Key Takeaway
Court ruling clarifies burden of proof standards in no-fault insurance cases, addressing cervical spine claims and delayed shoulder injury reporting requirements.
New York’s no-fault insurance system requires injured parties to prove their claims meet the “serious injury” threshold under Insurance Law Section 5102(d). This recent First Department decision in Guzman v Cruz provides valuable guidance on two critical aspects of proving no-fault claims: the burden of proof regarding pre-existing conditions and the impact of delayed symptom reporting.
The case addresses fundamental questions that arise frequently in New York no-fault insurance law practice. Courts must regularly determine what level of medical evidence is sufficient to establish causation, particularly when defendants argue that injuries stem from degenerative conditions rather than the motor vehicle accident. Additionally, insurance companies often challenge claims where patients don’t immediately report all symptoms, arguing that delays undermine causation.
Jason Tenenbaum’s Analysis:
Guzman v Cruz, 2020 NY Slip Op 03980 (1st Dept. 2020)
“In opposition, plaintiff raised issues of fact as to his cervical spine claim through the affirmed report of his radiologist, who found multiple bulging discs, and his treating physician, who provided evidence of limited range of motion about a week after the accident and four years later and opined that the cervical spine conditions were causally related to the accident. Since plaintiff’s own medical records did not reveal any degenerative conditions in his spine, he was not required to submit evidence from a medical expert detailing why degenerative conditions were not the cause of the reported symptoms”
……
“Although plaintiff did not initially complain to his doctor about his shoulder, he testified that his shoulder was bruised after the accident and then sought treatment within a month when pain developed. Such delay does not require a finding of lack of a causal connection, but rather presents an issue of fact”
Key Takeaway
This decision reinforces that plaintiffs don’t bear the burden of disproving pre-existing conditions when their medical records show no evidence of such conditions. The court also confirmed that delayed reporting of symptoms doesn’t automatically defeat causation claims but creates factual issues for trial, protecting injured parties who may not immediately recognize the full extent of their injuries.
Common Questions
Frequently Asked Questions
What is New York's no-fault insurance system?
New York's no-fault insurance system requires all drivers to carry Personal Injury Protection (PIP) coverage. This pays for medical expenses and lost wages regardless of who caused the accident, up to policy limits. However, you can only sue for additional damages if you meet the 'serious injury' threshold.
