How do you prove that an injury, that did not show symptoms for more than 4 weeks after an accident, is accident related? That was the problem facing a recent client, whose case settled last week.
While operating his motorcycle on a roadway in Huntington Beach, an adverse driver turned left into his path causing him to have to lay down his motorcycle, hurting his knee. Liability was clear and injury at the scene did not seem to be anything more than scrapes and road rash after the accident. There was however a small bruise on the knee, that our office photographed out of caution..
However, in the ensuing months, knee pain arose and had to be treated with physical therapy, and later arthroscopic surgery. Medical bills were approximately $11,000.00. The client had a good recovery although physical therapy was arduous.
The insurance company for the other driver contended that the knee injury was not related to the accident, because symptoms did not appear for weeks after the accident and no treatment was sought for more than 35 days. Despite photos of a bruise on the knee taken shortly after the accident, the defendant’s insurance refused to offer more than a few thousand dollars in settlement.
We obtained the medical records previous to the accident and demonstrated that this client had no prior complaints of knee pain. Additionally he was active and we documented his active lifestyle with statements of acquaintances. The insurance company continued to refuse any reasonable settlement.
Typically, insurance companies will refuse to pay for claims when symptoms do not arise immediately after the accident. Usually these cases have to be presented to a jury. Jurors are skeptical of such claims as well, and trial is expensive. Insurance companies hire a doctor of their choosing, a hired gun, to give an ‘unbiased’ opinion. Their opionion is anything but unbiased, and in todays environment, jurors tend to deny claims rather than give the benefit of the doubt to the victim. We had to find more.
Help came from a meeting with the client’s surgeon after arthroscope. The surgeon’s records and report reflected surgery to repair a torn meniscus. The cause was attributed to the accident, because the client reported no prior history of injury to the knee and no events after the accident. The report did not discuss any specific reason for delay in onset of symptoms.
The surgeon was not a legal expert. He had not handled many legal cases of injury caused by an accident, and when informed on the position of the insurance company. the surgeon shook his head and said, why are they arguing this case. “People are hurt all the time, but symptoms do not show up immediately”, he said. His clinical experience in everyday cases told him that symptoms do not arise immediately in many cases of injury caused by sports, falls, and all kinds of other maladies. He revealed that about half of his patients see him with no explainable immediate injury, but usually on questioning, they had an event within 2 or 3 months. We find many surgeons, unfamiliar with the legal system, shaking their head at the game played by insurance companies.
We predicted a trial if we could not find more. We asked him to review the case more thoroughly, and showed him photos of the injury taken by us immediately after the accident, to see if any other evidence could be uncovered to demonstrate an injury to the knee due to the motorcycle accident.
On his procedure review, and based on photos of the arthroscopic procedure, he found our golden nugget. The bruise that had been photographed by us, was in the same location as the injury to the meniscus that had to be repaired. We now had a great correlation of injury to the accident.
We arranged a mediation and shared our findings with the mediator. To our great pleasure, the insurance company agreed and settlement was reached at close to 6 figures.
Allen, Flatt, Ballidis & Leslie is proud to have been a part of this case, and we made a good impression with the doctor as well. We feel that the level of service for our clients is superior to most other practitioners who either can’t or won’t put in the effort to gain an advantage to settlement.