Causation: not enough to state pre-existing

Understanding Medical Causation in No-Fault Insurance Cases

In New York no-fault insurance litigation, establishing causation between a motor vehicle accident and claimed injuries is crucial for coverage. Insurance companies frequently rely on medical experts who review imaging studies and conclude that findings represent only “pre-existing degenerative changes” — essentially arguing that the patient’s condition existed before the accident. However, as demonstrated in a recent Fourth Department decision, such conclusions may not be sufficient to eliminate all factual disputes, particularly when the medical analysis fails to address key evidence about the patient’s pre-accident condition.

This case highlights an important principle in New York no-fault insurance law: even when imaging studies show degenerative changes, courts will look beyond the raw medical findings to determine whether causation questions remain for trial.

Jason Tenenbaum’s Analysis:

Barnes v Occhino, 2019 NY Slip Op 03159 (4th Dept. 2019)

(1) ” That report contains a review of plaintiff’s imaging studies, which showed disc herniations, and plaintiff’s medical records, which noted that plaintiff had significant limited range of motion as well as muscle spasms, thus raising a triable issue of fact whether there was objective evidence of an injury ”

(2)“Defendants’ submissions in support of their motion also raised a triable issue of fact whether the motor vehicle accident caused plaintiff’s alleged injuries (see Schaubroeck v Moriarty, 162 AD3d 1608, 1609 ). In the affirmed report of the same physician, he opined that the imaging studies showed only preexisting degenerative changes, but he ” fail to account for evidence that plaintiff had no complaints of pain prior to the accident’ ” (Crane, 151 AD3d at 1842; see Thomas v Huh, 115 AD3d 1225, 1226 ). ”

This is really interesting. A physician who reviews a study and says it is all degenerative will not eliminate all issues of fact where the report fails to account for evidence of a lack of pain prior to the incident.

Key Takeaway

Medical experts cannot simply declare injuries as “pre-existing degenerative changes” without addressing the complete clinical picture. When a physician’s report fails to account for evidence that a patient had no pain complaints before the accident, factual questions about causation remain that must be resolved at trial rather than dismissed on summary judgment.

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