GMR Wins New York UM Hearing on Serious Injury Threshold, Despite Significant Treatment and Injections

GMR Senior Counsel Ann Henriksen prevailed in a UM Hearing on behalf of the insurer. The applicant made a claim for uninsured motorist coverage for injuries she alleged she sustained to her left shoulder, cervical spine and lumber spine as a result of a motor vehicle accident. The claimant underwent physical therapy, chiropractic, and acupuncture treatments three times a week, as well as several trigger point injections to her cervical and lumbar spine. 

Ann argued that the claimant did not meet any of the categories of the Serious Injury Threshold as delineated in the law.  The applicant provided no objective evidence to sustain her allegation that she lifted weights and did high-impact cardiovascular exercises three times a week before the accident. Additionally, she argued that if the claimant exercised as she alleged, then the MRI of the left shoulder reflecting tendinosis is due to repetitive stress injury and not causally related.  Lastly, the objective evidence showed two bulges in her cervical spine and two in her lumbar spine, neither meeting the threshold.

The arbitrator found, concerning the categories of permanent consequential limitation of use of a body organ or member and significant limitation of use of a body function or system, the evidence did not adequately establish significant limitations for a sufficient period. Additionally, with regard to the category of an injury that prevents a claimant from performing substantially all of the material acts that constituted her usual daily activities for at least 90 of the 180 eighty days immediately following the accident, the arbitrator saw no actual finding that the claimant was disabled.

The claim was denied in its entirety.