Proof of causation

Establishing causation represents one of the most critical elements in New York personal injury litigation. Under Insurance Law § 5102(d), a plaintiff must demonstrate that an alleged injury was causally related to the subject accident through competent medical evidence. This requirement extends beyond merely identifying an injury; the plaintiff must prove through objective medical findings that the accident directly caused the claimed injury. Courts consistently reject speculative or conclusory assertions of causation, demanding instead that plaintiffs present contemporaneous medical treatment, positive objective findings, and expert medical opinions linking the injury to the accident.

The causation element becomes particularly challenging when plaintiffs claim injuries to body parts that lack documented contemporaneous treatment. New York courts have established a clear principle: the absence of medical treatment following an accident for a particular body part raises a strong inference that no causal connection exists between that body part and the accident. This evidentiary gap cannot be bridged by subsequent claims or delayed medical attention. Defense practitioners have successfully wielded the lack of contemporaneous treatment as a dispositive argument against claimed injuries, and appellate courts have consistently upheld this approach as a matter of law.

Case Background

Hernandez v Marcano, 2018 NY Slip Op 03816 (1st Dept. 2018)

In this First Department case, plaintiff Hernandez claimed injuries to her left shoulder, cervical spine, and lumbar spine following a motor vehicle accident. Defendants moved for summary judgment, submitting expert evidence that found full range of motion and absence of injury to the left shoulder. Critically, defendants also presented plaintiff’s own hospital records demonstrating that plaintiff sought no treatment for her shoulder following the accident. The plaintiff’s bill of particulars made no mention of the left shoulder injury, further undermining this claim.

For the cervical and lumbar spine injuries, plaintiff countered with her physician’s affirmed report documenting continuing range of motion limitations, positive objective tests, and a causal connection to the accident. Plaintiff also submitted affirmed reports of MRIs performed shortly after the accident. The trial court granted summary judgment on the shoulder claim but found triable issues of fact regarding the spine injuries, leading to this appeal.

Court’s Analysis

However, in any event, defendants Marcano and Crescent Cab Corp.’s expert found full range of motion and absence of injury to the left shoulder, and defendants Alvarado and Cook submitted plaintiff’s hospital records showing that plaintiff sought no treatment for her shoulder after the accident, indicating that any shoulder condition was not causally related to the accident (see Lee v Rodriguez, 150 AD3d 481 ).

In opposition, plaintiff raised an issue of fact as to her cervical and lumbar spine through her physician’s affirmed report, which found continuing range of motion limitations, positive results on objective tests for cervical and lumbar injury, and causally related these injuries to the accident (Moreira v Mahabir, 158 AD3d 518, 518-519 ; Encarnacion v Castillo, 146 AD3d 600 ; Santana v Tic-Tak Limo Corp., 106 AD3d 572 ). Plaintiff also submitted affirmed reports of MRIs of her spine performed shortly after the accident.

To the extent plaintiff asserts a left shoulder injury, as noted, it was not pleaded in her bill of particulars, and, in any event, she submitted no evidence of contemporaneous treatment of the shoulder in the period following the accident, indicating a lack of any causal connection (see Rosa v Mejia, 95 AD3d 402 ).

The bolded was my argument over 10 years ago in Stephen Fealy v. State Farm. Well, I knew I was right then and I am correct now,

Legal Significance

The First Department’s decision in Hernandez reinforces a fundamental principle that has become bedrock in New York personal injury defense practice: contemporaneous medical treatment serves as compelling evidence of causation, while its absence suggests no causal relationship exists. This evidentiary standard protects defendants from fraudulent or exaggerated claims while ensuring that legitimate injuries supported by objective medical evidence proceed to trial.

The court’s analysis demonstrates the multi-faceted inquiry required in causation determinations. While plaintiff successfully raised triable issues regarding her cervical and lumbar injuries through timely MRIs, continuing limitations, and positive objective findings, the complete absence of shoulder treatment proved insurmountable. The decision illustrates that different body parts can receive different treatment under summary judgment analysis when the medical evidence diverges significantly. Defense counsel should recognize opportunities to secure partial summary judgment even when some claimed injuries survive dismissal.

Practical Implications

For defense practitioners, Hernandez provides a roadmap for attacking causation claims through documentary evidence. Hospital records, emergency room reports, and treatment histories become critical discovery targets that can decisively defeat injury claims. When plaintiffs fail to seek medical attention for alleged injuries immediately following an accident, defense counsel should move aggressively for summary judgment on those specific body parts, even if other injuries remain viable.

Plaintiff’s counsel must recognize the importance of establishing a complete medical record from the earliest moments following an accident. Any gap in treatment, particularly for body parts claimed in the bill of particulars, creates vulnerability to summary judgment dismissal. The failure to include an injury in the bill of particulars, combined with lack of treatment, proves fatal to that claim.

Key Takeaway

New York courts require plaintiffs to establish causation through contemporaneous medical treatment and objective findings. The absence of medical treatment for a claimed body part following an accident creates a strong inference of no causal connection that cannot be overcome through later claims or delayed medical attention. Defense counsel should thoroughly review all medical records to identify untreated injuries and move for partial summary judgment on those specific claims, while plaintiff’s counsel must ensure comprehensive medical documentation from the immediate aftermath of any accident.

Related Articles

• Understanding Causal Relationship in New York Personal Injury Cases: Legal Guide
• New York Personal Injury Law: Proving Causation in Accident Cases
• Causation in Personal Injury Cases: Understanding 5102(d) Standards in New York
• Neurologist’s Insufficient Affirmation: Understanding Causal Connection in Personal Injury Cases
• Personal Injury