Gaps in Treatment After a New York Car Accident: Why Stopping Early Can Cost You the Case
You went to therapy three times a week for a while. Then work got busy, or the co-pays added up, or you simply started feeling a bit better. Two months went by. Now the insurance company is offering almost nothing and your lawyer looks concerned.
That gap is why. In New York it is not a small detail — it is one of the most reliable ways a legitimate injury claim gets dismissed before a jury ever hears it.
What New York’s Highest Court Actually Requires
The controlling case is Pommells v Perez, 4 NY3d 566 (2005). The Court of Appeals held that a plaintiff claiming serious injury “who terminates therapeutic measures following the accident, while claiming serious injury, must offer some reasonable explanation for having done so.”
Read that carefully. The burden is on you. A gap is not automatically fatal — the Court was explicit that it is not dispositive — but silence about it is. In Pommells itself, the plaintiff stopped treating after roughly six months and offered no explanation, and the case was dismissed.
Why Insurers Look for It First
A gap gives the defense a simple, intuitive story: she stopped going because she got better. It requires no expert, no surveillance, and no medical argument. It is the cheapest defense available, which is exactly why defense firms comb your records for it before anything else.
It also undermines the two threshold categories that carry most soft-tissue and disc cases — significant limitation and permanent consequential limitation — because both depend on a documented, continuing condition.
How Long Should Treatment Continue?
There is no magic number of visits or months, and any article that gives you one is guessing. The honest answer is that treatment should continue until one of two things happens:
- You recover, or
- You reach maximum medical improvement — the point at which your doctor concludes further treatment will not meaningfully improve your condition
Three months of physical therapy is a common milestone because many carriers schedule an IME around then, and because insurers often treat it as the point where they expect a soft-tissue injury to have resolved. It is not a legal threshold. What matters is that the stopping point was a medical decision documented by a physician, not a scheduling decision made by you.
The distinction that decides cases: “My doctor discharged me at maximum medical improvement” is a complete answer. “I just stopped going” is not. Same date, same records — entirely different outcome.
Explanations Courts Have Accepted
| Reason | What makes it work |
|---|---|
| No-fault benefits were cut off | The denial letter. This is common and persuasive — see our guide to the no-fault IME cutoff. |
| Reached maximum medical improvement | A physician’s note stating further therapy would not help. |
| Could not afford continued care | Credible testimony plus the absence of coverage. Tell your attorney early. |
| Treatment shifted to a home exercise program | Documented in the chart as a prescribed transition, not an assumption. |
| Pregnancy, surgery, or an unrelated illness intervened | Contemporaneous medical records covering the period. |
What these have in common is documentation created at the time. An explanation offered for the first time at a deposition two years later carries far less weight than a line in a chart.
If You Have Already Stopped
The situation is often recoverable, but it needs attention now rather than at settlement time.
- Tell your attorney the real reason. Financial hardship and a no-fault cutoff are both legitimate and common. Neither is embarrassing, and both are usable.
- Go back if you still have symptoms. Resuming care is better than a permanent stop, and re-establishes the ongoing nature of the condition.
- Ask your doctor for a narrative report addressing the gap and the causal relationship to the crash.
- Gather the paperwork — denial letters, discharge instructions, bills you could not pay.
The Other Side of the Coin
Treating excessively, at a clinic that runs every patient through an identical protocol regardless of injury, is its own problem. Defense carriers recognize those billing patterns and discount them. Consistent, medically-directed care from providers treating you as an individual is worth considerably more than a high visit count.
For how this feeds into valuation, see our guides on non-surgical back and neck settlements and how pain and suffering is valued in New York.
Worried a gap has damaged your claim?
It is usually fixable if addressed early. Tell us what happened — free consultation, no obligation.
Frequently Asked Questions
How long is too long for a gap in treatment?
There is no fixed cutoff in New York law. Courts look at whether the interruption was explained rather than counting days. A short unexplained gap can be more damaging than a long one you can account for with a denial letter or a discharge note.
Is three months of physical therapy enough for a settlement?
It depends entirely on your injury and what your doctors say. Three months is a common point for insurers to schedule an IME and push back on continued care, but it is not a legal threshold. Treatment should continue until you recover or reach maximum medical improvement, as documented by a physician.
Will a gap in treatment automatically kill my case?
No. In Pommells v Perez the Court of Appeals made clear a gap is not dispositive — but it does require a reasonable explanation. Cases are lost when the gap goes unexplained, not merely because it exists.
What if my no-fault benefits were cut off and I could not pay?
That is one of the strongest explanations available, and it is common. Keep the denial letter. Inability to continue paying for care after a cutoff is a recognized reason for stopping treatment, but it has to be raised and documented.
Should I go back to treatment if I stopped months ago?
If you still have symptoms, generally yes. Resuming care documents that the condition persists and is better than leaving a permanent stop in the record. Discuss it with your doctor and tell your attorney what happened during the gap.
Does a gap affect the 90/180-day category?
It can. That category requires proof your usual activities were prevented for at least 90 of the first 180 days after the crash, and a gap during that exact window is particularly harmful because it suggests you had resumed normal activity.
Disclaimer: This article is general information about New York law, not legal advice, and reading it does not create an attorney-client relationship. It is not medical advice, and decisions about your treatment should be made with your physician. Outcomes depend on the specific facts, records, and evidence in each case. Prior results do not guarantee or predict a similar outcome. Attorney advertising.
