Causation speculative

Medical causation remains one of the most challenging aspects of no-fault insurance claims, particularly when patients have pre-existing conditions. In Cirillo v Swan, the Third Department demonstrated how physicians can undermine otherwise strong medical opinions by failing to adequately address a plaintiff’s medical history and provide objective support for their conclusions.

The case highlights a fundamental requirement in New York No-Fault Insurance Law: medical professionals must do more than simply state their conclusions about accident-related injuries. They must provide a clear, objective medical foundation that distinguishes new injuries from pre-existing conditions. This becomes especially critical when dealing with spinal injuries, which frequently involve degenerative conditions that may predate any motor vehicle accident.

Jason Tenenbaum’s Analysis:

Cirillo v Swan, 95 A.D.3d 1401 (3d Dept. 2012)

“Ramaswami, plaintiff’s family physician, noted that MRIs of her spine revealed disc bulges and possible herniations, and opined that those conditions arose out of the automobile accident and left plaintiff permanently and significantly disabled. He did not, however, provide any explanation or objective medical basis for his belief that plaintiff’s limitations were unrelated to her several prior complaints for which she had received extensive treatment (see Anderson v Capital Dist. Transp. Auth., 74 AD3d 1616, 1617 , lv denied 15 NY3d 709 ; Wolff v Schweitzer, 56 AD3d 859, 862 ; cf. Perl v Meher, 18 NY3d at 219). Gamberg, a spine pain management specialist, found that plaintiff sustained injuries in the accident and also quantified how they significantly limited her range of motion. His affidavit is nonetheless inadequate, however, in that he wholly failed to address plaintiff’s prior back condition and injuries; nor did he sufficiently describe the objective tests used to determine her limitations”

Key Takeaway

The Cirillo decision underscores that medical opinions must include objective medical evidence and specifically address pre-existing conditions to establish causation. As demonstrated in similar cases involving causation challenges, physicians cannot simply ignore a patient’s prior medical history or fail to explain how accident-related injuries differ from pre-existing conditions.

Legal Update (February 2026): Since this 2012 post, New York’s no-fault regulations have undergone several amendments, particularly regarding medical causation standards and documentation requirements for pre-existing conditions. The Insurance Department has updated fee schedules and may have modified procedural requirements for medical opinions addressing accident-related injuries versus degenerative conditions. Practitioners should verify current provisions in 11 NYCRR Part 65 and recent departmental circulars for the most up-to-date causation and documentation standards.