Key Takeaway
In NY no-fault cases, medical experts must explain any deterioration after improvement to meet the serious injury threshold under Insurance Law 5102(d).
Understanding Medical Expert Requirements in New York No-Fault Cases
New York’s no-fault insurance law requires plaintiffs to meet a “serious injury” threshold under Insurance Law Section 5102(d) to pursue a personal injury lawsuit. This threshold demands more than just proving an injury occurred—it requires demonstrating that the injury meets specific statutory criteria. When a plaintiff’s medical condition shows improvement followed by deterioration, medical experts face heightened scrutiny from the courts.
The case of Rivera v Gonzalez illustrates a critical principle: medical experts cannot simply document changes in a patient’s condition without providing adequate explanation for those changes. This requirement becomes particularly important when objective signs of continuing disability appear inconsistent or when medical records show unexpected patterns of recovery and decline.
Courts demand thorough documentation and analysis from medical professionals, especially when examining patients years after an accident. Expert testimony must not only measure current limitations but also provide context for how and why those limitations developed or changed over time.
Jason Tenenbaum’s Analysis:
Rivera v Gonzalez, 2013 NY Slip Op 04431 (1st Dept. 2013)
Plaintiff makes marked improvements and the deteriorates. Court in the 5102(d) setting requires an explanation.
“The affirmed reports of Dr. Shahid Mian, an orthopedist who examined plaintiff nearly two years after the accident, in March 2009, and again in 2011, are insufficient to raise an issue of fact because he failed to compare his measurements to normal ranges of motion (Toure v Avis Rent A Car Sys., 98 NY2d 345, 350 ; Soho v Konate, 85 AD3d 522, 523 ). Nor did he provide any explanation for any decrease in mobility following plaintiff’s improvement in 2007 (see e.g. Jno-Baptiste v Buckley, 82 AD3d 578 ).”
Key Takeaway
When pursuing a personal injury claim under New York’s no-fault law, medical experts must provide comprehensive explanations for any deterioration that occurs after documented improvement. Courts will not accept unexplained changes in condition, particularly when a plaintiff’s own medical records show inconsistent patterns of recovery and decline.
Legal Update (February 2026): Since this 2013 post, New York’s serious injury threshold requirements under Insurance Law Section 5102(d) may have been subject to regulatory amendments, updated medical examination protocols, or revised judicial interpretations regarding expert testimony standards. Practitioners should verify current provisions and recent case law developments when addressing medical expert requirements for deterioration patterns in no-fault cases.
