Toure sought damages for neck and back injuries sustained when his vehicle was hit by a car driven by Susan Duncan and owned by Avis. He alleged two No-Fault Law serious-injury categories: permanent consequential limitation of use of a body organ or member, and significant limitation of use of a body function or system.
Avis moved for summary judgment. Its neurologist, Dr. Ralph Olson, examined Toure, reviewed his records, and concluded that no objective abnormalities or residual neurologic disability remained. In opposition, Toure submitted his affidavit and an affirmation from his treating neurosurgeon, Dr. Joseph Waltz. Waltz relied on MRI and CT results showing bulging and herniated discs, observed lumbar muscle spasms and reduced motion, and connected Toure's difficulty sitting, standing, walking, bending, and lifting heavy boxes to the accident injuries.
Supreme Court granted Avis summary judgment, and the Appellate Division affirmed over a two-Justice dissent. The Court of Appeals reversed, holding that Toure's evidence created a triable issue of serious injury. In the same combined opinion, the Court also resolved Manzano v. O'Neil and Nitti v. Clerrico, applying the same requirement of objective medical proof to other serious-injury claims.
Issue #1
Whether a plaintiff may establish a permanent consequential or significant limitation under Insurance Law § 5102(d) through a qualitative medical assessment rather than a numeric percentage loss of range of motion.
Holding
Yes. A numerical measurement is not indispensable if an expert gives an objectively grounded qualitative assessment that compares the plaintiff's limitations with the normal function, purpose, and use of the affected body part.
Reasoning
New York's No-Fault Law is intended to screen out insignificant and frivolous automobile-injury claims. Accordingly, subjective complaints of pain alone cannot establish a serious injury; the claim must rest on objective medical proof.
A doctor may quantify limitation through a percentage loss of range of motion, but that is one acceptable method rather than an exclusive rule. A qualitative description can also demonstrate medical significance when it explains how the injury limits the normal use of the relevant organ, member, function, or system.
The objective foundation requirement makes the expert's conclusion capable of meaningful testing. A conclusion supported by diagnostic evidence and clinical observations can be cross-examined, rebutted by competing expert testimony, and evaluated by the factfinder; an unsupported opinion is speculative and does not serve the statute's gatekeeping purpose.
Issue #2
Whether Toure's submissions raised a triable issue that he sustained a permanent consequential limitation or significant limitation of use.
Holding
Yes. Toure offered sufficient objective medical evidence and a sufficiently specific qualitative account of his limitations to defeat Avis's motion for summary judgment.
Reasoning
Avis met its initial summary-judgment burden through Dr. Olson's examination and opinion that Toure had no objective neurologic abnormality or residual disability. The burden therefore shifted to Toure to produce admissible evidence creating a factual dispute on the serious-injury threshold.
Dr. Waltz supplied more than Toure's subjective reports. He relied on MRI and CT testing that showed bulging and herniated discs, personally observed paraspinous muscle spasms, and found decreased lumbar range of motion. Those materials provided an objective medical basis for his opinion.
Although Waltz did not state a precise percentage of lost spinal motion, he adequately described the qualitative nature of Toure's condition in relation to ordinary bodily use. He explained that the disc pathology caused continuing difficulty with sitting, standing, walking, and lifting heavy objects at work.
Viewed favorably to Toure, the asserted neck and back limitations were not merely minor, mild, or slight. Because the evidence could support a finding of either a permanent consequential limitation or a significant limitation, summary judgment was improper.
Issue #3
Whether Manzano's proof supported the jury's finding of a permanent consequential limitation despite the absence of a numerical range-of-motion measurement and the age of her physician's examination.
Holding
Yes. The treating physician's testimony, supported by MRI films and tied to Manzano's functional limitations, furnished legally sufficient proof for the jury.
Reasoning
Manzano's orthopedic surgeon testified that MRI films showed two herniated cervical discs caused by the rear-end collision. The films were admitted into evidence, and the physician also based his opinion on his physical examination and her clinical history.
The physician connected the disc injuries to Manzano's inability to perform normal tasks, including heavy lifting, shoveling, housecleaning, carrying a vacuum, and lifting her children. This qualitative explanation adequately described the medical significance of the limitations without a numeric range-of-motion figure.
The physician testified that the injuries were permanent when he last examined Manzano and that further treatment would not help. The defendant offered no contrary medical proof, so the fact that the examination occurred more than four years before trial did not require setting aside the verdict.
Issue #4
Whether Nitti presented objective medical proof sufficient to establish a medically determined injury or impairment under the 90/180-day serious-injury category.
Holding
No. Her chiropractor's testimony did not provide an adequate objective basis for the claimed injury, so the verdict should have been set aside and the complaint dismissed.
Reasoning
The 90/180-day category does not use the terms significant or consequential, but it still requires objective proof of a medically determined, nonpermanent injury or impairment. Nitti therefore could not rely solely on her own account of pain and restricted activities.
A chiropractor's observation of a muscle spasm can be objective proof, but only if the spasm is objectively ascertained. Nitti's chiropractor said he detected a spasm but did not identify a test or other method used to induce or verify it.
The chiropractor also conceded that his range-of-motion tests depended at least partly on Nitti's reports of pain. That testimony did not independently establish an objective limitation.
Finally, the chiropractor merely mentioned an MRI report without testifying to its findings, introducing the report into evidence, or explaining how the underlying MRI film supported his diagnosis. Unlike the proof in Toure and Manzano, this record did not permit effective testing of the expert's conclusion through cross-examination or contrary evidence.