

While defendant’s experts found that plaintiff’s injuries were degenerative, plaintiff’s doctors were unanimous in concluding that the subject accident was the sole competent producing cause of plaintiff’s knee injuries, based upon (1) their individual examinations; (2) MRI results; and (3) the necessity of surgery to repair a tear in the medial meniscus, a partial tear of the anterior cruciate ligament, chondromalacia, synovitis, and fibrosis (see Pommells v Perez, 4 NY3d 566 ; Colon v Bernabe, 65 AD3d 969, 970 ). It also bears noting that plaintiff was 37 years old when he was hit on his right side by defendant’s taxi, he had no prior knee problems or injuries to his right leg, and his right knee surgery took place within four months of the accident.”


Legal Update (February 2026): Since this 2010 post, New York’s no-fault regulations and causation standards may have been modified through regulatory amendments or updated case law precedents. Practitioners should verify current medical causation requirements, expert testimony standards, and summary judgment motion procedures under the most recent Insurance Law provisions and departmental regulations.

Legal Context

Why This Matters for Your Case

New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.

Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.

About This Topic

Causation in New York Personal Injury & No-Fault Law

Causation — proving that the defendant's negligence or the accident caused the plaintiff's injuries — is an essential element of every personal injury and no-fault claim. New York courts distinguish between proximate cause, intervening causes, and pre-existing conditions that may have been aggravated by an accident. The legal standards for establishing causation through medical evidence and the defenses available to challenge causal connection are analyzed in depth across these articles.

177 published articles in Causation

Common Questions

Frequently Asked Questions

How is causation established in New York personal injury cases?

Causation requires proof that the defendant's conduct was a substantial factor in causing the plaintiff's injuries. In motor vehicle and slip-and-fall cases, medical experts typically establish causation through review of the patient's medical history, diagnostic imaging, clinical examination findings, and the temporal relationship between the accident and the onset of symptoms. The plaintiff must also address any pre-existing conditions and demonstrate that the accident was a proximate cause of the current complaints.

What are common coverage defenses in no-fault insurance?

Common coverage defenses include policy voidance due to material misrepresentation on the insurance application, lapse in coverage, the vehicle not being covered under the policy, staged accident allegations, and the applicability of policy exclusions. Coverage issues are often treated as conditions precedent, meaning the insurer bears the burden of proving the defense. Unlike medical necessity denials, coverage defenses go to whether any benefits are owed at all.

What happens if there's no valid insurance policy at the time of the accident?

If there is no valid no-fault policy covering the vehicle, the injured person can file a claim with MVAIC (Motor Vehicle Accident Indemnification Corporation), which serves as a safety net for people injured in accidents involving uninsured vehicles. MVAIC provides the same basic economic loss benefits as a standard no-fault policy, but the application process has strict requirements and deadlines.

What is policy voidance in no-fault insurance?

Policy voidance occurs when an insurer declares that the insurance policy is void ab initio (from the beginning) due to material misrepresentation on the application — such as listing a false garaging address or failing to disclose drivers. Under Insurance Law §3105, the misrepresentation must be material to the risk assumed by the insurer. If the policy is voided, the insurer has no obligation to pay any claims, though the burden of proving the misrepresentation falls on the insurer.

How does priority of coverage work in New York no-fault?

Under 11 NYCRR §65-3.12, no-fault benefits are paid by the insurer of the vehicle the injured person occupied. For pedestrians and non-occupants, the claim is made against the insurer of the vehicle that struck them. If multiple vehicles are involved, regulations establish a hierarchy of coverage. If no coverage is available, the injured person can apply to MVAIC. These priority rules determine which insurer bears financial responsibility and are frequently litigated.

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Attorney Jason Tenenbaum

About the Author

Jason Tenenbaum, Esq.

Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.

Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.

New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.

If you need legal help with a causation matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.

Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (14)

Archived from the original blog discussion.

S
slick
in no-fault, the burden is less because aggravation of an existing injury is sufficient to establish causation. As a result, a surgeon can also argue that, even if there was degeneration of the joint at issue, the covered incident caused additional symptoms such as pain that required surgery to be treated.
J
JT Author
The burden on the defendant in the summary judgment postulate is the same – I think – whether it be a no-fault or a 5102(d) case. Lack of causation should never differ. I also am not sure subjective symptoms of pain, in the no-fault context, are sufficient to a constitute an aggravation to impose coverage upon an otherwise non-covered event.
RZ
raymond zuppa
Maybe this comment is off. Maybe things are bit more complex but I don’t think so. There is still an egg shell plaintiff rule in NY. For e.g. the knee sucks. Its all messed up. The guy played football and did MMA with plenty of knee locks. But he’s getting around fine. Bam the accident. And everything that was about to give — well it gives. We measure causation from the give for all purposes. What did he lose because of the accident.
S
slick
The causation defense is much more powerful to defeat a personal injury claim. In a personal injury claim, an “eggshell plaintiff” would be entitled to only minimal damages if an accident cracks the eggshell. In a no-fault context, the surgery to repair the shell would be 100% covered no matter how fragile the patient was at the time of the accident. Under Stephen Fealy, M.D., P.C. v. State Farm Mut. Auto Ins. Co., complaints of pain after the accident are sufficient to defeat summary judgment. If a patient reports that before the accident, the joint in question was functional. However, after the accident there is pain and difficulties with range of motion, walking, etc. Unless there is an exam prior to the accident, there is no way for an insurer to refute the claim that the symptoms were caused by the accident as opposed to any prior conditions.
J
JT Author
It is no different in BI. The thing about BI is that there are two (2) inquiries. The first involves causal relationship. The second involves whether the exacerbation is a serious injury. In no-fault, you only deal with the first. As to Fealy, you need to see the record on appeal before you make the conclusions you did. The Court held that the hospital records and complaints of pain coupled with a garbage affidavit were sufficient to defeat a causal relationship motion. It also was the first of what might be many cases on the topic, and who knows where subsequent cases will go. I would be curious to see where the Appellate Division would go with this issue.
RZ
Raymond Zuppa
J.T. you nailed it. That’s why it seems easier in No Fault because there is no serious injury requirement. The guy’s knee is about to fall apart but he’s walking. Bam the accident and now he needs a knee replacement and will always walk with a cane. Defendant has to pay for PI damages from knee replacement through loss of movement — I can no longer do MMA; have sex; etc. That’s the Egg Shell Plaintiff rule. No?
J
JT Author
You are out of your mind Ray. You are correct. My only question is that if the guy had an asymptomatic bum knee, why the heck would he be doing MMA and risk the need for a total knee replacement, irrespective of whether he is involved in a motor vehicle accident.
S
slick
the reason he’s doing MMA is because he’s asymptomatic. He doesnt know about any problems until it affects his life.
J
JT Author
Honestly, I have trouble believing that. There has to be some clue that something is amiss. In the hypothetical world, that is possible. In reality, I have to imagine that most asymptomatic persons were symptomatic prior to attaining asymptomatic status.
RZ
Raymond Zuppa
I simply made the hypothetical in extremis to have my point confirmed — that is all. I have been out of personal injury for a while and was just making sure that the Appellate Term did not get rid of the hornbook with regard to the Egg Shell Plaintiff Rule as they did with just about everything else. That being said it is possible to have an active guy with a bum knee just waiting to totally go. I played D-1 football and I know a bunch. I remember when I first started at the Corp Counsel. I am doing a depo of a guy who’s knee tendon snapped as he went down steps. He claimed there was a defect in the steps. I did a thorough job and found out that the tendon in his other knee snapped while descending steps. “That’s my knees. That’s what they do. I have to live with it.” I thought “Wow I got ’em. He’s predisposed to knee injuries.” And then one of the senior attorneys said “Ray you just got out of law school. Don’t you remember the Egg Shell Plaintiff Rule?” However the above fact pattern does make for some interesting issues. The argument would be that there was no defect or since there was a picture of the defect [the step had a slight incline] — a gutsy lawyer would have argued that your knee tendon snapped on its own; then your lawyer saw the defect and said “let’s blame it on that.” A judge could kill that whole line with one or two sustained objections. Trial tip: Open on it. Explain to the jury that there are two phases to this trial. Negligence/causation and then injury. [explain it] Then the order is important here. Start by saying that in this case there is an injury and there is a defect but the defect did not cause the injury. Continue by saying that slight incline on the steps was an opportunity to make money for the Plaintiff. When the Plaintiff’s knee tendon snapped it just snapped on its own. The plaintiff’s lawyer said “you can’t sue for that” so they decided to blame the incline. Tell the jury you will see that this is true because the evidence will demonstate that the Plaintiff has a condition where his knee tendons just snap when going down stairs. Sounds hard to believe but listen to this. It happened once before. The Plaintiff was simply walking down some stairs and the tendon in his other just snapped by itself. The same exact type of snap. You’ll see that the Plaintiff testified under oath: “That’s my knees. That’s what they do. I have to live with it.” And when it happened here the Plaintiff said “hey time to make some money” — so him and his lawyer blamed the defect so that they could sue. Because you can’t sue if your knee tendon’s just snap by themselves. Judge is hard pressed to sustain an objection to questions about the prior injury once you have presented your theory. Once the jury hears that this guy’s knee tendons snap by themselves they’ll nullify the law.
RZ
Raymond Zuppa
Of course you have to lead off every accusation with “the evidence will demonstrate” so that you don’t get a sustained objection as to the opening being arugmentative. “The evidence will demonstrate that the Plaintiff and his lawyer decided to blame the step because you can’t sue when your knee tendon snaps by itself. You’ll see ….” [Then list the evidence — the other knee snapping; the slight incline of the step; the lawyer is the plaintiff’s friend’s uncle; etc] The summation can be argumentative but not the opening.
S
slick
JT, I think you are confusing reality with proof. Even if he has an inkling, it’s realistic to assume he will report that his injuries and disability are caused by the accident. Further, it is extraordinarily difficult to refute the assertion that the accident caused the injury and symptoms without medical records documenting the condition of the joint prior to the accident. In most circumstances, they dont exist.
J
JT Author
I am not confusing reality with proof. I am cognizant that the evidence viz medical records and other documentary evidence will demonstrate that the patient never had any prior complaints of pain or symptoms prior to the MVA. Yet, the reality is usually otherwise. Yes, go prove it. I understand your point.
RZ
Raymond Zuppa
Wait boys. This debate is starting to miss the point. I don’t care if he had 10 prior surgeries on the damn knee. If the accident injures the knee further then if your the insurance company you are on the hook. Even if it injures the same part of the knee that was surgically repaired. Now it is a matter of degrees. If the subject accident is a 60 mph head on collision it is easy. If it is a low damage 5 mph hit then it might be tougher on the claimant/plaintiff. But under the law if the knee was a basket case. A time bomb. And the five MPH was the straw that broke the camel’s back this time around — even if the camel’s back was going to break anyway; your stuck with it. “Yeah the knee stunk. Major surgeries. But I was getting along with it. It hurt. I limped but I got around. Now I need a four prong walker/cane to even go ten yards and that’s it” Well the insurer is stuck with that if the proof is there. “Patient had prior knee surgeries, etc. Prior injuries aggravated by accident …”

Legal Resources

Understanding New York Causation Law

New York has a unique legal landscape that affects how causation cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For causation matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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