Gap in Treatment After a Car Accident in New York: What It Means for Your Claim

If you were injured in a car accident in New York and there was a period of weeks or months when you were not receiving medical treatment, the insurance company will use that gap against you. It does not matter whether you had good reasons for not treating. The insurer’s defense attorney will argue that the gap means your injuries were not as serious as you claim — or that they resolved entirely during the period you were not treating, and that any symptoms you have now arose from a new cause unrelated to the accident.

This is one of the most common and effective tactics in New York car accident defense. Understanding how gaps in treatment arise, how New York courts evaluate them, and what you can do to protect your claim is essential.

What Is a “Gap in Treatment”?

A gap in treatment is any period after a car accident during which an injured person did not receive medical care for their injuries. In the context of a New York personal injury claim, insurance defense attorneys typically focus on gaps of four weeks or longer — though even shorter interruptions can be used to challenge the consistency and credibility of the plaintiff’s treatment narrative.

The argument is straightforward: if you were truly injured and in pain, you would have been treating consistently. A gap in treatment, the insurer argues, is circumstantial evidence that either (a) your injuries resolved during the gap and your current symptoms are from a different cause, or (b) the injuries were never as severe as you claim.

In New York no-fault litigation, where carriers are required to pay medical expenses and lost wages up to the policy limit, the gap in treatment argument is used both to challenge the medical necessity of treatment following the gap and to challenge the seriousness of the injury in the third-party personal injury lawsuit against the at-fault driver.

Why Legitimate Gaps Occur

Real gaps in treatment happen for reasons that have nothing to do with whether a person is injured. Understanding these reasons matters because New York courts have recognized that a gap does not automatically defeat a personal injury claim — but the plaintiff must offer an adequate explanation.

No-fault benefit denial or exhaustion. New York’s no-fault system provides up to $50,000 in basic economic loss coverage, including medical treatment and lost wages. When a no-fault insurer denies treatment as not medically necessary — often based on an independent medical examination (IME) ordered by the carrier — the treating physician’s bills stop being paid. Many New York injury victims have no other means to pay for physical therapy, chiropractic care, or pain management injections, and treatment stops when no-fault coverage is denied or exhausted. This is one of the most common causes of treatment gaps in Long Island and New York City car accident cases.

Cost and lack of supplemental coverage. Even with no-fault coverage nominally available, out-of-pocket costs for imaging, specialist visits, and procedures can be prohibitive. A plaintiff with a high-deductible health plan, no health insurance, or exhausted no-fault benefits who cannot afford treatment out of pocket will stop treating — not because the injury resolved, but because the financial barrier is insurmountable.

Work and childcare obligations. Physical therapy typically requires appointments two to three times per week. Pain management visits, orthopedic follow-ups, and imaging require additional time away from work and family. For a single parent working multiple jobs, consistent treatment attendance can be practically impossible despite genuine injury. Courts have recognized work and childcare obligations as legitimate excuses for treatment gaps when adequately documented.

Belief that symptoms would improve. Many car accident victims initially believe their injuries will resolve with time, particularly when emergency room physicians tell them to rest and follow up with their primary care doctor “if symptoms persist.” When symptoms do persist — and worsen — the plaintiff may have gone weeks or months without seeking specialist care, creating an unintentional gap.

Geographic access issues. In parts of Long Island and upstate New York, access to specialist orthopedic or pain management care may require long travel times, creating practical barriers to consistent treatment attendance.

New York’s No-Fault System and How It Creates Gaps

New York Insurance Law §5102 et seq. requires that drivers and their passengers receive no-fault benefits — covering medical expenses up to $50,000 and a portion of lost wages — without regard to fault. The no-fault insurer has 30 calendar days from receipt of a complete application (NF-2) to pay or deny each bill.

Critically, no-fault insurers have the right to require a claimant to attend an independent medical examination (IME) conducted by a physician of the insurer’s choosing. If the IME physician concludes that the claimant has reached maximum medical improvement (MMI) — meaning further treatment will not improve the condition — the no-fault insurer can and typically does use that finding to deny all subsequent treatment bills as not medically necessary.

Here is where treatment gaps are most commonly created: the IME physician examines the claimant three to six months post-accident, opines that MMI has been reached and further treatment is unnecessary, and the insurer cuts off no-fault benefits. The treating physician disagrees but cannot force the insurer to continue paying. The claimant, without an alternative payment source, stops treating. Six months later, at deposition, the defense attorney asks: “You stopped treating in October 2025 and didn’t see another doctor until April 2026 — is that correct?” The gap, created by the insurer’s own IME-driven benefit cutoff, is now being used to attack the plaintiff’s credibility.

This is why the no-fault cutoff mechanism and the treatment gap it produces must be carefully documented as an excuse for the gap.

How New York Courts View Treatment Gaps: The Pommells v. Perez Standard

The leading New York Court of Appeals case on gaps in treatment in personal injury litigation is Pommells v. Perez, 4 NY3d 566 (2005). The court addressed what happens when a defendant moves for summary judgment dismissing the plaintiff’s serious injury claim on the ground that the plaintiff’s treatment gap demonstrates the injuries resolved before the claim was brought.

The Pommells court held that when a defendant raises a treatment gap as part of a summary judgment motion — supported by an IME physician’s report opining that the plaintiff’s injuries have resolved — the burden shifts to the plaintiff to raise a triable issue of fact explaining the gap. The plaintiff cannot simply rest on the treating physician’s earlier documentation; the treating physician (or the plaintiff) must offer a reasonable explanation for why treatment was discontinued.

However, Pommells does not establish a per se rule that a gap defeats a serious injury claim. Rather, the court recognized that whether a gap in treatment is adequately excused is typically a credibility issue for the jury, not a dispositive legal rule. A gap explained by cessation of no-fault benefits, economic hardship, or a treating physician’s instruction to return only as needed — documented in the medical record — raises a triable issue of fact on the excuse question that survives summary judgment.

The practical implication is clear: the plaintiff must have an explanation, and that explanation must appear in the record. A plaintiff who cannot explain a lengthy treatment gap — and whose treating physician provides no explanation either — is vulnerable to having the serious injury claim dismissed on summary judgment, regardless of how severe the underlying injury may have been at the time of the accident.

The IME Cutoff Gap: A Special Problem

When no-fault coverage is cut off after an insurer-ordered IME, the treatment gap that follows has a specific and documentable cause. The treating physician’s records before the IME cutoff establish the ongoing nature of the injury and the necessity of continued treatment. The IME report that triggered the cutoff is itself part of the record. The plaintiff’s inability to pay for continued treatment out-of-pocket after the cutoff is a documented circumstance.

But the documentation must be explicit. The treating physician should, at the time of the no-fault cutoff, make a note in the medical record: “Patient advises that no-fault benefits have been cut off and she cannot afford to continue treatment out of pocket. I recommend she return for re-evaluation if her condition worsens or if coverage is restored.” That entry — brief as it is — creates the documentary basis for the Pommells excuse when the plaintiff’s attorney needs to respond to a summary judgment motion two years later.

Without that entry, the gap appears inexplicable. With it, the gap is excused by the most common cause of treatment interruption in New York no-fault cases.

What the Defense Does With a Gap

The insurer’s defense strategy around treatment gaps operates on two levels.

At the threshold level — whether the plaintiff has a “serious injury” under Insurance Law §5102(d) — the defense will argue that the gap demonstrates the plaintiff’s injuries resolved during the period of non-treatment, so the plaintiff cannot show a permanent or significant limitation as of the time of trial. The defense IME physician will opine that the plaintiff was at MMI by the time of the gap (or before), and the gap confirms this.

At the damages level — even if the threshold is conceded or the defense fails — the insurer will argue that the gap breaks the causal chain between the accident and any injuries the plaintiff now reports. Post-gap symptoms, the defense argues, could have resulted from new accidents, new activities, or natural degeneration unrelated to the original car accident.

Both arguments require a factual response grounded in the medical record. The treating physician’s post-gap records, if they document the same injury pattern as the pre-gap records — the same affected body parts, the same clinical findings, the same symptoms described consistently from the accident forward — substantially undermine the defense’s causal chain argument.

How to Protect Your Claim if There Has Been a Gap

Treat as consistently as you can. The single most effective protection against the gap defense is consistent medical treatment. Every gap is a potential vulnerability. If you cannot treat due to no-fault denial, document the reason in the medical record.

Get a letter from your treating physician explaining the gap. If there is already a gap in your treatment history, your treating physician should document the reason in the medical record and, if necessary, provide a letter to your attorney explaining the gap. The physician should state: (1) that the patient continued to have symptoms during the gap; (2) the clinical reason for the gap (no-fault denial, financial hardship, the physician’s own instruction to follow up only as needed); and (3) that the current symptoms are causally related to the original accident and are consistent with the patient’s pre-gap presentation.

Document why the gap occurred at the time it occurs. The best documentation is contemporaneous. If no-fault benefits are denied, save the denial letter. If you stopped treating because you could not afford to pay out of pocket, tell your doctor and ask that it be noted in the chart. If your doctor told you to come back only if your condition worsened, that instruction should appear in the visit note.

Resume treatment promptly when possible. The longer the gap, the harder it is to explain. When circumstances change — no-fault benefits are reinstated after an arbitration, health insurance coverage becomes available, a treating physician refers you to a specialist — resume treatment immediately, and make sure the re-initiation of care is documented as a continuation of treatment for the original accident injuries, not a new complaint.

Consult a lawyer before speaking to the insurance company. Statements made to the insurance company about your symptoms, treatment history, or activities during a treatment gap can create inconsistencies in the record that will be used at deposition. A Long Island car accident lawyer can advise you on how to handle insurer communications while protecting your claim.

The Broader Picture: Treatment Gaps and Long Island Car Accident Claims

A treatment gap is not a death sentence for a New York car accident claim. Pommells v. Perez establishes that a reasonably explained gap presents a credibility issue for the jury — not a legal bar to recovery. Defense attorneys know this, which is why they focus on gaps with no documented explanation. When the explanation is clear, documented, and consistent with the clinical record, the gap defense loses its force.

If you were injured in a Long Island car accident and there has been a gap in your treatment — whether because of no-fault denial, financial hardship, work obligations, or any other reason — you need a lawyer who understands both the medical documentation requirements and the New York case law governing the treatment gap excuse doctrine.

Our Long Island car accident lawyers have handled hundreds of New York personal injury cases involving treatment gaps caused by no-fault benefit denials, IME cutoffs, and financial hardship. We know how to build the record that explains and excuses the gap — and how to counter the defense’s attempt to use it against you.

Call us at (516) 750-0595 for a free consultation. There is no fee unless we win.