Delayed Medical Treatment and Causation in New York Serious Injury Cases: The Perl Problem

In personal injury litigation, proving that an accident directly caused your injuries is fundamental to any successful claim. Courts scrutinize not just the medical evidence, but also the plaintiff’s actions immediately following an incident. The timing of when injuries are reported and when medical treatment is sought can significantly impact a case’s viability.

This principle becomes particularly important in motor vehicle accidents, where causation defenses are commonly raised by defendants and insurance companies. When plaintiffs fail to document their injuries promptly or delay seeking medical care, it can break the chain of causation that courts require to establish liability.

The Decision

Lee v Rodriguez, 2017 NY Slip Op 03869 (1st Dept. 2017)

“They also submitted evidence that plaintiffs neither reported any injury to the police immediately after the motor vehicle accident nor sought any medical treatment shortly after the accident, indicating that their claimed injuries were not causally related to the accident”

I cannot say much more.

The Legal Background: Perl, Contemporaneous Proof, and the Serious Injury Threshold

The headline of this post references Perl v Meher, 18 NY3d 208 (2011), the Court of Appeals decision that pushed back against an overly rigid approach to threshold proof. Before Perl, defendants argued — often successfully — that a plaintiff could not satisfy the serious injury threshold of Insurance Law § 5102(d) without contemporaneous quantitative measurements of range of motion taken shortly after the accident. Perl rejected that rule: a treating physician’s qualitative contemporaneous findings, later supplemented by quantitative measurements, can suffice.

But Perl did not abolish the role of timing in threshold litigation; it relocated it. Contemporaneous proof still matters enormously on causation. A plaintiff who tells the responding police officer she is uninjured, declines an ambulance, and first sees a doctor weeks or months later hands the defense a powerful narrative: whatever appears on the later MRI was not caused by this accident. Lee v Rodriguez is that narrative in operation. The First Department treated the absence of any injury report to police and the failure to seek treatment shortly after the accident as affirmative evidence that the claimed injuries were not causally related to the collision.

In other words, the contemporaneous-treatment battleground that Perl “spoke up against” on the measurement question survives in full force on the causation question. Defendants no longer win by demanding day-one goniometer readings — they win by pointing to a gap between accident and treatment that the plaintiff’s experts never adequately explain. The need for contemporaneous records thus remains a fixture of serious injury practice.

A current-law note: the serious injury threshold itself was reshaped by New York’s auto tort reform signed May 27, 2026 (S9008-C Part EE). Among other changes, the 90/180-day category of serious injury was eliminated for actions commenced on or after the effective date. For cases still governed by prior law, and for the categories that remain, the causation principles discussed here are unchanged: late reporting and delayed treatment continue to invite summary judgment.

Why This Matters

For plaintiffs and the lawyers who represent them, the lessons are practical and immediate:

• Report injuries at the scene. Telling the police officer about pain, even if it seems minor, creates the first contemporaneous record tying symptoms to the accident.
• Seek treatment promptly. Emergency room or urgent care visits within days of the accident anchor the causal chain. Unexplained gaps — whether before treatment begins or in the middle of a course of care — must be addressed head-on by the treating physician or expert, with a reasonable explanation in the record.
• Expect the defense to mine the file. Police reports, ambulance refusals, ER triage notes, and first-visit histories will all be compared against the bill of particulars. Inconsistency is the defense’s best friend.

For defense counsel and carriers, Lee v Rodriguez confirms that post-accident conduct is admissible, persuasive causation evidence. A threshold motion that pairs an expert’s opinion with proof that the plaintiff neither reported injury nor sought timely treatment forces the plaintiff to produce a substantive medical answer, not just an attorney’s argument.

Key Takeaway

The Lee v Rodriguez decision illustrates how courts view immediate post-accident behavior as crucial evidence in establishing causation. Contemporaneous records and prompt medical attention serve as vital proof that injuries were directly caused by the accident, rather than developing from other sources or pre-existing conditions.

Related Resources

• Break in the chain of causation
• Very interesting discussion on Perl
• Proof of causation
• Pre-existing injuries in New York personal injury cases — our cluster hub on prior-injury defenses
• The 2026 New York auto tort reform explained
• The firm’s Legal Encyclopedia of New York injury law topics
• Our Long Island car accident practice