Key Takeaway
Gaughan v Censeo Health: the plaintiff’s summary-judgment motion, spinal limitations and an unexplained degeneration theory.
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.
Last reviewed: September 2026.
Historical note (September 2026): this note reads a 2022 decision on medical proof under two serious-injury categories; the current text of Insurance Law § 5102(d) is linked below. For the threshold as applied today see New York’s serious injury threshold: all nine categories, the 2025 reversal in Prado v Harrison, and PTSD as a serious injury.
Understanding the Serious Injury Threshold in New York Personal Injury Cases
This historical note concerns medical proof under two serious-injury categories, not a rule that pain alone establishes a qualifying injury.
Gaughan v Censeo Health, LLC, 201 AD3d 1350, 2022 NY Slip Op 00587, was decided January 28, 2022, by the Fourth Department.
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Case Background
The plaintiff moved for partial summary judgment on liability and won. Defendants appealed, arguing that serious injury and causation had not been established. The Fourth Department affirmed.
The plaintiff’s expert documented spinal range-of-motion limitations of up to 50%, compared with normal ranges, and described them as permanent. The expert also connected the injuries to the collision after reviewing the medical history.
The defense expert found similar limitations but attributed them to age-related degeneration without accounting for the absence of prior spinal pain. The court found that explanation conclusory.
The opinion cites Toure v Avis Rent A Car Systems, 98 NY2d 345 (2002), and Ashquabe v McConnell, 46 AD3d 1419 (2007). Read the linked opinion for the complete citation chain.
Jason Tenenbaum’s original February 2022 analysis
I really love the “no prior pain” line of cases. It is akin to the prior asymptomatic injury that became symptomatic. I do enjoy the discussion.
Legal Significance of the “No Prior Pain” Discussion
The outcome depended on an expert’s documented limitations, permanence opinion and causation analysis. An absence of earlier pain was part of that evidence, not a substitute for it.
The ruling does not mean that every asymptomatic condition later causing pain was necessarily aggravated by a crash. Nor does it establish a universal 50% range-of-motion cutoff.
Keep three questions separate when reading a medical report:
- What condition or limitation was measured?
- What evidence connects it to the accident?
- Which statutory category does the evidence address?
The current text of Insurance Law § 5102(d) must be distinguished from the version governing an older claim. This note does not apply 2026 amendments retroactively.
Practical Implications for Attorneys and Litigants
A useful chronology includes symptoms before the collision, first reported symptoms afterward, examinations, imaging, treatment and later measurements. Give the treating clinician an accurate history, including prior problems.
A lawyer reviewing the proof should identify which records each expert considered and whether the opinion explains competing causes. Timing alone should not be presented as medical proof.
The distinction also matters when discussing pain-and-suffering damages: proving a qualifying injury and valuing damages are separate tasks.
Connect to the Encyclopedia
- CPLR 3212(g) and facts established on summary judgment
- Timing rules for summary-judgment motions
- Long Island car-accident representation
- Legal Encyclopedia
- 5102(d) baseline under an aggravation and exacervbation
The 2022 observation is historical. Counsel should check subsequent case treatment and the law governing the particular accident before relying on it in a current claim.
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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