Underinsured Motorist Arbitration – T4 to Sacrum Fusion Surgery Claimed

James Miller headshotJim Miller completed a first party underinsured motorist hearing on October 23, 2014. This arbitration hearing arose from a three vehicle motor vehicle accident. However, the claimant was involved in both earlier and subsequent motor vehicle accidents. She also had an extensive surgical history, having undergone carpal tunnel releases in 1970 and 1971, cervical fusion surgeries in 1988 and 1992 and total bilateral knee replacement surgeries in 2003 and 2004. She also had extensive lumbar and lower extremity complaints including a right sided decompression at L3-4 and L4-5 in 1993 and a laminectomy revision of L3-5 in 2003. Following the earlier motor vehicle accident, the claimant underwent a re-exploration of the L3-4 decompression laminectomy and L3-4 micro discectomy which occurred in September 2009.

As a result of the subject incident, the claimant alleged to have sustained injuries to her neck, bilateral arms and hands, chest, low back and lower extremities. The claimant ultimately ended up in the care of a spinal surgeon who performed spinal surgery on each level of the spine from T4 to the sacrum. The cost of the surgery was in excess of $1,000,000.00. The claimant alleged that the surgical procedure was necessitated by the subject accident. The spinal surgeon who performed the surgery supported the claimant’s position as well as did claimant’s retained radiologist. Jim’s client retained a qualified neurosurgeon to review the medical records and surgery reports and determined that the T4 to sacrum surgery was not related to the accident but was rather related to the long history of back difficulties. Jim also relied upon a radiologist who testified at the hearing that there was no identifiable injury to the claimant’s spine as a result of the subject accident.

The parties agreed that the related economic damages, absent the cost of the surgery, was $42,411.41. The claimant’s attorney asked the arbitrator to award $2,200,000.00. Jim asked for an award of $75,000.00. The arbitrator found that the T4 through sacrum surgery was unrelated to injuries sustained in the subject accident and agreed that the stipulated economic damages were reasonable and related to the incident. The arbitrator ultimately awarded $172,411.41. The underinsured motorist limit was $500,000.00.

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