Key Takeaway
Learn how medical professionals must document and explain changes in patient conditions to prove serious injury claims in New York no-fault cases.
Understanding Medical Documentation Requirements in Serious Injury Claims
In New York’s no-fault insurance system, proving a serious injury requires more than just showing that a patient’s condition has worsened over time. Medical professionals must provide clear, consistent documentation that explains any changes in a patient’s condition. This becomes particularly challenging when dealing with conditions that naturally fluctuate, as the courts require objective evidence while also demanding explanations for any inconsistencies in medical findings.
The case of Rose v Tall illustrates a common dilemma in New York no-fault insurance law: how to balance the need for objective medical evidence with the reality that many injuries improve or worsen over time. Understanding this balance is crucial for both medical providers seeking to establish medical necessity and patients pursuing serious injury claims.
Jason Tenenbaum’s Analysis:
Rose v Tall, 2017 NY Slip Op 02947 (1st Dept. 2017)
“However, his report is insufficient to raise a triable issue of fact because, on his initial examination, he found normal to near-normal range of motion, which did not qualify as a serious injury (see Eisenberg v Guzman, 101 AD3d 505 ). Furthermore, on a more recent examination, that neurologist found a deficit in one plane and normal to near-normal range of motion in all other planes, and failed to explain the inconsistencies between his earlier findings of almost full range of motion and his present findings of additional deficits, rendering his opinion speculative (see Santos v Perez, 107 AD3d 572, 574 ; see Colon v Torres, 106 AD3d 458 ). Plaintiff’s showing of relatively minor limitations was insufficient to sustain a serious injury claim”
How does one reconcile (1) Need for objective evidence to prove medical necessity of services; (2) A patients conditions waves and wanes; and (3) There is need to explain inconsistencies between patients initial and subsequent conditions.
Key Takeaway
Medical professionals must provide detailed explanations when documenting changes in patient conditions over time. While conditions naturally fluctuate, unexplained inconsistencies between initial and subsequent examinations can render medical opinions speculative and insufficient for establishing serious injury claims. Clear documentation and proper foundation are essential for successful outcomes.
