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NYS Department of Motor Vehicles
Governor's Traffic Safety Committee
Guidelines for Granting Medical Exemptions for Safety Belt Use
These guidelines are issued by the Governor's Traffic Safety Committee and the New York State Department of Health. Medical conditions which may warrant an exemption from safety belt use, recommendations for the issuance of such medical exemptions, and requirements of law or regulations concerning medical exemptions are discussed.
The New York State Vehicle and Traffic Law, Section 1229-c states that "no person shall operate a motor vehicle in New York State unless all front seat occupants are restrained by a safety belt." The law "shall not apply to a passenger or operator with a physically handicapping condition when the physical disability would prevent appropriate restraint in such safety seat or seat belt provided however that 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 have supported the use of safety belts for many years, recognizing the fact that injuries and fatalities sustained by unrestrained drivers and passengers are greater than by those who are properly restrained in motor vehicle crashes.
The safety belt law provides no specific or routine medical grounds for granting a medical exemption. Each case should be decided on its own merit. If a medical exemption is granted, it should be issued for a valid medical reason.
Because of the benefits of using a safety belt, physicians should weigh the advantages of reducing the risk of injury or death to the patient who drives against any medical reason the patient may give for seeking an exemption from using a safety belt. If a person is fit to be in control of a vehicle, the evidence indicates that he or she is fit to wear a safety belt. Physicians should be extremely reticent in granting medical exemptions to patients who are primarily passengers. If patients are unable to use a safety belt, they should be advised to ride in the back seat of the motor vehicle where it may be safer and is not illegal to ride without a seat belt if they are over the age of sixteen.
A physician granting a medical exemption may be held personally responsible for his action and should be prepared to defend the medical exemption in court. It is conceivable that physicians granting exemptions may be sued by unrestrained patients subsequently injured in a motor vehicle crash. For this reason, physicians are advised to keep a record of any medical exemption granted and the reason for it, the date it was granted and its expiration date, if any.
Many of the reasons presented for a medical exemption are the result of a lack of knowledge about the purpose and correct adjustment of the safety belt itself. Some of the medical reasons that may be presented by patients for obtaining a medical exemption include:
Musculoskeletal Conditions and Deformities - A safety belt which fits correctly should not restrict the motion of patients with arthritis of the neck and shoulders while driving. If the rotation of the neck is limited and trunk cannot be rotated while reversing the motor vehicle because of the safety belt, the patient should be informed that while not technically legal to do so, it would not be unreasonable to remove the safety belt when backing up.
Certain severe abnormal skeletal deformities or orthopedic devices such as body casts may make it impossible for the patient to fasten a safety belt properly. In such conditions, a medical exemption may be considered for the time period of treatment.
Disabling Conditions - Physically disabled persons permitted to drive with a restricted driver's license will benefit from the use of safety belts because of the stabilization provided by the restraints. The guidelines for musculoskeletal conditions and deformities also apply to physically disabled persons.
Scars - Well-healed scars on the chest or abdomen are not harmed by a correctly positioned safety belt. Occasional irritation and pain have resulted from prolonged periods of wearing of a safety belt, often because the belt was too loose, allowing friction and movement over parts of a scar. Recent tender or painful scars may require padding between the skin and the safety belt to prevent irritation and pain.
Pacemakers - Pacemakers are commonly implanted just below the collar bone. In general, safety belts do not cause discomfort to the pacemaker wearer. If the pacemaker has been recently implanted and the surgical wound still painful, padding may be put between the scar and the safety belt to prevent any irritation while the safety belt is being used.
If the wearer of a pacemaker is involved in a motor vehicle crash, he or she may want to take the precaution of having the pacemaker checked by his or her physician. Pacemakers have not been observed to be damaged by seat belts in motor vehicle crashes.
Ileostomies and Colostomies - Ileostomies and colostomies in persons of average size and build do not interfere with the use of a correctly fitted safety belt. Persons with ileostomies and colostomies who have been involved in motor vehicle crashes while wearing a safety belt have occasionally suffered irritation caused by sudden constriction of the safety belt. Such injuries are relatively minor in comparison to what could be expected when not wearing a safety belt.
Conditions of the Breast - Breast irritation (mastitis) is rarely caused by belt use. When the safety belt is repositioned, the condition usually is resolved within a short time.
Pregnancy - Pregnancy is not a valid reason for exempting safety belt use. Pregnant women should use safety belts. The main risk to the baby is injury or death of its mother, motor vehicle crashes are a leading killer of women in their child-bearing years, injuries and death to the baby are closely related to injuries to its mother, and mothers who wear safety belts sustain fewer injuries, and risk to the unborn baby is reduced.
Pregnant women should be instructed to position the belts correctly. Make sure the lap belt is low on the hips, under the unborn child, and the shoulder belt is resting across the chest and shoulder.
Special Height or Weight Conditions - People under five feet tall may have the shoulder belt crossing their neck. Some vehicles have shoulder belt adjusters that allow you to move the shoulder belt's upper anchorage. This feature makes it easier to adjust the shoulder belt so that it does not touch the neck. If the shoulder belt still crosses the neck, the person should be referred to their car dealer for possible adjustment of the height of the seat or installation of a power seat. Persons who are obese and complain that the safety belt does not reach across their abdomen should be referred to their automobile dealer for modification of the safety belt. If none of these alternatives are feasible, consideration may be given to granting an exemption.
Psychological Conditions - Patients with severe claustrophobia can often be helped to accept safety belts by an explanation of the need and reasons for their use. A demonstration of the use of safety belts as part of the operation of a motor vehicle could serve to overcome such phobias.
Recommendations
A medical exemption should only be granted for a sound medical reason.
The patient should be encouraged to adapt the restraint system to their condition (i.e., adjusting the position and height of the car seat, and adjusting and positioning the safety belt) before asking a physician for a medical exemption.
If a medical exemption is granted, a record should be kept by the physician of the medical reason the patient requested an exemption, documentation of the medical problem for which the exemption was granted, the date it was granted and expiration date if any.
For temporary conditions, a medical exemption should be granted for periods of no more that six months, and renewed as necessary. For permanent conditions, a medical exemption should be granted for no more that four years and renewed as necessary.
A patient who is primarily a passenger and who is unable to use a safety belt should be advised to ride in the back seat of motor vehicles.
Requirements
A medical exemption may be granted only by a licensed physician.
A certification of exemption for medical reasons must be issued on the physician's prescription pad or letterhead. It must include:
http://www.nysgtsc.state.ny.us/seat-exm.htm – Revised: January 09, 2006
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