Jim Miller recently completed a binding arbitration in this matter. The claimant was involved in a moderate impact rear-end accident that occurred on Highway 99 northbound which resulted in a total loss of the claimant’s vehicle.
Claimant settled with third party’s liability insurance limits. The claimant then presented a first party claim against his insurance company, alleging that he suffered significant injuries to his cervical spine and lumbar spine with radicular components to both the upper extremities and the lower extremities. Claimant had a rather significant work up that involved multiple presentations to a chiropractor and an orthopedic spine surgeon.
During the course of treatment, the claimant’s orthopedic spine surgeon expressed opinions that the claimant would require a single level disc replacement surgery and fusion for the cervical spine along with a two level disc replacement and fusion surgery for the lumbar spine in order to alleviate his cervical, lumbar, and radicular extremity complaints. It was also learned that the claimant had a prior 10 year history involving cervical, lumbar, and extremity complaints. He had been diagnosed with chronic neck, low back, and neuropathic extremity pain complaints. None of this information was ever provided by the claimant to his post-accident providers.
An independent medical exam (IME) was performed of the claimant on behalf of MetLife. The neurosurgeon performing the IME expressed opinions that the subject accident resulted in exacerbation of the claimant’s pre-existing chronic neck, low back, and extremity complaints. MetLife’s neurosurgeon also expressed opinions that the claimant was magnifying his symptoms. This was largely due to the fact that the claimant was not receiving any significant pain or neuropathic medication along with the fact that the claimant had withheld his significant pre-existing history from his post-accident medical providers.
The claimant’s orthopedic spine surgeon offered opinions in his deposition that included the recommended surgeries were a result of the accident. The claimant’s orthopedic spine surgeon primarily relied upon the claimant providing information that there was no significant pre-existing history in relating the surgery to the accident. However, the claimant’s orthopedic spine surgeon was never provided with complete medical records including the claimant’s prior medical history record. Overall the claimant’s orthopedic surgeon estimated future surgical costs for the cervical and lumbar surgery at approximately $300,000.
At the arbitration Mr. Miller and Mr. Sciacca argued that the claimant merely suffered soft tissue injuries that resulted in exacerbation of the claimant’s pre-existing condition. Furthermore, it was argued that the claimant’s orthopedic surgeon’s opinions were not reliable based on the fact that the orthopedic surgeon was never provided with the claimant’s complete medical history.
Ultimately, the arbitrator issued a ruling adopting the arguments presented by Mr. Miller and Mr. Sciacca. The arbitrator specifically found that the opinions expressed by the claimant’s orthopedic spine surgeon were not reliable and thus did not accept that the proposed cervical and lumbar surgeries were related. Ultimately, the arbitrator awarded $20,000.00 (new money). The award was nowhere close to the $650,000 demanded by the claimant.