Accident-Triggered Cervical Myelopathy and Level-Specific Stenosis Progression Can Create Triable Causation Despite Extensive Comorbidities: Moore v. Maley

Introduction

In Moore v. Maley, 2025 NY Slip Op 05304 (1st Dept Oct. 2, 2025), the Appellate Division, First Department, affirms the denial of a threshold summary judgment motion under New York’s No-Fault law (Insurance Law § 5102[d]) brought by a tractor-trailer driver and his employer. The defendants argued that plaintiff’s decedent, Kenneth Moore—who lived with profound preexisting medical conditions—did not sustain a “serious injury” causally related to a 2017 multi-vehicle collision, and that his later death resulted from his comorbidities rather than the accident.

The court holds that even when a plaintiff suffers from extensive baseline illnesses (including sickle-cell disease, end-stage renal disease on dialysis, longstanding spinal degeneration, and prior osteomyelitis), triable issues of fact as to causation and the § 5102(d) serious-injury categories exist where the record contains:

Competent evidence that the accident precipitated new spinal cord pathology (myelopathy) and accelerated stenosis at a different cervical level (C2–3) than the most prominent pre-accident degeneration (noted around C5–6),
Objective post-accident imaging comparing level-specific changes over time,
Lay testimony evidencing a marked deterioration in function and activities of daily living (including progression from cane to walker to wheelchair to bedridden), and
Conflicting but sufficiently grounded expert opinions on causation and aggravation/acceleration.

The decision also underscores that defendants must specifically address each pleaded injury (e.g., shoulder and knee claims) to obtain summary judgment, and that the 90/180-day category remains viable where admissible proof shows accident-related impairment preventing substantially all customary activities for at least 90 of the 180 days after the accident.

Summary of the Opinion

The defendants (Roger Wood and K&B Transportation Inc.) moved for summary judgment dismissing the complaint, arguing that Moore’s alleged injuries and death were not caused by the 2017 accident but by his numerous preexisting conditions. The motion relied on medical records and defense expert opinions. Plaintiff opposed with deposition testimony (from Moore and his daughter), medical records documenting marked post-accident functional decline, and expert reports opining that the collision caused new injuries (including myelopathy) and accelerated cervical stenosis at C2–3, leading to a rapid deterioration that culminated in surgery and death in 2019.

The Supreme Court (Bronx County) granted the motion in part (dismissing lumbar spine claims not addressed by plaintiff’s expert) but otherwise denied it, finding issues of fact as to the cervical spine, right shoulder, knees, causation, and the 90/180-day category. The First Department affirmed, holding:

Defendants made a prima facie showing that Moore’s cervical injuries were preexisting and not caused by the accident,
Plaintiff, however, raised triable issues of fact by:
- Presenting expert evidence comparing pre- and post-accident imaging indicating significant progression of stenosis at C2–3 and new-onset myelopathy,
- Providing testimony and records of stark functional decline post-collision, and
- Showing continuous—albeit different—modalities of treatment after ceasing initial PT/chiropractic sessions.
Defendants failed to address shoulder and knee claims, warranting denial of summary judgment as to those injuries, and
Evidence sufficed to create issues of fact under the 90/180-day category.

The court reiterated that negligent aggravation or acceleration of a preexisting disease (including hastening death) is actionable, citing McCahill v. New York Transportation Co. It concluded that a jury must resolve whether the accident caused new or exacerbated injuries and whether it accelerated Moore’s decline and death.

Analysis

Precedents Cited and Their Influence

Insurance Law §§ 5102(d), 5104(a): The “serious injury” threshold restricts recovery for non-economic loss unless the plaintiff proves a qualifying injury (e.g., death, fracture, permanent consequential limitation, significant limitation, or 90/180-day impairment). The decision applies these categories to evaluate triable issues of causation and severity.
Vega v. Restani Constr. Corp., 18 NY3d 499 (2012); Winegrad v. NYU Med. Ctr., 64 NY2d 851 (1985); Zuckerman v. City of New York, 49 NY2d 557 (1980): The court restates core summary judgment principles: the movant bears a heavy burden; evidence is viewed in the light most favorable to the nonmovant; the motion fails if the movant does not meet its prima facie burden; and the opponent must submit admissible proof raising material factual disputes.
Spencer v. Golden Eagle, Inc., 82 AD3d 589 (1st Dept 2011): In serious-injury motions, a defendant must show either the absence of a “serious injury” or lack of causation. Here, defendants chose a causation attack based on preexisting disease.
Pommells v. Perez, 4 NY3d 566 (2005): A seminal case on causation and burden shifting in no-fault threshold litigation. Even where objective injury exists, “additional contributory factors” (e.g., preexisting conditions, gaps in treatment) may break causation—but only if the plaintiff cannot adequately explain them. The First Department follows Pommells: once defendants tied Moore’s symptoms to preexisting disease, the burden shifted to plaintiff to offer a persuasive causation narrative and explanation of treatment patterns. Plaintiff did so with comparative imaging, testimony, and expert opinions.
Matthews v. Cupie Transp. Corp., 302 AD2d 566 (2d Dept 2003); Style v. Joseph, 32 AD3d 212 (1st Dept 2006): Preexisting conditions do not foreclose causation. The collision can aggravate degenerative disease. Moore reinforces that principle despite unusually severe comorbidities (sickle cell disease, ESRD, osteomyelitis).
McIntosh v. Sisters Servants of Mary, 105 AD3d 672 (1st Dept 2013), citing Perl v. Meher, 18 NY3d 208 (2011): McIntosh sustained triable issues by showing asymptomatic degeneration pre-accident, new range-of-motion deficits post-accident, and expert opinions of superimposed injury. Perl validates qualitative assessments when supported by objective grounds. Moore deploys the same approach: plaintiff’s expert identified level-specific worsening (C2–3) and new myelopathy post-accident, coherently tying trauma to symptom onset and progression.
Giap v. Hathi Son Pham, 159 AD3d 484 (1st Dept 2018): Aggravation of degenerative disease, transformation from asymptomatic to symptomatic, and trauma accelerating disc desiccation can establish triable causation. In Moore, the expert’s level-specific analysis similarly sufficed.
Gjoleka v. Caban, 188 AD3d 458 (1st Dept 2020); Attilio v. Torres, 181 AD3d 460 (1st Dept 2020); Ledesma v. Rodriguez, 217 AD3d 453 (1st Dept 2023); Massillon v. Regalado, 176 AD3d 600 (1st Dept 2019): These cases reflect that defendants can meet their prima facie burden by demonstrating preexisting degeneration and lack of causal nexus. The court found defendants met that burden for Moore’s cervical claims—but plaintiff then successfully raised triable issues.
Ortiz v. Boamah, 169 AD3d 486 (1st Dept 2019): A plaintiff’s cessation of one modality of care does not doom causation if the plaintiff pursued “continuous, albeit different modalities” thereafter. Moore uses Ortiz to treat Montefiore hospitalizations as ongoing treatment after PT/chiropractic stopped.
McCree v. Sam Trans Corp., 82 AD3d 601 (1st Dept 2011): Conclusory defense statements about preexisting pathology are insufficient to defeat detailed plaintiff-side medical proof. The court found the defense did not adequately contradict plaintiff’s expert analysis regarding new-onset myelopathy and C2–3 progression.
Garcia v. Leon, 70 AD3d 566 (1st Dept 2010); Liburd v. Mondal, 215 AD3d 655 (2d Dept 2023): Support triable issues where plaintiff’s proof shows aggravation and functional limitations notwithstanding degeneration. Moore aligns with this line.
McCahill v. New York Transp. Co., 201 NY 221 (1911): A defendant is liable for negligently hastening or accelerating death even if disease would have eventually caused death. Moore invokes McCahill to neutralize the defense argument that Moore’s death was inevitable due to ESRD and sickle-cell disease.

Legal Reasoning

The First Department employs the classic two-step Pommells burden framework:

Prima facie showing by defendants. Defendants marshaled extensive pre-accident medical history and imaging to argue Moore’s symptoms flowed from longstanding disease: sickle-cell anemia with recurrent pain crises, dialysis-dependent ESRD, osteomyelitis, avascular necrosis, and diffuse degenerative cervical changes (with prior compression fractures at C5–6). Defense spine expert Dr. Yong Kim opined that Moore’s myelopathy predated the accident and that May 2019 surgeries were unrelated to the collision. This established prima facie lack of causation for cervical injuries.
Plaintiff’s rebuttal raising triable issues. Plaintiff countered with granular, level-specific evidence that the accident initiated or accelerated cervical cord compromise:
- New symptomatology and functional decline. Moore reported post-collision neck pain and headaches distinct from generalized sickle-cell pain, with increasing difficulty in ambulation and self-care; his daughter corroborated a sharp post-accident decline (cane → walker → wheelchair → bedbound).
- Objective imaging progression at C2–3. Plaintiff’s spine expert, Dr. Franco Cerabona, performed a comparative review of CT scans (June 2017 vs. August 2018) and noted significant progression at C2–3—the level later showing “severe impingement” and “severe stenosis” (per April/May 2019 myelogram/MRI). He emphasized the absence of documented myelopathic signs pre-accident and initially post-accident (no hyperreflexia, clonus, Babinski/Hoffman, ataxia), undermining the defense’s assertion that myelopathy preexisted.
- Continuity of care. Although PT/chiropractic ceased in January 2018, Montefiore hospitalizations and other care continued, satisfying Ortiz’s “different modality” principle and addressing any claimed “gap in treatment.”
- Unaddressed injuries and 90/180-day category. Defendants did not substantively address shoulder and knee sprain claims (with documented decreased ROM), warranting denial. Hospital admissions and therapy in the six months after the accident, coupled with testimony about severe functional limitations, created triable issues under the 90/180-day category.

On this record, the court concluded that plaintiff’s integrated evidentiary showing—comparative imaging tied to a different cervical level (C2–3), new-onset myelopathy, a coherent expert explanation of trauma-induced acceleration, and robust lay testimony of functional collapse—was enough to present causation to a jury. The court expressly rejected the view that pervasive comorbidity or the anticipation of death in 2019 precluded liability, invoking McCahill to reaffirm that acceleration/hastening is compensable.

Impact

Moore v. Maley refines serious-injury threshold jurisprudence in several practical ways:

Level-specific degeneration matters. Where preexisting degeneration is localized (e.g., C5–6) and post-accident progression is most marked at a different level (e.g., C2–3), competent expert comparison can establish triable causation. Defense arguments premised on “general degenerative disease” may be inadequate if they fail to grapple with level-specific worsened pathology.
“Inevitable decline” is not a defense to acceleration. Medical inevitability (e.g., ESRD on dialysis, predicted mortality within a year) does not immunize a defendant if evidence supports that the accident hastened decline or precipitated additional disabling pathology. Expect defendants’ “inevitability” opinions to face McCahill-based resistance at the summary judgment stage.
Silence in voluminous records is not dispositive. The court did not treat the absence of accident references in 15,000 pages of Montefiore records (apart from day-of ER notes) as fatal, given other contemporaneous accident-related treatment and credible testimony about functional change.
“Different modalities” can bridge treatment gaps. Plaintiffs who stop PT/chiropractic but continue hospital-based or medical management can rely on Ortiz to defeat “gap in treatment” arguments if they show ongoing, medically directed care causally tied to accident sequelae.
Defense must address each claimed injury. Failing to analyze shoulder and knee claims led to denial as to those injuries. Practitioners should ensure defense submissions meet each pleaded site with admissible proof and, where appropriate, comparative imaging or function testing.
90/180-day claims remain robust with admissible functional proof. Hospital admissions, therapy records, and lay testimony describing inability to perform substantially all customary activities can create triable issues, even in medically complex plaintiffs. The inquiry focuses on the extent accident-related impairments prevented performance for at least 90 of the first 180 days.

More broadly, Moore underscores that the serious-injury threshold remains a fact-intensive gatekeeping device rather than a categorical bar for medically fragile plaintiffs. The opinion will likely be cited to sustain threshold claims where plaintiffs can marshal:

Comparative, level-specific imaging and change over time,
Distinctive post-accident symptom complex and functionality evidence, and
Non-conclusory expert causation opinions that address preexisting disease head-on.

Complex Concepts Simplified

Serious injury (Insurance Law § 5102[d]): A defined set of injury categories (e.g., death, fracture, permanent or significant limitations, or a 90/180-day impairment) that allows a plaintiff to recover non-economic damages in a motor vehicle accident case.
90/180-day rule: A plaintiff qualifies if a medically determined, non-permanent injury prevents them from performing substantially all of their usual and customary daily activities for at least 90 days during the 180 days immediately following the accident.
Myelopathy: Injury/dysfunction of the spinal cord, often due to compression; can cause weakness, gait disturbance, and other neurologic deficits. It is distinct from mere degenerative disc changes; its onset and level can be critical to causation.
Spinal stenosis: Narrowing of the spinal canal; when severe, it can compress the cord or nerves. Progression at a specific vertebral level (e.g., C2–3) can be linked to trauma if imaging and clinical course support it.
Osteomyelitis: Bone infection; prior cervical osteomyelitis can complicate the spine but does not rule out accident-induced aggravation or new pathology.
Prima facie showing: The moving party’s initial burden on summary judgment to produce evidence that, if uncontradicted, would entitle it to judgment as a matter of law.
Burden shifting and causation: In threshold cases, once a defendant shows lack of serious injury or lack of causation (e.g., preexisting conditions), the plaintiff must counter with admissible medical proof explaining why current symptoms are not attributable solely to preexisting disease and, where relevant, why any treatment gaps occurred.
Acceleration/hastening of death: A tortfeasor remains liable if their negligence advances a plaintiff’s preexisting fatal condition, even if the plaintiff might have died later from disease alone (McCahill rule).

Additional Observations

Timeline note: The opinion references an August 26, 2019 myelogram for Moore, but he died on May 26, 2019. Elsewhere, the decision cites April 26, 2019 myelogram and May 6, 2019 MRI, consistent with the surgical chronology. The August date appears to be a typographical error; the analysis proceeds on the April/May 2019 imaging and surgery sequence.
Scope of decision: The court decides only whether triable issues preclude summary judgment. It does not determine ultimate causation, damages, or liability; those are for the jury. Lumbar spine claims were dismissed below and are not at issue on appeal (see fn. 1).

Conclusion

Moore v. Maley is a consequential First Department decision clarifying that even with overwhelming comorbidities, plaintiffs can survive the serious-injury summary judgment hurdle where they present integrated, level-specific medical proof linking post-accident myelopathy and stenosis progression to the trauma, corroborated by stark functional decline and ongoing treatment. The case enforces core Pommells principles—requiring defendants to meet a rigorous prima facie burden and plaintiffs to offer targeted, comparative medical explanations that confront preexisting disease head-on. It also reiterates that acceleration of decline or hastening of death remains compensable under McCahill, and that defense motions must engage every pleaded injury site.

Key takeaways:

Level-specific comparative imaging and coherent expert analysis can create triable causation issues even in medically complex plaintiffs.
“Different modalities” of post-accident care can explain treatment gaps and sustain causation.
Failure to address all claimed injuries, and credible 90/180-day proofs, will defeat threshold motions.
“Inevitable decline” does not erase liability for hastening or aggravating a preexisting condition.

By affirming the denial of summary judgment, the court ensures that a jury—not the motion court—will resolve the nuanced medical causation questions at the heart of this case.

Case Details

Court: Appellate Division of the Supreme Court, First Department (Renwick, P.J., Manzanet-Daniels, Higgitt, Rosado, Michael, JJ.)
Decision Date: October 2, 2025
Docket: Index No. 22507/18; Appeal No. 4240; Case No. 2024-02148
Disposition: Order denying summary judgment (in relevant part) affirmed, without costs.
Opinion by: Michael, J.