Guidelines: Granting Medical
Exemptions for Safety Belt Use

The following guidelines are issued by the Governor's Traffic Safety Committee and the New York State Department of Health. They briefly describe the legal requirements and regulations concerning a physician's issuance of a medical exemption from mandated safety belt use, medical conditions that may warrant an exemption, and recommendations for issuance.

Medical Exemptions for Safety Belt Use

The New York State Vehicle and Traffic Law (Section 1229-c) requires all front seat occupants of a motor vehicle and all other occupants under 16 years old, regardless of where they are in the vehicle, to be restrained by a safety belt. Children under the age of four must ride in safety seats. Children age four, five, or six must ride in child restraint systems. Safety seats and child restraint systems must be certified according to Federal Motor Vehicle Safety Standard 213. Note: The effective date of the requirement to use a child restraint system for a child age four, five, or six is March 27, 2005.

It also allows that this law "shall not apply to a passenger or operator with a physically disabling condition whose physical disability would prevent appropriate restraint in such safety seat or safety belt provided, however, such condition is duly certified by a physician who shall state the nature of the handicap, as well as the reason such restraint is inappropriate."

The physicians of New York State consistently support safety belt use and recognize that mortality and morbidity rates due to motor vehicle crashes are lower for properly restrained drivers and passengers than for those not properly restrained.

National experience shows that safety belts prevent or mitigate serious or fatal injuries by 50 percent.

In New York State, increased use of safety belts could prevent an estimated 300 - 400 deaths each year.

Each year, nearly 12,000 residents are hospitalized for motor vehicle crash injuries, costing NYS more than $13 million per year in medical treatment.

Despite popular misconception, less than one percent of all motor vehicle related injuries are caused by the safety belt itself - and these injuries usually occur when an unrestrained occupant would have been much more seriously injured or killed.

The New York State safety belt law does not provide categorical, specific or routine medical grounds for granting medical exemption. Each case should be decided on its own merit. A medical exemption should be granted only for a valid medical reason.

Because the benefits of using a safety belt are well documented, a physician should carefully consider the advantages of reduced risk of injury or death to the patient, compared to the medical reason the patient may give for seeking an exemption from using a safety belt.

In general, a person whose physical condition allows him or her to drive a vehicle is probably fit to wear a safety belt.

Physicians should be cautious about granting a medical exemption to a patient who primarily is a passenger. Patients genuinely unable to, or who refuse to, use a safety belt should be advised and strongly urged to ride in the back seat of the motor vehicle, where it may be relatively less dangerous to ride.

An examination for a safety belt exemption is Medicaid-reimbursable when it includes a complete physical checkup (Code 90021).

A physician who grants medical exemption from safety belt use should be prepared to defend the exemption in court, perhaps even against a lawsuit by the unrestrained patient subsequently injured in a motor vehicle crash. Therefore, the physician is advised to keep a written record of any medical exemption granted. This record should include the reason for the exemption, the date it was granted, and its expiration date, if any.

Medical Reasons

The medical reasons patients give for requesting a medical exemption may result from the patient not understanding how a safety belt works and how it can be adjusted. These reasons may include musculoskeletal conditions and deformities, other physical disabilities, pregnancy, scars, pacemakers, ileostomies or colostomies, conditions of the breast, unusual body size or shape, or psychological conditions.

Musculoskeletal Conditions and Deformities

A correctly applied safety belt should not restrict the driving ability of a patient with arthritis of the neck and shoulders. If the patient's neck rotation is limited and the safety belt prevents the patient from rotating his or her body to place the motor vehicle in reverse, the patient should be informed that while not technically legal to do so, it would be reasonable to remove the safety belt for backing up.

The patient may find it impossible to properly fasten a safety belt because of severe abnormal skeletal conditions such as rheumatoid spondylitis, ankylosed major joints, deformity or fusion of the spine or major joints, other gross musculoskeletal deformities, or orthopedic devices such as body casts. Under such conditions, a medical exemption may be considered.

Other Physical Disabilities

A physically disabled person who holds a restricted driver's license may benefit from using a safety belt. The belt can help hold the driver more securely, which could help the driver maintain vehicular control under potentially demanding or dangerous conditions. The guidelines for these physical disabilities are the same as those for musculoskeletal conditions and deformities.

Pregnancy

Research and experience indicates pregnancy at any stage is not a valid reason for exempting safety belt use. Studies of belted pregnant women involved in motor vehicle crashes show no increase in injuries to the fetus, or in fetal loss or abortion, as a result of proper use of a safety belt.  A pregnant woman should be instructed to position the belts correctly; the lap part should lie comfortably below the anterior superior iliac spines and the diagonal part across the costal margin, the sternum and clavicle. Thus, no part of the harness is allowed to compress the uterus.

Scars

Well-healed scars on the chest or abdominal wall are not harmed by a correctly positioned safety belt. Occasional irritation and pain may result from prolonged wearing of a safety belt, often positioned too loosely, that allows friction and movement over parts of a scar.

To prevent irritation and pain to tender scar tissue, a foam pad may be taped to the skin over which the safety belt lies.

Pacemakers

About 85 percent of all heart pacemakers are placed in the right upper part of the anterior chest just below the clavicle; about 15 percent are placed similarly on the left side. In general, safety belts do not cause discomfort to the pacemaker wearer or damage to the pacemaker itself.

If the pacemaker has been recently implanted and the surgical wound still painful, a foam pad may be taped to the skin overlying the pacemaker to prevent irritation while using the safety belt.

As standard precaution, the wearer should have a physician check for pacemaker malfunction if it had received a direct blow by the safety belt during a motor vehicle crash. Such malfunctions, however, have not been observed clinically or experimentally.

Ileostomies and Colostomies

Ileostomies and colostomies in persons of average size and build do not interfere with the use of a correctly applied safety belt. Where persons with ileostomies and colostomies are concerned, sudden constriction by the safety belt during a motor vehicle crash can occasionally cause irritation of the exposed mucosa with some bleeding and even tearing of the mucosa from the stoma wall. Such injuries are relatively minor compared to the serious injuries that could be expected from not wearing a safety belt.

Conditions of the Breast

Safety belts rarely cause breast irritation (mastitis). When irritation does occur, the condition usually quickly resolves after the safety belt becomes repositioned, or the safety belt's tension is reduced by using a comfort clip or the safety belt's "window shade" feature.

Special Height or Weight Conditions

A patient five feet tall or less may complain that the shoulder harness safety belt crosses the neck, causing discomfort. This person's car dealership or repair shop may be able to adjust the vehicle's seat height, install a power seat, or reposition the upper safety belt mounting point by using a drop link. The difficulty also may be lessened by adjusting the position or tension of the safety belt with a comfort clip or the safety belt's "window shade" feature. An extremely obese patient may complain that the safety belt does not reach across the abdomen. This person's car dealership or repair shop maybe able to modify the vehicle's existing belt, provide a safety belt extender, or replace the safety belt with one that is more appropriate in length. If these alternatives are not feasible, consideration may be given to granting an exemption.

Psychological Conditions

A thoughtful explanation of the need and reasons for safety belt use can often help increase its acceptance by a patient who is subject to severe claustrophobia. A patient who suffers from such phobias may feel more secure following a demonstration of the use of safety belts as part of the operation of a motor vehicle.

Recommendations

A physician doctor should grant a medical exemption only for a sound medical reason and never routinely.

Before a physician decides whether or not to grant medical exemption, the patient should be encouraged to adapt the vehicle's restraint system to the patient's condition (such as adjusting the position and height of the car's seat, and adjusting and positioning of the safety belt).

If medical exemption is granted, the physician should keep written record of the medical reason given by the patient for the exemption. This record should include the documentation of the basis for which the medical exemption was granted, the date it was granted, and the expiration date, if any.

For temporary conditions, a physician should grant a medical exemption for periods of no more than six months and renewed as necessary.  For permanent conditions, a medical exemption should be granted for no more than four years and renewed as necessary.

A patient who is primarily a passenger and who is unable to, or refuses to, use a safety belt in a motor vehicle should be advised to ride in the back seat.

Whether as a driver or a passenger, a patient who possesses a medical exemption should carry the physician's written exemption, as described in "Legal Requirements," whenever traveling in a motor vehicle. The patient should be prepared to present this written exemption to law enforcement authorities upon request.

Legal Requirements

Only a licensed physician can grant a medical exemption from safety belt use.

The physician must issue the medical exemption on the physician's prescription pad or letterhead.

The physician's certification of exemption must include the patient's name, date of birth and address, the date of issuance, a clear statement of medical exemption from belt use, and the doctor's signature.

NEW YORK STATE DEPARTMENT OF MOTOR VEHICLES David A. Paterson, Governor David J. Swarts, Commissioner

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C-58 (3/03)
Edited for the Internet (3/08)