On behalf of Licatesi Law Group, LLP on Monday, March 12, 2012.

Imagine a scenario where a sixty year old man was stopped at a red light when his car was struck from behind by a vehicle traveling 10 mph. Besides the initial jolt, he felt no pain or discomfort. After surveying his vehicle and finding no damage, he felt it was best to let the other driver go without filing a police report. A few days later he started getting headaches, dizziness, and pain in his neck, back, and shoulder. He is diagnosed as suffering from whiplash and only through a course of treatment with his chiropractor is he able to find relief from his symptoms. Although he was entitled to medical benefits through his auto no-fault policy, his insurance company is now attempting to deny his healthcare benefits by alleging that his injuries did not arise from a covered accident. To add insult to injury, he lives in Brooklyn and paid over $8,000 for insurance coverage that he cannot use!

In order for injuries to qualify for no-fault benefits, those injuries must be sustained by a covered person in a covered accident. If an insurer can establish that no accident occurred and/or the injuries were not caused by the accident in question, then no benefits are due to the injured person. In the above scenario, with no police report, witnesses, evidence of physical injury or vehicle damage, the injured man gave the insurance company plenty of ammunition to argue that his injuries were not caused by a motor vehicle accident.

A common argument made by insurance companies in justifying denial of medical payments is that if there were no injuries at the scene of the accident, and no visible vehicle damage, the claimant’s injuries could not have arisen out of the subject car accident. If in addition to the proceeding there is no car accident report or witnesses other than the injured party, insurance companies may further argue that no accident occurred and the claim is fraudulent. Insurance companies intentionally ignore the fact that it is very possible for an individual to sustain severe and potentially permanent serious injuries in an auto accident where no visible damage was caused to the vehicle and the injured person’s pain did not manifest until well after the time of injury.

Whiplash often occurs in rear end collisions and delayed reactions to pain are the norm, not the exception. The rear impact causes your body to be pushed forward while your head is rocked up and back causing stretching and/or tearing of muscles, tendons, and ligaments. The muscles will then react automatically to bring the head forward, potentially causing further stretching of the muscles and vertebrae can be forced out of their normal alignment. Spinal cord and/or nerve roots in the neck can get stretched and irritated causing more pain called radiculopathy. The entire process typically occurs within ¼ of a second, precluding any voluntary or reflex motion.

When a vehicle is involved in a low speed accident it is very common that the car will show no visible signs of damage. In an attempt to reduce repair cost, insurance companies themselves lobbied to adopt crash standards mandating rear bumpers withstand a 5 mph collision into a fixed barrier. In a vehicle to vehicle crash where bumpers are lined up well, it has been estimated that the minimum speed required to cause visible bumper damage is 15 mph.

Independent studies have demonstrated that whiplash can be caused by a force as low as 2.5 mph. Insurance company sponsored studies have found the threshold for injury to be closer to 5 mph. Even accepting the insurance company findings, it is possible to be involved in an accident with a force of energy three times greater than the threshold for human injury where the vehicle will show no visible signs of damage. When the impact is not absorbed by the bumper it is transferred into the vehicle and its occupants.

More than half of whiplash injuries occur in crashes where there is little or no car damage and injured party has no subjective complaints of pain. Whiplash injuries are endemic in the United States and each year 3 million Americans will experience a whiplash related neck and back injury. Of those 3 million, 600,000 will continue to have long-term symptoms and pain. 45% of Americans with chronic neck pain can attribute it to a past car accident.

If you are injured in an auto accident in the state of New York you have a right to receive no fault benefits and treatment for your injuries arising out of that accident. Insurers practicing claim avoidance will use any means to deny you payment, including ignoring established medical evidence that severe and permanent injuries can be caused by a low impact accident. Do not assist them by failing to document an auto accident just because there is no visible vehicle damage and/or you do not believe you were injured. The last place you want to be is in pain and having your medical payments denied because your insurance company determines that your injuries did not arise out of a covered accident.