Key Takeaway
Court ruling on cessation of no-fault treatment - when plaintiffs must prove benefit termination and reasonable explanation for stopping therapy in 5102(d) cases.
This article is part of our ongoing 5102(d) issues coverage, with 89 published articles analyzing 5102(d) issues 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.
Ramkumar v Grand Style Transp. Enters. Inc., 2013 NY Slip Op 06638 (2013)
“The Appellate Division’s requirement that plaintiff either offer documentary evidence to support his sworn statement that his no-fault benefits were cut off, or indicate that he could not afford to pay for his own treatment, is an unwarranted expansion of Pommells. Plaintiff testified at his deposition that “they” (which a reasonable juror could take to mean his no-fault insurer) cut him off, and that he did not have medical insurance at the time of the accident. While it would have been preferable for plaintiff to submit an affidavit in opposition to summary judgment explaining why the no-fault insurer terminated his benefits and that he did not have medical insurance to pay for further treatment, plaintiff has come forward with the bare minimum required to raise an issue regarding “some reasonable explanation” for the cessation of physical therapy.”
This is interesting because the Appellate Division in the 5102(d) context held that the failure to present an NF-10 stating that benefits were cut off or to affirmatively state that Claimant did not have insurance other that no-fault would non-suit the plaintiff on a threshold motion.
The Court I think is now holding that an insurance carrier has to affirmatively state as part of its motion for summary judgment that the Claimant had medical insurance other that no-fault in order to defeat this contention.. Alternatively, and this is interesting, the issue of reasonableness of cessation of treatment now goes to the jury. This is a radical change because cessation of treatment has never been an issue for a jury and, in fact, there is no PJI for this issue.
As to the pure first-party no fault issue, the dissent says it all:
“he legislative intent underlying the No-Fault Law was to weed out frivolous claims and limit recovery to significant injuries” (Dufel v Green, 84 NY2d 795, 798 ). Since the statute was enacted, false claims of “serious injury” have done much to undermine the legislative goal. A number of courts, including ours, have pointed out that the no-fault system is riddled with abuse (see Matter of Medical Socy. of State of N.Y. v Serio, 100 NY2d 854, 861 [*3] [“Between 1992 and 2001, reports of suspected automobile insurance fraud increased by 275%, the bulk of the increase occurring in no-fault insurance fraud”]; Pommells v Perez, 4 NY3d 566, 571 [“Abuse … abounds”]; Perl v Meher, 18 NY3d 208, 214 [“No-fault abuse still abounds today”]; Fair Price Med. Supply Corp. v Travelers Indem. Co., 9 Misc 3d 76, 78 [“the steep increase in fraudulent no-fault benefits claims”], aff’d 42 AD3d 277 , aff’d 10 NY3d 556 ; id., 9 Misc 3d at 83 [“fraudulent claims are an ever increasing issue”]; Metroscan Imaging P.C. v GEICO Ins. Co., 8 Misc 3d 829, 831-832 [“unfortunately well documented … deluge of fraudulent claims”]).”
Related Articles
- Critical mistakes that can destroy your personal injury case under 5102(d)
- When IME doctors must explain their findings about self-restricted motion
- Understanding serious injury threshold versus medical necessity requirements
- How suboptimal effort can derail serious injury threshold cases
- Personal Injury
Legal Update (February 2026): The standards for establishing cessation of treatment under Insurance Law §5102(d) discussed in this 2013 analysis may have evolved through subsequent appellate decisions and regulatory amendments. Practitioners should verify current case law requirements for documentary evidence of benefit termination and the burden of proof regarding alternative insurance coverage, as courts have continued to refine these evidentiary standards in threshold motions.
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.
Keep Reading
More 5102(d) issues Analysis
Significant limitation v. permanent consequential, again
New York court ruling creates apparent contradiction in no-fault threshold requirements for significant limitation vs. permanent consequential limitation cases.
May 22, 2021NY Serious Injury Threshold: When Suboptimal Effort Derails Personal Injury Cases
Learn how NY's serious injury threshold works and why suboptimal effort can destroy your personal injury case. Expert Long Island attorney guidance. Call 516-750-0595.
Nov 25, 201990/180 claim has serious consequences despite 5102(d) dismissal of permanent consequential and significan limitation
New York no-fault law creates paradoxical situations where courts dismiss serious injury claims yet allow full damages under 90/180 day categories, highlighting systemic...
May 24, 2012First Department Legal Decisions: Impact on No-Fault Practice and New York Legal Practitioners
First Department decisions impact no-fault insurance practice, criminal law, and negligence cases for NY attorneys. Analysis of Garcia v Leon hearsay ruling.
Feb 24, 2010Feigned issue of fact coupled with cessation of treatment
NY court case on feigned issue of fact when plaintiffs contradict deposition testimony about cessation of treatment in personal injury claims.
Mar 29, 2018Suspended physician
Court rules that a physician's medical affirmation remains admissible even after license revocation, as long as the affirmation was executed while licensed.
Apr 8, 2015Common Questions
Frequently Asked Questions
What is the serious injury threshold under Insurance Law §5102(d)?
New York Insurance Law §5102(d) defines 'serious injury' as a personal injury that results in death, dismemberment, significant disfigurement, a fracture, loss of a fetus, permanent loss of use of a body organ, member, function or system, permanent consequential limitation of use of a body organ or member, significant limitation of use of a body function or system, or a medically determined injury that prevents the person from performing substantially all of their daily activities for at least 90 of the first 180 days following the accident.
Why does the serious injury threshold matter?
In New York, you cannot sue for pain and suffering damages in a motor vehicle accident case unless your injuries meet the serious injury threshold. This is a critical hurdle in every car accident lawsuit. Insurance companies aggressively challenge whether plaintiffs meet this threshold, often relying on IME doctors who find no objective limitations. Successfully establishing a serious injury requires detailed medical evidence, including quantified range-of-motion findings and correlation to the accident.
Was this article helpful?
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.
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 5102(d) issues 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.