Key Takeaway
Court ruling demonstrates that medical conditions can evolve over time, challenging the emphasis on immediate post-accident medical examinations in necessity determinations.
Understanding Medical Necessity and the Evolution of Injuries Over Time
In New York’s no-fault insurance system, determining medical necessity often hinges on various factors, including the timing of medical examinations and treatments. Insurance companies and defense attorneys frequently argue that medical conditions must be documented immediately after an accident to be considered legitimate. However, a recent First Department decision challenges this rigid approach, recognizing that injuries can develop and change significantly over time.
This principle is particularly important in New York No-Fault Insurance Law cases, where the timing and documentation of medical conditions can make or break a claim. The evolving nature of injuries is a critical consideration that courts must weigh when evaluating medical necessity disputes, especially when medical necessity reversals are at stake.
Jason Tenenbaum’s Analysis:
Hayes v Gaceur, 2018 NY Slip Op 04080 (1st Dept. 2018)
“In opposition, however, plaintiff raised an issue of fact as to her claimed cervical spine, shoulder and left knee injuries through the report of her treating orthopedic surgeon. The physician examined plaintiff the day after the accident and on several occasions thereafter. He found limitations in range of motion of her cervical spine the day after the accident and on recent examination; he examined plaintiff’s shoulders and left knee within a month after the accident and found limitations in range of motion at the initial examination and recently (see Perl v Meher, 18 NY3d 208, 218 [“Injuries can become significantly more or less severe as time passes”]“
Key Takeaway
The Hayes decision reinforces that medical conditions are not static and can evolve substantially over time. Courts recognize that the absence of immediate, comprehensive documentation does not automatically invalidate later-discovered or worsening conditions. This principle protects injured parties whose conditions may not manifest fully until days, weeks, or even months after an accident.
