New York Law Review

Tag: Insurance Law 5102(d)

  • Dufel v. Green, 84 N.Y.2d 795 (1995): Admissibility of Expert Testimony on ‘Serious Injury’ Threshold

    84 N.Y.2d 795 (1995)

    Expert medical testimony is admissible to establish whether a plaintiff has sustained a “permanent consequential limitation of use of a body organ or member” or a “significant limitation of use of a body function or system” as defined by Insurance Law § 5102(d), even if the testimony addresses ultimate issues for the jury.

    Summary

    In a personal injury action arising from a car accident, the New York Court of Appeals addressed whether it was improper for the plaintiff’s doctors to testify, using the exact language of Insurance Law § 5102(d), that the plaintiff sustained a “permanent consequential limitation” and a “significant limitation” of use of a body function. The Court held that such testimony was admissible, reasoning that whether an injury meets these statutory definitions often requires medical expertise beyond the ken of a lay jury. The Court emphasized that the expert opinions were supported by objective medical evidence and the defense had the opportunity to cross-examine and present their own expert testimony.

    Facts

    Plaintiff sustained injuries to her ankle and knee in a car accident. She sued the other driver and the vehicle’s owner for damages. To establish a “serious injury” under New York’s No-Fault Law (Insurance Law § 5102(d)), plaintiff’s physicians testified that she suffered a “permanent consequential limitation” and a “significant limitation” of the use of a body member, function, organ, or system.

    Procedural History

    The trial court allowed the plaintiff’s doctors to testify as to whether the plaintiff suffered a permanent consequential limitation or a significant limitation. The jury found in favor of the plaintiff, determining that she sustained a permanent consequential limitation and a significant limitation and that she was medically prevented from performing normal activities for 90 out of 180 days following the accident. The Appellate Division affirmed. The New York Court of Appeals granted leave to appeal to determine if the doctor’s testimony was improper.

    Issue(s)

    1. Whether it is an error to allow medical experts to testify, using the statutory language of Insurance Law § 5102(d), as to whether a plaintiff sustained a “permanent consequential limitation of use of a body organ or member” or a “significant limitation of use of a body function or system”.

    Holding

    1. No, because whether an injury constitutes a “permanent consequential limitation” or a “significant limitation” often requires medical expertise, and the expert’s opinion was supported by objective evidence and subject to cross-examination and rebuttal.

    Court’s Reasoning

    The Court of Appeals reasoned that the admission of expert opinion is within the trial court’s discretion when it involves knowledge or skill beyond the range of ordinary training and intelligence. The Court found that determining whether an injury is permanent, “significant,” or “consequential” involves medical judgments about the seriousness and qualitative nature of an injury, compared to the normal function of the body, and thus falls within the scope of medical expertise. The court quoted Selkowitz v County of Nassau, 45 NY2d 97, 102, stating that an “expert” should be permitted to offer an opinion on an issue which involves ” ‘professional or scientific knowledge or skill not within the range of ordinary training or intelligence’ ”. The Court also emphasized the No-Fault Law’s intent to weed out frivolous claims. Permitting medical testimony on the seriousness of the injury assists the jury and is consistent with that intent. The Court acknowledged that there could be instances where asking experts questions in the statutory form would be unduly prejudicial. However, in this case, because the expert’s opinions were supported by objective evidence, the defense had the opportunity to cross-examine and present its own expert who testified that the plaintiff sustained a 20% permanent loss of use of her ankle, the court found no error. Thus, the jury could exercise independent judgment without relying solely on the plaintiff’s experts’ statutory conclusions. The court cited Licari v Elliot, 57 NY2d 230, 234-235, stating that “the legislative intent underlying the No-Fault Law was to weed out frivolous claims and limit recovery to significant injuries”.

  • Gaddy v. Eyler, 79 N.Y.2d 955 (1992): Establishing Serious Injury Under New York’s No-Fault Law

    Gaddy v. Eyler, 79 N.Y.2d 955 (1992)

    Under New York’s No-Fault Insurance Law, to defeat a motion for summary judgment, a plaintiff must present objective evidence demonstrating a ‘serious injury’ as defined by the statute, showing more than minor limitations or subjective complaints of pain.

    Summary

    Gaddy was involved in a car accident and sued for personal injuries. Eyler, the defendant, moved for summary judgment, arguing Gaddy did not sustain a ‘serious injury’ as defined by Insurance Law § 5102(d). The Court of Appeals affirmed the grant of summary judgment for the defendant. Even accepting Gaddy’s claims and her doctors’ reports as true, the court held that she failed to demonstrate a ‘permanent consequential limitation,’ a ‘significant limitation,’ or a substantial curtailment of daily activities for 90 out of 180 days following the accident. The court emphasized the need for objective evidence to substantiate claims of serious injury under the No-Fault Law.

    Facts

    Gaddy was involved in a motor vehicle accident in June 1987, when her car was rear-ended while she was stopped at a red light.

    She claimed neck and back injuries resulting in a ‘permanent consequential limitation of use’ or ‘significant limitation of use,’ ‘permanent loss of use of a body organ, member, function or system,’ and a ‘medically determined injury or impairment of a non-permanent nature’ which lasted for 90 days or more, substantially limiting her daily activities.

    Her doctors diagnosed chronic cervical and lumbosacral sprain and strain as a result of the accident.

    Procedural History

    After Gaddy sued, Eyler moved for summary judgment, arguing the absence of a ‘serious injury’ under Insurance Law § 5102(d), supporting the motion with a physician’s affidavit indicating a normal neurological examination for Gaddy.

    The Appellate Division affirmed the lower court’s grant of summary judgment to Eyler, finding that Gaddy failed to demonstrate a ‘serious injury’ as required by the No-Fault Insurance Law.

    The New York Court of Appeals affirmed the Appellate Division’s order.

    Issue(s)

    1. Whether the plaintiff presented sufficient evidence to demonstrate a ‘permanent consequential limitation of use of a body organ or member’ or a ‘significant limitation of use of a body function or system’ within the meaning of Insurance Law § 5102(d)?

    2. Whether the plaintiff presented sufficient evidence to demonstrate a ‘permanent loss of use of a body organ, member, function or system’ within the meaning of Insurance Law § 5102(d)?

    3. Whether the plaintiff presented sufficient evidence to demonstrate that she suffered an injury which prevented her from performing substantially all of her daily activities for 90 out of the 180 days following the accident, as required by Insurance Law § 5102(d)?

    Holding

    1. No, because the plaintiff’s doctors only concluded that she had a minor limitation of movement in her neck and back, which is considered insignificant under the no-fault statute.

    2. No, because while there was evidence of the plaintiff’s subjective pain, there was no objective evidence supporting a claim of permanency, and the neurosurgeon’s statements were speculative.

    3. No, because the plaintiff only experienced a slight impediment to her usual activities; she missed only two working days and was able to maintain most of her daily routine, and she provided no evidence to support her claim that her household and recreational activities were curtailed.

    Court’s Reasoning

    The court reasoned that to overcome a summary judgment motion in a No-Fault case, the plaintiff must present objective evidence demonstrating a ‘serious injury’ as defined by the statute. The court emphasized that a ‘minor, mild or slight limitation of use’ is considered insignificant under the statute, citing Licari v Elliott, 57 NY2d 230, 236. Regarding the claim of ‘permanent loss of use,’ the court found the plaintiff’s evidence, particularly the neurosurgeon’s speculative statements, insufficient to establish permanency. The court noted, “the expert’s statements reflect the speculative nature of plaintiff’s condition.” Furthermore, the court dismissed the treating physician’s affidavit as consisting of conclusory assertions tailored to meet statutory requirements. Finally, regarding the 90/180-day rule, the court stated that the plaintiff must prove she was “curtailed from performing [her] usual activities to a great extent rather than some slight curtailment” (Licari v Elliott, supra, at 236). Because the plaintiff only experienced a slight impediment to her usual activities, she failed to meet this threshold. The court emphasized the need for objective evidence and a substantial curtailment of activities to meet the statutory threshold for a ‘serious injury.’