Key Takeaway
Santos v Traylor-Pagan analysis: carpal tunnel causation fails without contemporaneous treatment under the Perl standard in NY personal injury threshold 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.
The Perl Standard: When Delayed Treatment Defeats Causation
In personal injury cases arising from car accidents in New York, the timing of medical treatment plays a critical role in establishing causation. The First Department’s decision in Santos v Traylor-Pagan illustrates how significant gaps between an accident and medical treatment can be fatal to a plaintiff’s claim under the Perl v Meher standard.
Key Takeaway
Under the Perl standard, a plaintiff who waits 13½ months for orthopedic treatment and nearly four years for neurological evaluation cannot establish that carpal tunnel syndrome was causally related to a motor vehicle accident.
The Court’s Ruling: Santos v Traylor-Pagan
Santos v Traylor-Pagan, 2017 NY Slip Op 05502 (1st Dept. 2017)
The First Department laid out a devastating timeline for the plaintiff’s case:
“Plaintiff failed to raise a triable issue of fact as to whether his carpal tunnel syndrome was causally related to the accident (Perl v Meher, 18 NY3d 208, 217-218). This Court, in Rosa v Mejia (95 AD3d 402, 404), opined that the decision in Perl did not abrogate the need for at least a qualitative assessment of injuries soon after an accident.”
The Treatment Gap That Doomed the Claim
The court detailed the plaintiff’s treatment history:
- Day of the accident: Treated and released from Westchester Medical Center with a right elbow laceration (three sutures)
- 13½ months later: First saw an orthopedist — with no medical treatment in between
- Following months: Allegedly had physical therapy, though no details appear in the record
- Nearly four years after the accident: First saw a neurologist about carpal tunnel syndrome
The court found this timeline insufficient to establish causation as a matter of law.
Jason’s Analysis: First Department vs. Second Department Split
I always read Perl for the proposition that issues regarding qualitative evaluation and “causation” following the accident were questions of fact for the jury. I think the Second Department reads Perl the same way as they have not kicked a case on contemporaneous treatment issues since Perl.
Remember, the crux of this case is that causation is not established without contemporaneous treatment. In the no-fault world, the same argument could hold since the burden on summary judgment for lack of causation is the same in the 5102(d) and first-party benefit sense.
Practical Implications for Personal Injury Practitioners
This decision highlights important strategic considerations for both sides:
For Plaintiff’s Counsel
- Ensure clients seek medical evaluation for all symptoms as soon as possible after an accident
- Document the connection between the accident and any delayed-onset conditions through contemporaneous medical records
- Be prepared that the First Department may apply a stricter standard than the Second Department on treatment gaps
For Defense Counsel
- Scrutinize the timeline between the accident and the onset of treatment for each claimed injury
- In First Department cases, significant treatment gaps may support summary judgment on causation grounds
- The same causation arguments apply in both 5102(d) serious injury threshold and no-fault first-party benefit cases
Related Articles
- Understanding causation requirements and renewal procedures in serious injury cases
- Critical mistakes that can destroy your 5102(d) personal injury case
- How IME doctors must explain findings about self-restricted range of motion
- When suboptimal effort undermines serious injury threshold claims
- Personal Injury
Legal Update (February 2026): Since this 2017 post discussing Perl v Meher and causation standards for delayed-onset injuries, New York courts have continued to refine the application of causation requirements under Insurance Law § 5102(d), and the Court of Appeals may have issued additional precedential decisions affecting the qualitative assessment standards for injuries manifesting months or years after an accident. Practitioners should verify current judicial interpretations of causation requirements and any updates to the serious injury threshold analysis.
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.
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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.
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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.