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This article is part of our ongoing no-fault coverage, with 271 published articles analyzing no-fault issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
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)
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(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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Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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