Personal Injury Law
Insurance companies may argue that injuries were preexisting or degenerative. Learn how medical records, diagnostic imaging, and expert opinions help establish causation in Long Island personal injury cases.
One of the most misunderstood parts of a personal injury case is causation.
I understand why. If you were feeling fine before an accident, get hit by another car, and wake up the next morning with terrible neck or back pain, it seems obvious that the accident caused the problem.
Unfortunately, the insurance company may not see it that way.
In fact, in many personal injury cases I handle on Long Island, the real fight is not over whether my client is injured. The insurance company may accept that there is a herniated disc, torn shoulder, damaged knee, or other condition. The fight is over what caused it.
Was it the accident? Was it already there? Was it degenerative? Did the accident aggravate something that previously existed?
These questions go directly to causation, and they can have a tremendous impact on the value and outcome of a personal injury case.
When I first meet with a client, I often explain that a personal injury case has two basic components: liability and damages.
Asks who was responsible for causing the accident. You can have an extremely strong liability case — a clear rear-end collision at a red light — with very little dispute over fault.
Concern what the accident actually caused you to suffer: your injuries, medical expenses, lost earnings, and pain and suffering. This is where causation is fought, even when fault is clear.
You can have an extremely strong liability case and still have a major dispute over damages.
For example, another driver may rear-end you while you are completely stopped at a red light. There may be very little dispute about who caused the collision. But that does not necessarily mean the insurance company will agree that your herniated disc, shoulder tear, or need for surgery was caused by that collision.
That is where causation comes into the case.
Learn how Palermo Law handles liability and damages in New York car accident claims on our Long Island car accident lawyer page.
In simple terms, causation means establishing a connection between the accident and the injury for which you are seeking compensation.
It is not enough to prove:
I was in an accident. I have an injury.
We also have to establish:
The accident caused the injury, aggravated the injury, or made a previously existing condition symptomatic or worse.
That distinction is extremely important.
New York courts recognize that preexisting conditions, gaps in treatment, intervening medical problems, and degenerative findings can raise legitimate questions concerning whether an accident actually caused a claimed injury. That is why medical proof can become so important in a personal injury case.
I hear this frequently, and it can be an important fact.
A client may tell me:
“I never had back pain before this accident.”
“I never treated for my neck before.”
“I was working every day without a problem.”
“I never even knew I had arthritis.”
Then an MRI performed after the accident shows a herniated disc along with words such as “degenerative,” “desiccation,” “spondylosis,” “arthrosis,” or other findings suggesting that some changes existed before the accident.
That does not necessarily mean the accident did not cause an injury.
Our bodies change as we get older. Many people have abnormalities that appear on imaging studies without having significant symptoms.
The important question may therefore be whether the accident caused a new injury, aggravated an existing condition, or turned a previously asymptomatic condition into a symptomatic one.
New York law recognizes that an injured person may recover when an accident aggravates a preexisting condition. The existence of a prior condition does not automatically defeat a personal injury claim.
But we still have to prove the connection.
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01
The Imaging Defense
“It’s Degenerative, Not Traumatic” A defense radiologist reviews the MRI and concludes a disc condition or arthritis existed before the accident rather than being caused by it.
Answered with treating-physician opinion
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02
The Records Search
Prior Injuries & Treatment Carriers obtain old medical records looking for prior accidents, earlier MRIs, and complaints made years before the collision.
Answered with the before-and-after chronology
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03
The Timeline Attack
Gaps in Treatment An unexplained stretch with no treatment lets the defense argue the original injury resolved and something else caused later complaints.
Answered with a documented explanation
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Insurance carriers and their attorneys know exactly what to look for.
They will obtain medical records. They may look for prior accidents, prior injuries, previous MRIs, chiropractic treatment, physical therapy, orthopedic visits, injections, surgeries, and even complaints made years before the accident.
They will also examine the diagnostic films themselves.
A defense radiologist may review an MRI and conclude that a disc condition is degenerative rather than traumatic. An orthopedic surgeon may claim that arthritis existed before the accident. Another doctor may acknowledge an abnormality but conclude that it was not caused by the collision.
The defense may also focus on gaps in treatment.
If someone stops treating for a year and then begins treating again shortly before litigation becomes active, the insurance company will likely question why.
These arguments matter. The New York Court of Appeals has specifically recognized that preexisting conditions, intervening medical problems, and unexplained gaps in treatment can interrupt the claimed connection between an accident and an injury.
This is why I tell clients that a personal injury case is built through evidence, not simply through the fact that they are experiencing pain.
MRIs are extremely important, but they do not necessarily answer the causation question by themselves.
An MRI can show anatomy. It can identify a herniated disc, tear, degeneration, arthritis, stenosis, or other abnormality.
The harder question is often why that abnormality is causing problems now.
Sometimes the imaging itself provides evidence that helps distinguish an acute traumatic injury from a longstanding degenerative condition. Other times it does not.
That is where the client’s history, prior medical records, physical examinations, objective findings, timing of symptoms, mechanism of injury, diagnostic testing, and treating physicians’ opinions become important.
The entire medical picture has to make sense.
I think clients are sometimes afraid to tell their attorney about an old accident or prior medical treatment because they believe it will hurt their case.
That is a mistake.
I would much rather know about a prior accident or prior treatment at the beginning of a case than learn about it from the defense attorney during a deposition.
A prior condition does not necessarily prevent someone from recovering compensation.
Suppose you had some degeneration in your lumbar spine before an accident but had no meaningful back pain and were functioning normally. After a significant collision, you develop severe pain, begin treatment, undergo injections, and ultimately require surgery.
The issue may not be whether the degeneration existed before the accident. It may be whether the accident aggravated that condition and caused the symptoms, limitations, and treatment that followed.
That is a very different question.
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If a carrier is calling your injury degenerative, pointing to an old MRI, or questioning a gap in treatment, the causation fight is already underway. Palermo Law knows how to build the medical record that connects your injury to the accident. Contact us today for a free consultation, and there’s no fee unless we recover for you.
There is no single document that proves causation in every case.
Instead, I look at the complete medical history.
What did the client complain about immediately after the accident? What did the emergency room records say? When did treatment begin? What objective findings were documented? What do the MRIs show? Was there treatment to the same body part before the accident? If so, how long ago? What was the client’s condition immediately before this accident?
Sometimes obtaining prior medical records actually helps us.
If someone treated for a back problem five years earlier but then went several years without treatment or complaints before a new accident, those records may help demonstrate the difference between the client’s condition before and after the accident.
The chronology can be extremely important.
| 1 | What did you complain about immediately after the accident?
The emergency room records and earliest medical notes establish what hurt and when, connecting the symptoms to the crash from day one. |
| 2 | When did treatment begin, and what did it show?
Early, consistent treatment and the objective findings documented along the way build the medical record a claim rests on. |
| 3 | What do the MRIs and diagnostic studies reveal?
Imaging can identify a herniated disc, tear, or other abnormality — and sometimes helps distinguish an acute traumatic injury from longstanding degeneration. |
| 4 | Was there prior treatment to the same body part?
If so, how long ago, and what was your condition immediately before this accident? The chronology is often what separates a new injury from an old one. |
| 5 | Do we need a treating physician’s narrative report?
When causation is disputed, a detailed report that addresses the records, the imaging, and any degenerative findings can be what carries the case past a motion for summary judgment. |
When causation is disputed, I may ask a treating physician to prepare a detailed narrative report.
A good narrative should do much more than simply state that the injuries were “causally related” to the accident.
The physician may need to review the relevant records, discuss the diagnostic studies, address prior injuries or degenerative findings, explain objective examination findings, and give a medical opinion as to why the accident caused or aggravated the condition.
This can be particularly important when the insurance company’s doctor claims that everything shown on an MRI is degenerative.
New York courts have repeatedly examined whether a plaintiff’s medical expert actually addressed evidence of degeneration or prior conditions rather than simply offering a conclusory opinion.
That distinction can determine whether a case survives a motion for summary judgment.
In a New York automobile accident case, the No-Fault insurance carrier may require an injured person to attend an Independent Medical Examination, commonly called an IME. New York’s No-Fault regulations permit insurers to require medical examinations under appropriate circumstances.
Most clients understandably view an IME as something designed to hurt their case.
Frequently, it is.
The insurance company’s doctor may conclude that additional treatment is unnecessary or that the client has reached maximum medical improvement. That opinion can result in the termination of No-Fault medical benefits.
But there are situations where an IME report can also contain something helpful.
For example, an insurance company’s doctor might conclude that no further treatment is necessary while still acknowledging that the client sustained a cervical sprain, lumbar sprain, shoulder injury, or other condition as a result of the accident.
That can be significant.
The carrier may have sent the client to its own physician expecting an opinion favorable to the defense, but the report may nevertheless contain an acknowledgment that at least some of the injuries were causally related to the accident.
Every IME report needs to be read carefully.
You can learn more about these examinations and New York’s No-Fault system on my Long Island No-Fault Insurance Lawyer page.
Some cases ultimately come down to competing medical opinions.
The defense radiologist says the MRI shows degeneration.
The treating surgeon says the accident caused a traumatic injury or aggravated a preexisting condition.
The defense orthopedist says the client has no disability.
The treating doctor documents continued limitations and explains why they are related to the accident.
At that point, the dispute may become a battle between experts.
A jury may ultimately have to decide which medical explanation makes more sense based upon the records, diagnostic films, examinations, testimony, and the client’s medical history.
This is one reason medical documentation throughout a personal injury case matters so much.
| The Causation Question | The Serious Injury Question |
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| Was the injury actually caused by the accident, rather than a preexisting or degenerative condition? | Does the injury qualify as a “serious injury” under New York Insurance Law § 5102(d)? |
| A person can have an objectively documented condition and still face an argument that the accident did not cause it. | An accident may have clearly caused an injury, yet the defense argues it does not meet the statutory threshold. |
In New York motor vehicle accident cases, there can actually be two separate medical issues.
First, was the injury caused by the accident?
Second, does the injury qualify as a “serious injury” under New York Insurance Law § 5102(d)?
These questions overlap, but they are not identical.
A person can have an objectively documented medical condition and still face an argument that the condition was not caused by the accident. Likewise, an accident may have caused an injury, but the defense may argue that the injury does not satisfy New York’s statutory serious injury threshold.
This is one reason car accident cases can become much more medically complicated than clients initially expect.
Another issue that frequently becomes part of the causation defense is a significant gap in medical treatment.
There are perfectly legitimate reasons why someone may stop treating. A doctor may say additional therapy will not help. No-Fault benefits may be terminated. Insurance may become an issue. A patient may be told to continue exercises at home.
But an unexplained gap can give the defense an argument.
If you claim that an injury has caused continuous problems for several years but there is a lengthy period with no treatment, the insurance company may argue that the original injury resolved and that something else caused the later complaints.
New York courts recognize that a gap in treatment does not automatically defeat a claim, particularly where there is a reasonable explanation for it. But the explanation can matter.
One of the most important things a client can do is be completely honest with his or her attorney about prior medical problems.
Do not hide a prior accident.
Do not forget to mention an old MRI.
Do not say that you never injured your back if you treated for your back three years earlier.
Insurance companies have access to substantial information during litigation, and prior treatment often comes out eventually.
A prior injury that we know about can usually be investigated and addressed. A prior injury that first appears during a deposition can create an unnecessary credibility problem on top of the medical issue.
The truth gives us an opportunity to deal with the issue directly.
Not every causation dispute has a perfect answer.
Medicine is not always black and white.
A 55-year-old person may have degeneration and still suffer a significant traumatic injury in an accident. An MRI may contain both chronic and acute findings. Two qualified doctors can review the same films and reach different conclusions.
That uncertainty affects how cases are evaluated.
Part of my job as a Long Island Personal Injury Attorney is not simply to tell clients what we hope a jury will believe. I have to evaluate the strengths and weaknesses of the medical proof, explain the risks, and help the client make an informed decision.
Sometimes the evidence strongly supports causation and we should continue fighting.
Sometimes there is genuine medical uncertainty, and a reasonable settlement takes that risk into account.
That is not necessarily a weakness in the case. It is part of realistically evaluating litigation.
Causation should not first become a concern when the insurance company raises it two years into a lawsuit.
I prefer to identify these issues early.
If there was a prior accident, I want to know about it.
If there was an old MRI, I may want to see it.
If the new MRI describes significant degeneration, I want to understand it.
If there is a substantial gap in treatment, I want to know why.
If a treating physician needs to address the relationship between the accident and the injury, it is usually better to recognize that issue before the defense builds its entire case around it.
The stronger we make the medical record, the harder it becomes for an insurance company to dismiss a legitimate injury as simply “degenerative.”
If you are hurt after an accident, your pain is real. But a personal injury claim requires us to do more than establish that you are hurting — we have to connect the injury to the accident through the medical records, diagnostic studies, prior history, and the opinions of the physicians involved.
We have to connect the injury to the accident.
That means understanding the medical records, diagnostic studies, prior history, objective findings, treatment, and opinions of the physicians involved.
Causation is sometimes straightforward. Other times, it becomes one of the most heavily contested issues in the entire case.
That is why I believe a good personal injury lawyer has to understand the medical evidence almost as well as the liability evidence. Winning the argument over who caused the accident is only part of the case.
We also have to prove what the accident caused.
If you were injured in an accident on Long Island and have questions about whether a prior condition, degenerative finding, or previous injury may affect your case, you can contact Palermo Law to discuss your claim.
Causation is the connection between an accident and the injury for which you are seeking compensation. It is not enough to establish that an accident occurred and that you have an injury. Medical evidence may be necessary to establish that the accident caused, aggravated, or worsened the condition you are claiming.
Yes, potentially. Degenerative findings do not automatically prevent you from recovering compensation. The important question is whether the accident caused a new injury or aggravated a preexisting condition. Your medical history, symptoms before and after the accident, examinations, diagnostic studies, and treating doctors' opinions can all become important evidence.
A prior back problem does not automatically eliminate your claim. New York law allows recovery for an accident-related aggravation of a preexisting condition. The medical evidence should distinguish your prior condition from what happened after the accident and explain how the collision caused additional symptoms, limitations, treatment, or disability.
Yes. Insurance companies frequently have radiologists and orthopedic doctors review MRIs and determine whether findings appear traumatic or degenerative. A defense doctor may attribute a disc herniation or other abnormality to degeneration. Your treating physician may need to specifically address that opinion and explain why the accident caused or aggravated your condition.
Not necessarily. An MRI can provide objective evidence of an abnormality, but the imaging alone may not establish when or why the condition developed. Doctors may consider the MRI together with your prior medical history, mechanism of injury, examination findings, onset of symptoms, prior imaging, treatment history, and functional limitations.
Sometimes. Although an IME doctor is selected by an insurance company, the doctor's report may acknowledge that you sustained an accident-related injury even while concluding that additional treatment is unnecessary. That acknowledgment can become useful evidence on causation. Each IME report should therefore be carefully reviewed rather than simply treated as unfavorable.
It can. An insurance company may argue that a lengthy unexplained treatment gap means your accident-related injury resolved. However, there may be legitimate explanations, including a doctor's determination that further treatment would not help. New York courts recognize that an adequately explained cessation of treatment does not necessarily defeat an injury claim.
Prior medical records can show whether you previously complained about or treated the same body part injured in the accident. Insurers use those records to argue that a condition was preexisting. Those same records can sometimes help establish that an older problem had resolved or was substantially different before the new accident.
A narrative report is a detailed medical report explaining the patient's diagnosis, treatment, objective findings, limitations, prognosis, and relationship between the injury and the accident. When causation is disputed, a strong narrative may also address prior injuries and degenerative findings and explain why the doctor believes the accident caused or aggravated the condition.
When qualified doctors reach different conclusions, causation can become a disputed issue for a judge or jury. The strength of each opinion may depend on the medical records reviewed, diagnostic studies, examinations, prior history, objective findings, and reasoning offered. These disputes can also affect settlement negotiations and the ultimate value of a case.
The information provided in this blog is for general informational purposes only and reflects the opinions of the author. It is not legal advice and does not create an attorney-client relationship. Every case is different, and results depend on the specific facts and applicable law. You should not act or rely on any information in this blog without first seeking advice from a qualified attorney regarding your individual situation.
