Opinion
016626/06.
Decided June 24, 2008.
Sackstein, Sackstein Lee, LLP, Garden City, NY, Attorneys for Plaintiff.
Law Office of John P. Humphreys, By: Michael T. Reilly, Esq., Melville, NY, Attorney for Defendant.
The defendants move for summary judgment dismissing the complaint on the grounds that the plaintiff has not sustained a serious injury as defined in Insurance Law § 5102(d), and that the demand for non-economic loss is barred by § 5104(a). The motion is denied.
The relevant statutory provisions are as follows:
§ 5104. Causes of action for personal injury
(a) Notwithstanding any other law, in any action by or on behalf of a covered person against another covered person for personal injuries arising out of negligence in the use or operation of a motor vehicle in this state, there shall be no right of recovery for non-economic loss, except in the case of a serious injury, or for basic economic loss. The owner, operator or occupant of a motorcycle which has in effect the financial security required by article six or eight of the vehicle and traffic law, or which is referred to in subdivision two of section three hundred twenty-one of such law, shall not be subject to an action by or on behalf of a covered person for recovery for non-economic loss, except in the case of a serious injury, or for basic economic loss injuries, the amount of his basic economic loss shall not be recoverable.
The term "serious injury" is defined as follows:
§ 5102. DefinitionsIn this chapter:(d) "Serious injury" means a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system; or a medically determined injury or impairment of a non-permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person's usual and customary daily activities for not less than ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.
In his bill of particulars the plaintiff asserts that he suffered injuries satisfying the "permanent consequential limitation of use of body organ or member," "significant limitation of use of body function or system," and "90/180" categories. The affected parts of the body are alleged to be the cervical and lumbosacral spines, right knee and shoulder, and right hand. All are alleged to be the result of a "rear end" collision on the Grand Central Parkway in the vicinity of 188th Street on January 20, 2006.
A defendant may raise an issue as to the seriousness of the plaintiff's injuries by sworn statements of their own examining physician, or the unsworn reports of the plaintiff's treating physician. Pagano v. Kingsbury, 182 AD2d 268 (2d Dept. 1992). If sufficient to raise the serious injury issue, the burden shifts to the Plaintiff to submit prima facie evidence in admissible form to support the claim. Licari v. Elliot, 57 NY2d 230 (1982). To suffice, the affirmation or affidavit must be based upon the physician's own examinations, tests, and observations and record review, and not simply on the plaintiff's subjective complaints. Toure v. Avis Rent A Car Sys., 98 NY2d 345 (2002).
The plaintiff was examined by physicians on behalf of the defendants, and his medical records referable to the claimed injuries were reviewed. John C. Killian, M.D. examined Han on 8/20/07. The history and response to questions were elicited with difficulty because of Han's limited use of English. But Dr. Killian also had evaluations of Dr. Pahng, plaintiff's own treating physician; an acupuncture evaluation; MRI reports, an orthopedic evaluation by Paul M. Brisson, M.D; an evaluation and operative report from NYU Hospital for Joint Diseases where plaintiff under went a cervical discectomy in 2006, performed by Dr. Yong H. Kim; an orthopedic consultation report from Dr. David T. Neuman; an operative report from New York Hospital Medical Center of Queens concerning surgery in 2007; and radiology reviews done by Dr. Sheldon B. Feit on behalf of the defendants.
After noting these reports, Dr. Killian set forth the results of his examination of Han. The plaintiff reported daily neck pain, right arm weakness, and pain in the mid and lower areas of his back. Muscle groups were symmetrical, with sensation different in the right upper extremity as compared to the left. There was no evidence of a limp on ambulation.
The shoulders evidenced well-healed arthroscopic portals from surgery on 5/7/07. Range of motion testing showed forward flexion of the right shoulder limited to 160 § as opposed to 180 § of the left, and external rotation of the right was limited to 60 § versus 80 § of the left. The lumbar examination was unremarkable other than a complaint of pain with full flexion of the back and left lateral flexion, with no objective signs of restriction of motion or muscle spasm. He finds mild cervical impairment consistent with surgery to remove the herniated disc at C5-6 with fusion, but that the restriction is of minimal functional significance.
Mauro M. Cataletto, M.D., an orthopedist, also examined the plaintiff on behalf of defendants and reports his findings by report dated October 17, 2007. Han complained of pain in his neck, weakness of both upper extremities, the right more than the left, and constant pain in his lower back. Dr. Cataletto concluded that Han sustained injuries to his cervical spine, lumbar spine, right knee, right shoulder and right hand at the time of the accident. However, he found no limitation of range of motion of the cervical spine at the time of the examination with no neurological deficit.
He reports the MRI readings of Dr. Feit, on behalf of the Defendants, which find no traumatic injuries, only degenerative changes to the cervical discs. As to the lumbar spine, he concludes that Han suffered, at most, soft tissue injury to the lumbar spine, and the MRI findings are consistent with a long-standing, pre-existing degenerative process. The same findings of soft tissue injury were found for his right knee and right hand. The examination of the right shoulder revealed symmetrical range of motion in both shoulders. He cannot correlate the present symptoms to the accident of 1/20/06.
Also submitted are affirmed reviews of films by Dr. Feit, on behalf of the defendants. There were no discernible abnormalities to the cervical spine shown on the 1/24/06 plain film. The plain film examination of the thoracic spine of 1/24/06 was normal, and shows no abnormalities. The plain film examination of the lumbosacral spine shows osteophyte formation, evidence of degenerative changes, and no abnormalities causally related to the accident. The films of the left shoulder on 1/24/06 and an MRI of 2/20/06 showed no abnormalities. Mild impingement on the supraspinatus muscle secondary to hypertrophic changes, which are degenerative in nature. The right shoulder plain film study of 1/24/06 shows no abnormalities, while the MRI of 2/17/06 was classified as "essentially normal" with no evidence of impingement on the supraspinatus muscle at the level of the acromioclavicular joint or coracoacromial arch. The film of the left hand shows evidence of a prior fracture of the distal radius. Plain film study of the right knee was normal as was the MRI of 2/21/06.
The defendants also submit a copy of the plaintiff's deposition transcript in support of their contention that he did not sustain an injury that prevented him from performing substantially all of the material acts that constitutes his normal and customary activities.
Based on the foregoing, the Court concludes that the defendants have made out a prima facie case that the plaintiff did not sustain a "serious injury" as that term is defined by the Insurance Law, thereby shifting the burden to the plaintiff to present evidence placing this in issue. However, the Court finds that the plaintiff's burden has been met in this case.
On the day following the accident, Han visited a physician, Sung J. Pahng, M.D., who has submitted an affirmation chronicling his professional contacts with Han. On the first visit Dr. Pahng found limited range of motion as compared to normal of both the cervical and lumbosacral spine. The straight leg raise test was positive, and he determined that Han had partial disability as he was limited from performing all normal daily activities. MRI's on 2/15/06 revealed multiple disc herniations at L4-5, impinging on the anterior aspect of the spinal canal, and multiple posterior disc herniations at C3-4, C5-6, with the latter impinging on the anterior aspect of the spinal cord. An MRI of the right shoulder on 2/17/06 showed acromium impingement on the suprastinatus muscles. On March 3, 3006 Dr. Pahng performed an EMG which indicated left radiculopathy at the C-6 level.
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He continued to see Han through February 2007, and throughout that time the patient continued to experience loss of range of motion of both the cervical and lumbar spine, with muscle spasm in the latter area. On 5/3, 5/10 and 5/17/06 he gave Han cervical epidural injections at the C5-6 level. Because of continued complaints of shoulder pain there was an orthopedic consultation with Dr. Neuman, who diagnosed a supraspinatus tendon strain and shoulder derangement, and recommended physical therapy. A third orthopedic consultation with Dr. Brisson, produced a diagnosis of cervical radiculopathy secondary to large central disc herniation at C 6, and a recommendation for a cervical discectomy.
On 8/17/06 Han underwent the recommended surgery, performed by Dr. Kim, at NYU Hospital for Joint Diseases. The pre-operative and post-operative diagnoses were cervical radicular syndrome status post-motor vehicle accident, resulting in herniated nucleus pulposus of cervical spine, at the C5-6 level.
Han also underwent right shoulder arthroscopic acrimonoplasty and manipulation under anesthesia on 5/24/07. An affidavit of a physical therapist, Minsuk Kwak Kim, P.T., annexed to which are copies of the records for Han, is also included in the opposition papers. The records reflect limitations in range of motion testing of the right shoulder and cervical spine on each visit.
Dr. Pahng opines that throughout the course of treatment, and up to his recent examination of Han on April 28, 2008, the patient was permanently disabled and unable to perform the functions associated with his normal daily activities. These limitations have prevented him from performing substantially all the material acts which constituted his usual daily activities for at least ninety days of the first one hundred-eighty days following the accident.
The physical examination by Dr. Pahng of Han in April, 2008 revealed a 58% loss of cervical extension, 40% loss of cervical flexion, and 44% loss of lateral bending. The examination of the lumbar spine showed a 20% loss of extension, and a 33% loss of flexion. These losses are measured as against the normal ranges. Dr. Pahng classifies these findings as confirmatory of the fact that Han suffers permanent effects and residuals of cervical herniated discs and cervical radiculopathy, and is status post-cervical discectomy and fusion, lumbar disc herniation and right shoulder impingement syndrome. He concludes that this is a permanent injury to his musculoskeletal system and will prevent him from performing all activities of daily living without pain.
He also states his opinion that the injuries are not the result of a preexisting degenerative condition and that the pain and restrictions of motion did not hamper Han before the motor vehicle accident. He disagrees with the opinion of the defendants' radiological report to the effect that the disc herniations were a pre-existing condition; but even if that were so, Han was asymptomatic until the date of the accident. His medical opinion is that Han has suffered a permanent partial disability with significant limitation of the use of his cervical and lumbar spine, and right shoulder, which restricts his ability to perform normal everyday activities.
"In order to prove the extent or degree of physical limitation, and expert's designation of a numeric percentage of a plaintiff's loss of range of motion can be used to substantiate a claim of serious injury". Toure v. Avis Rent A Car Sys., supra, at 350, citing Dufel v. Green, 84 NY2d 795, and Lopez v. Senatore, 65NY2d 1017. "An expert's qualitative assessment of a plaintiff's condition also may suffice, provided that the evaluation has an objective basis and compares the plaintiff's limitations to the normal function, purpose and use of the affected body organ, member, function or system." Id.
Further, the mere existence of a preexisting condition does not automatically preclude a determination of serious injury. Where such conditions are quiescent, and the patient is asymptomatic, the aggravation of those conditions by the trauma of an automobile collision, if supported by the requisite objective findings, may constitute serious injury. Mack v. Pullum , 37 AD3d 1063 (4th Dept. 2007); Talcott v. Zurenda , 48 AD3d 989 (3d Dept. 2008); Bolowske v. Eastman Kodak Co., 288 AD2d 851 (4th Dept. 2001).
The affirmation of the Plaintiff's physician, based upon six physical examinations over the course of 17 months beginning shortly after the accident, which included findings of limited ranges of motion in the cervical and lumbar spine, and right elbow, which assigned specific percentages and compared them to the normal range was adequate to meet the minimal standard to substantiate a claim of "serious injury". Silva v. Vizcarrondo, 31 AD3d 392 (1st Dept. 2006). This satisfies the well-established standard that the limitation must be more than slight, and be supported by medical proof based on credible medical evidence of an objectively measured and quantified medical injury or condition, Gaddy v. Eyler, 79 NY2d 678 (1987); Licari v. Elliot, 57 NY2d 230 (1982); see also Picott v. Lewis, 26 AD3d 319 (2d Dept. 2006).In the instant case, the plaintiff's proof thus is sufficient even assuming the presence of pre-existing degenerative disease, as the restrictions may be considered an exacerbation of a previously quiescent condition.
The determinations that the X-Rays and MRI's showed pre-existing degenerative changes, which are not the result of trauma, may well be accurate. But where an individual with degenerative spinal changes is asymptomatic until the time of an accident, he or she may have sustained a "serious injury". In Talcott v. Zurenda , 48 AD3d 989 (3d Dept. 2008) the Court affirmed a monetary award to a Plaintiff who had been struck in the rear by the Defendant's vehicle. Talcott's orthopedist, Dr. Desai, testified that he diagnosed chronic cervical, throracic, and lumbar syndrome within one week of the accident. During the course of treatment over a two-year period, he qualitatively measured range of motion testing which demonstrated marked restriction of flexion, extension and rotation compared with normal results. He also opined that the previously asymptomatic degenerative condition was aggravated by the trauma of the automobile accident, and it was possible that the patient could have otherwise remained asymptomatic for the rest of his life. See also, Bolowske v. Eastman Kodak Company, 288 AD2d 851, 852 (4th Dept. 2001); Mack v. Pullum , 37 AD3d 1063 (4th Dept. 2007).
Dr. Pahng states that the limitation of use of a body function or system is significant. The defendants' examining physicians claim it is insignificant. Dr. Pahng's statement is based on objective medical findings and is not dependent on subjective complaints of pain made by Han. In addition, Dr. Pahng states that Han was unable to perform substantially all material acts of his usual daily activities for 90 of the first 180 days after the accident. Han has testified that he has not returned to his usual activity of pattern cutter in his wife's garment factory, or as a part-time golf instructor since the accident, and there has been no evidence presented to the contrary.
The foregoing is thus sufficient to defeat the motion, as the Plaintiff has raised triable questions of fact on the issues of "significant limitation of use of a body function or system", "permanent consequential limitation of a body organ or member", and an injury satisfying the "90/180" category.
Having met this threshold, it is for the trier of fact to resolve the diametrically opposed medical opinions and representations by the plaintiff regarding his limitations and recurring pain.
Accordingly, the motion to dismiss the complaint is denied.
This shall constitute the Decision and Order of this Court.