Perl Standard and Causation: Delayed Treatment Defeats Carpal Tunnel Claim in New York

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.

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.