Key Takeaway
Court ruling clarifies that gaps in medical treatment only matter for causation issues when defendants fail to establish prima facie lack of causation in serious injury claims.
Gap in medical treatment is often a crucial factor in New York no-fault insurance litigation, particularly when defendants attempt to challenge the causation between an accident and claimed injuries. However, the legal landscape around treatment gaps can be nuanced, with courts making important distinctions about when and how these gaps affect a plaintiff’s case.
The Second Department’s decision in Lambropoulos v Gomez provides valuable clarification on this issue, demonstrating how the burden-shifting framework in serious injury threshold cases can limit when treatment gaps become relevant. This ruling is particularly significant for understanding how personal injury claims proceed when defendants fail to meet their initial burden regarding causation.
Understanding these procedural requirements is essential, as courts have consistently held that the failure to properly establish a prima facie case can have serious consequences for defendants, sometimes resulting in cases where they effectively undermine their own arguments.
Jason Tenenbaum’s Analysis:
Lambropoulos v Gomez, 2018 NY Slip Op 08118 (2d Dept. 2018)
In opposition, however, the plaintiff submitted evidence sufficient to raise a triable issue of fact as to whether he sustained serious injuries to the cervical and lumbar regions of his spine under the permanent consequential limitation of use and significant limitation of use categories of Insurance Law § 5102(d) (see Perl v Meher, 18 NY3d 208, 218-219). As the defendants failed to establish, prima facie, a lack of causation, the burden did not shift to the plaintiff to raise a triable issue of fact regarding causation or to explain any gap in treatment (see Pommells v Perez, 4 NY3d 566, 572; Rivera v Ramos, 132 AD3d 655, 656).
Nice to a gap in treatment is limited to “causation” issues. This is an interesting wrinkle on gap in treatment law.
Key Takeaway
This decision establishes that gaps in medical treatment only become relevant when defendants successfully establish a prima facie case regarding lack of causation. When defendants fail to meet this initial burden, plaintiffs are not required to explain treatment gaps, highlighting the importance of the burden-shifting framework in serious injury threshold cases.
Related Articles
- Understanding when serious injury threshold requirements don’t apply to economic loss recovery
- How suboptimal effort can undermine personal injury cases in New York
- Critical mistakes that can destroy your personal injury case under 5102(d)
- Understanding the distinction between serious injury threshold and medical necessity
- Personal Injury
Legal Update (February 2026): Since this 2018 post, Insurance Law § 5102 and related no-fault provisions may have been subject to regulatory amendments or judicial clarifications that could affect gap in treatment analysis and serious injury threshold determinations. Practitioners should verify current statutory language, updated fee schedules, and recent appellate decisions regarding burden-shifting frameworks in serious injury cases.
