Causation and “Serious Injury” Are Distinct Threshold Inquiries Under Insurance Law § 5102(d): Range-of-Motion Proof Cannot Cure a Causation Failure

1. Introduction

Case: Fernandez v Sukhdeep, 2026 NY Slip Op 00422 (App Div, 1st Dept Jan. 29, 2026).
Parties: Plaintiff-Respondent Randy Fernandez (and plaintiff Jose Peralta) versus defendants-appellants (including driver Singh Sohal Sukhdeep and related entities).
Posture: Defendants appealed from an order denying summary judgment on New York’s No-Fault “serious injury” threshold. The Appellate Division reversed and granted dismissal.

Accident and claimed injuries: Plaintiff alleged left shoulder injury and cervical/lumbar spine injuries from a December 12, 2020 motor vehicle accident, invoking categories of “permanent loss of use,” “significant limitation,” “permanent consequential limitation,” and the “90/180” category under Insurance Law § 5102(d).

Key issues: (i) whether plaintiff’s spinal complaints were causally related to the 2020 accident or instead to degeneration and a 2013 motor vehicle accident; (ii) whether the shoulder condition met the “serious injury” threshold and was causally connected; and (iii) how “gap/cessation of treatment” and appellate issue-preservation principles affect summary judgment.

2. Summary of the Opinion

The First Department held that defendants made a prima facie showing that plaintiff’s cervical and lumbar spine conditions were degenerative and/or attributable to a prior 2013 accident, not causally related to the 2020 accident. Plaintiff failed to rebut causation with competent medical proof—his subjective belief of recovery and conclusory treating opinions that ignored the prior accident were insufficient.

As to the left shoulder, defendants’ orthopedist’s essentially normal exam established prima facie absence of a “serious injury” (and defendants also prevailed on a separate point: plaintiff’s cessation of treatment severed causation absent a reasonable explanation). The court dismissed the 90/180-day claim as well.

A central doctrinal clarification in the decision is that seriousness and causation are distinct inquiries under Insurance Law § 5102(d): a defendant may satisfy its prima facie burden by negating either one, and the plaintiff’s responsive proof must match the ground on which defendants met their burden.

Dissent (Mendez, J.): would have affirmed denial of summary judgment, emphasizing alleged inconsistencies in defendants’ range-of-motion findings and viewing plaintiff’s medical records and surgeries as raising triable issues; the dissent also argued defendants waived the “gap in treatment” argument by raising it first in reply.

3. Analysis

3.1. Precedents Cited

A. Degeneration / prior accident and the need to address alternative causes

  • Massillon v Regalado and Santos v UM Cab Corp.: used by the majority to support that a defendant can meet its prima facie burden by showing claimed spinal findings are degenerative rather than traumatically caused.
  • Brewster v FTM Servo, Corp. and Bobbio v Amboy Bus Co. Inc.: reinforce that prior injuries to the same body parts can defeat causation where the record supports an alternative, non-accident explanation.
  • Chintam v Fenelus: invoked for the proposition that plaintiff’s own medical records may be sufficiently persuasive to shift the burden to plaintiff to explain causation.
  • Grate v Rodrigues, Deneen v Bucknor, Williams v Laura Livery Corp., Diakite v PSAJA Corp. (and contrast Jenkins v Livo Car Inc.): collectively stand for the principle that where defendants attribute symptoms to degeneration or prior injury, plaintiff must provide a competent medical explanation addressing why the subject accident—rather than the preexisting condition—is the cause of the claimed limitations.
  • Dorrian v Cantalicio and Chintam: establish that a plaintiff’s subjective belief of recovery is not competent medical evidence of causation.
  • Santos, Moctezuma v Garcia, and Thompson v Bronx Merchant Funding Servs., LLC: treating opinions that are conclusory—especially where they do not acknowledge or analyze a prior accident or relevant records—do not raise a triable causation issue.

B. The “serious injury” inquiry is distinct from causation

  • Lindo v Brett: cited for the key distinction that “serious injury” and causation are separate questions; a defendant need not disprove both at the prima facie stage.

C. Shoulder “serious injury” and minor measurement anomalies

  • Hamilton v Marom and Cano v U-Haul Co. of Ariz.: support that a normal orthopedic exam can establish prima facie lack of serious injury for limitation categories.
  • Cardwood v R&F Limousine Inc. and Blumenberg v Lora: support the majority’s view that a minor deficit in one plane does not necessarily defeat prima facie showing, particularly where function is deemed normal and symmetry exists with the uninjured side.

D. Cessation/gap in treatment and explanation requirement

  • Pommells v Perez: central authority for the rule that a plaintiff claiming serious injury who ceases treatment must offer a reasonable explanation; otherwise the cessation may undermine causation.
  • Pastora L. v Diallo: applied to find plaintiff’s explanation inadequate where records recommended continued treatment.

E. Appellate issue framing/preservation and party presentation

  • Misicki v Caradonna: used to justify reaching the treatment-gap issue because defendants raised it in their opening appellate brief and plaintiff responded on the merits (i.e., the court was not “blindsiding litigants” with a rationale never raised by the parties).

F. 90/180-day category

  • Tarjavaara v Considine: cited for dismissal of the 90/180 claim where the record demonstrates the lack of a causally related serious injury.

G. Dissent’s additional authorities

The dissent relied heavily on cases treating internal inconsistencies in defense IME range-of-motion findings as fatal to prima facie proof, and on waiver principles when issues are raised first in reply: Santos v New York City Tr. Auth., Feaster v Boulabat, Bernardez v Babou, Torres v Knight, McCree v Sam Trans Corp, Frias v James, Glynn v Hopkins, Jeffers v Style Tr. Inc., Beazer v Webster, Paterson v Rivera, Pouchie v Pichardo, Lamb v Rajinder, Toure v Avis Rent a Car Sys., Spencer v Golden Eagle, Inc., Vazquez v Almanzar, Perez-Vargas v Aarron, Curet v Kuhlor, Linton v Nawaz, Yuen v Arka Memory Cab Corp., Blake v Cadet, Brown v Achy, Vaughan v Leon, Nwanji v City of New York, Ocean v Hossain, Bianchi v Mason, Correa v Saifuddin, Steele v Santana, Silverman v MTA Bus Co., and Skeete v Greyhound Lines, Inc ..

3.2. Legal Reasoning

A. How defendants won on the spine: MRI comparison + prior accident + degeneration

Defendants’ experts compared MRIs from the 2013 accident with post-2020 studies and opined that the later findings reflected the “normal progression” of preexisting degenerative conditions. That comparative imaging analysis—paired with evidence of prior injury to the same body regions—allowed defendants to negate causation at the prima facie stage.

The burden then shifted to plaintiff to provide a medical explanation differentiating the 2020 accident from the preexisting conditions. The majority found plaintiff’s opposition failed because it relied on (i) plaintiff’s subjective belief that he had recovered and (ii) conclusory treating opinions that did not acknowledge the prior accident or review its records.

B. The decision’s doctrinal clarification: seriousness vs. causation are distinct

The court explicitly separated the threshold inquiries: whether an injury is “serious” under Insurance Law § 5102(d) is distinct from whether it was caused by the accident. A defendant may obtain summary judgment by negating either element; accordingly, evidence directed only to “seriousness” (such as quantified range-of-motion deficits) does not create an issue of fact if the plaintiff has not raised a triable issue on causation.

This is the opinion’s most practically significant rule: it polices the common litigation move of attempting to defeat a causation-based summary judgment motion solely by proving objective limitations, without medically addressing the alternative cause shown by the defense.

C. How defendants won on the shoulder: normal exam + cessation of treatment

Even though the majority acknowledged flaws in Dr. Bazos’s causation discussion (including an erroneous assumption about imaging dates), defendants still prevailed because (i) the physical exam was sufficient to show no qualifying serious limitation and (ii) defendants independently relied on Pommells v Perez to argue that treatment cessation severed causation absent a reasonable explanation.

The court rejected plaintiff’s proffered explanation (“maximum benefit”) because contemporaneous records repeatedly recommended continued treatment, including by pain management.

D. Appellate procedure overlay: reaching the gap-in-treatment issue

The dissent viewed the “gap in treatment” argument as waived because it was raised for the first time in reply below. The majority sidestepped strict motion-practice waiver by emphasizing what occurred on appeal: defendants raised the issue in their opening appellate brief, plaintiff responded substantively, and thus the rationale was fairly before the court under Misicki v Caradonna.

E. 90/180-day claim

Once the court concluded there was no causally related serious injury, it dismissed the 90/180 claim as well, citing Tarjavaara v Considine.

3.3. Impact

  • Sharper burden-matching in summary judgment practice: The decision underscores that once defendants meet prima facie burden on causation (degeneration, prior accident, comparative imaging), plaintiffs must respond with a medical causation analysis—ROM deficits or seriousness proof alone will not do.
  • Comparative MRI review is emphasized: The opinion highlights the persuasive force of side-by-side MRI comparisons (pre-accident/prior-accident versus post-accident) as a causation tool, especially where radiology impressions can be framed as progression rather than trauma.
  • Treating-doctor affidavits must confront adverse history: Conclusory causation opinions that fail to acknowledge prior accidents or review earlier records are especially vulnerable to dismissal.
  • Pommells remains a decisive “second path” to dismissal: Even if a plaintiff contests seriousness or points to imaging/surgery, unexplained treatment cessation may independently break the chain of causation.
  • Appellate issue framing matters: The majority’s use of Misicki v Caradonna signals that litigants should address “reply-raised” points if they appear in appellate briefing, because substantive engagement can make the issue “properly before” the court.

4. Complex Concepts Simplified

“Serious injury” (Insurance Law § 5102(d))
New York’s No-Fault law bars most lawsuits for pain and suffering unless the plaintiff proves an injury falls within statutory categories (e.g., significant limitation, permanent consequential limitation, 90/180).
Causation vs. seriousness
“Seriousness” asks: is the injury significant enough under the statute? “Causation” asks: did this accident cause the injury (as opposed to degeneration or a prior accident)? This case stresses they are separate—proof of one does not automatically prove the other.
Prima facie burden on summary judgment
The moving party must first make a legally sufficient showing. Here, defendants satisfied that burden by showing an alternative cause (degeneration/prior accident) for spine complaints and lack of serious limitation for the shoulder.
Degenerative findings
Age- or wear-related changes visible on imaging. If defendants show the imaging looks like degeneration (or continuation of earlier findings), plaintiff must medically explain why the accident nonetheless caused the claimed symptoms/limitations.
Gap/cessation of treatment (Pommells rule)
If a plaintiff stops treatment but still claims a serious injury, courts often require a reasonable explanation. Without one, the stoppage can undermine the claim by suggesting the injury resolved or is not accident-related.
90/180 category
A non-permanent, medically determined injury preventing performance of “substantially all” usual activities for at least 90 of the first 180 days post-accident.

5. Conclusion

Fernandez v Sukhdeep reinforces a stringent, practice-shaping principle in No-Fault threshold litigation: serious injury and causation are distinct inquiries, and once defendants negate causation—particularly through comparative imaging and prior-accident evidence—plaintiffs must respond with competent medical proof that directly confronts the claimed alternative causes. Range-of-motion deficits and other seriousness-oriented findings cannot substitute for a causation analysis.

The decision also shows the continuing force of Pommells v Perez in requiring a credible explanation for treatment cessation, and it illustrates that appellate briefing choices (and substantive responses) can bring otherwise disputed issues squarely before the court.