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Court assessed whether injuries were serious as required by insurance law. Massillon v. Regalado, 176 A.D.3d 600 (N.Y. App. Div. 2019)


A 90/180-day claim typically refers to a type of claim under New York’s No-Fault Insurance Law (Insurance Law § 5102(d)). It involves an assertion by a plaintiff that they suffered a qualifying injury that impaired their ability to perform substantially all of their daily activities for at least 90 out of the 180 days following a motor vehicle accident. This claim is significant because it can affect the determination of whether a plaintiff meets the threshold for “serious injury” under New York law, which is required to bring a lawsuit for damages beyond basic no-fault benefits.

In the case of Massillon v. Regalado, the Supreme Court of Bronx County considered issues related to the 90/180-claim rule as well as whether the plaintiff suffered a serious injury as defined by insurance law.

Background Facts
The case arises from a motor vehicle collision that occurred in October 2015, involving the plaintiff who alleges sustaining multiple severe injuries. These injuries include significant trauma to his cervical and lumbar spine, shoulders, left thumb, and legs, purportedly rendering him unable to resume work for a period exceeding five months subsequent to the accident.

In their defense, the defendants argued that the injuries to the plaintiff’s cervical and lumbar spine were not directly caused by the accident but were instead due to pre-existing degenerative conditions exacerbated by a prior 2010 motor vehicle accident. They supported this claim with medical reports from their radiologist, which suggested chronic and degenerative changes in the plaintiff’s spine.

Contrarily, the plaintiff’s case relied on the testimony and medical opinions of his treating physiatrist, who compared MRIs from before and after the 2015 accident, asserting that the newer MRIs indicated worsened disc bulges and herniations attributable to the collision. Additionally, contemporaneous medical reports were presented that specifically excluded degenerative changes in the cervical and lumbar spine at certain disc levels, further supporting the argument of injury causation from the 2015 accident.

Whether the injuries claimed by the plaintiff qualified as “serious injuries” within the meaning of Insurance Law § 5102(d), specifically focusing on the alleged injuries to his cervical and lumbar spine, as well as his claim of being disabled for 90 out of 180 days following the accident.

Upon review, the court modified its initial order granting the defendants’ motion for summary judgment to dismiss the complaint, except as to the plaintiff’s claims concerning serious injuries to his cervical and lumbar spine and his 90/180-day claim. The court affirmed the decision without imposing costs.

Initially, the defendants argued that the plaintiff’s injuries to his cervical and lumbar spine were not causally linked to the accident, relying on medical reports indicating pre-existing chronic conditions and referencing a prior spine injury sustained by the plaintiff in a 2010 motor vehicle accident. In response, the plaintiff presented evidence from his treating physiatrist, who compared MRIs from both accidents and concluded that the 2015 MRIs revealed exacerbated disc bulges and herniations attributable to the subject accident. Additionally, contemporaneous MRI reports were submitted, explicitly negating degenerative changes in the cervical and lumbar spine at specific disc levels, along with medical opinions asserting a causal connection between the injuries and the accident. This evidence raised a genuine issue of fact, particularly given the plaintiff’s youth and the absence of prior medical records indicating degenerative conditions.

Regarding the 90/180-day claim, while the defendants initially demonstrated a lack of causation, the plaintiff countered with his deposition testimony and affirmed medical evaluations documenting a significant period of disability following the accident, which created triable issues of fact.

For individuals involved in motor vehicle accidents resulting in spinal injuries or facing challenges related to the determination of “serious injury” under New York’s Insurance Law, consulting with a knowledgeable New York spinal injury lawyer is critical. They can offer expert legal advice and representation tailored to navigating the complexities of personal injury claims.

Massillon v. Regalado underscores the importance of thorough medical documentation and skilled legal advocacy in establishing claims of serious injury. Individuals seeking assistance with spinal injury cases in New York are encouraged to seek the counsel of an experienced attorney who can provide guidance and pursue their legal rights effectively.

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