Femur Fracture and New York's Serious Injury Threshold: When Causation Becomes a Question of Fact

A fractured femur is among the most severe injuries one can sustain in a motor vehicle accident, typically requiring immediate medical intervention and rendering walking impossible. However, what happens when a plaintiff claims such a catastrophic injury yet demonstrates the ability to walk freely after the collision? This scenario presents fascinating questions about causation and credibility that can make or break a personal injury case.

The Peterson v Ward decision from New York’s Fourth Department illustrates how seemingly contradictory evidence can create significant factual disputes in threshold injury cases. When medical records and witness testimony don’t align with the claimed severity of injuries, courts must carefully examine whether the alleged injuries actually resulted from the accident in question.

The Decision: Peterson v Ward

Peterson v Ward, 2017 NY Slip Op 09024 (4th Dept. 2017)

“We conclude, however, that there are material issues of fact whether plaintiff’s alleged injury, i.e., a fractured femur, was caused by the motor vehicle accident and thus that the court properly denied that part of plaintiffs’ motion on the issue of serious injury (see generally Derdiarian v Felix Contr. Corp., 51 NY2d 308, 315 , rearg denied 52 NY2d 784 ). Specifically, there is an issue of fact, among others, concerning whether plaintiff would be able to ambulate freely without assistance for a day and a half following the accident if she had sustained a fracture to her femur as a result of the collision.”

Interesting observation by the court and defense counsel.

The Serious Injury Threshold and the Fracture Category

New York’s no-fault law trades the right to sue for minor injuries for prompt first-party benefits. To maintain a lawsuit for non-economic loss arising out of a motor vehicle accident, a plaintiff must establish a “serious injury” within the meaning of Insurance Law § 5102(d), which enumerates the qualifying categories — among them, a fracture.

Fracture is generally considered one of the cleaner threshold categories. Unlike the “significant limitation” or “permanent consequential limitation” categories, which generate endless expert battles over range-of-motion measurements and the meaning of “significant,” a fracture either appears on the imaging or it does not. Plaintiffs’ attorneys often treat a documented fracture as close to an automatic pass through the threshold.

Peterson v Ward shows why that confidence can be misplaced. Proving the existence of a fracture is only half the job. The statute requires a serious injury arising out of the accident at issue — which means causation is an independent element, even within the fracture category.

Causation: The Often-Overlooked Battleground

A plaintiff moving for summary judgment on the serious injury threshold bears the burden of establishing, with admissible medical evidence, both a qualifying injury and its causal connection to the collision. Where the record contains evidence cutting against causation, the motion fails — not because the injury is doubted, but because a jury could find the accident did not produce it.

That is precisely what happened here. The Fourth Department pointed to a concrete, common-sense fact: the plaintiff was able to walk freely, without assistance, for a day and a half after the accident. The court asked whether someone who had just fractured her femur in the collision could have done so. That question, the court held, is for a factfinder — and it cited Derdiarian v Felix Contracting Corp., the touchstone New York causation case, in framing the issue.

For defense counsel, the decision validates a basic investigative discipline: build the post-accident timeline. Ambulation at the scene, statements to EMS, the gap before the first complaint of pain, the first imaging study showing the fracture — each data point either corroborates or undermines the causal story. As we have noted before, a plaintiff’s own records can reveal what the timeline shows, and inconsistent medical records can defeat even strong-appearing cases.

Why This Matters for Both Sides

For plaintiffs and their counsel, the lesson is to treat causation as an element to be proven, not assumed. If there is an innocent explanation for post-accident ambulation — adrenaline, an incomplete or non-displaced fracture, delayed symptom onset — it needs to come into the motion record through competent medical opinion, not argument. A summary judgment motion that ignores an obvious timeline problem invites exactly the denial that occurred in Peterson.

For defendants and carriers, the case is a reminder that even an enumerated, objectively verifiable injury like a fracture can be contested at the threshold stage. The dispute is not “was the femur broken” in the abstract — it is “was the femur broken in the accident.” Surveillance, EMS run sheets, emergency department triage notes, and witness accounts of the plaintiff’s mobility in the hours after the crash are all fair game, and in this case they were enough to keep the serious injury question alive for trial.

Credibility, in short, is evidence. When claimed injuries and observed behavior diverge, New York courts will let a jury sort it out.

Related Resources

• Pre-existing injuries in New York personal injury cases — our cluster hub on causation and prior-condition defenses
• The firm’s Legal Encyclopedia — explainers on the serious injury threshold and related doctrine
• Personal Injury and Long Island car accident lawyer — our practice pages
• Was That Injury Really Insignificant? Understanding the Serious Injury Threshold in New York
• Causation in New York Personal Injury Cases, Proving the Link