USAA Casualty Insurance Company: Case Study

Gonzales was first employed by the Plaintiff in this case on December 2, 2014. He met with the Plaintiff on January 12, 2015. He discussed with the Plaintiff her prior medical history and performed a physical examination. He then reviewed the Plaintiff’s medical records.

By way of background, Fulton County is responsible for a New York State Workers’ Compensation claim, WCB# 50413999 with a date of accident of 10/01/2003. The case has been established for an injury to the neck by Administrative Decision filed on 12/29/2004. A copy of that decision is attached hereto as exhibit A. The case was later amended to include right carpal tunnel syndrome and

Overall, Dr. Scharf’s report is quite concise. He documented the applicant’s current complaint as neck pain, radiating pain to both arms, and occasional headaches, as

A review of the subpoenaed records from Dr. Sharma’s office indicates the applicant visited Dr. Sharma on September 21, 2010 regarding his neck pain. Applicant was diagnosed with neck pain, cervical and left shoulder girdle pain, degenerative joint disease of the lumbar spine, degenerative joint disease of the right knee and leg pain. The subpoenaed records indicate the applicant continued to see Dr. Sharma until the end of 2010 and throughout 2011.

Admittedly, my file on this matter is fairly limited. We were recently joined into this claim as a co-defendant. I believe we are in the process of securing additional records (i.e., medical records and medical-legal records) from our co-defendant, Employer Assurance Fund, who is administering this claim.

Facts: This is a UIM claim arising from a motor vehicle accident in Oxford, Alabama. The plaintiff and your insured, Jamie Holt, was stopped behind another vehicle at a red light on Highway 21. A vehicle struck Mr. Holt’s vehicle from the rear while traveling at approximately 40 mph, pushing Mr. Holt’s vehicle into the vehicle directly in front of his. Mr. Holt was taken to Regional Medical Center in Anniston, Alabama via ambulance. Mr. Holt has already settle with the tortfeasor insurer, Progressive, for the policy limits of $100,000.00.

This deposition was scheduled for the testimony of your consultant, Dr. Belmonte. Dr. Belmonte examined the claimant on two occasions, the first was on 12/29/16 and the second on 04/12/17. In his 04/12/17report, he finds that the claimant is at maximum medical

Based on my review of his report, I do not believe the applicant has sought any treatment or made any significant complaints with respect to the left shoulder. I only saw the mentioning of a shoulder pain as a result of the chest wall and sternal discomfort as the applicant was unable to raise his hands over his head at the time. There was no specific mentioning of the left shoulder.

Barta reports his pain level was a 8 with any movement. Since the last appointment with Wesley Fischer PA the pain level has decreased to a /34 with movements. He was instructed on a home exercise program to avoid the shoulder becoming frozen. Mr. Barta’s examination showed an improvement with range of motion, and strength. Work restrictions were discussed. Per Mr. Barta he was told that he needs to be full duty to come back to work. I advised that the restrictions need to reflect what he can and cannot do with the right arm since that is the injured part. If the employer has the ability to bring him back to work then they must follow the restrictions. I asked that the restrictions reflect

Because Dr. Fichtel has not treated the Plaintiff in seven years, he is not in a position to give an opinion as to the cause of the Plaintiff’s injuries. Prior to him giving an opinion as to the cause of the Plaintiff’s cervical spine injuries, he would have to examine her, which he has not.

Dr. Jones examined as a consultant for the claimant. A review of the IME-3 materials, Dr. Jones report and testimony reveals that he was not provided with any history of the claimant’s 2012 motor vehicle accident nor was he advised of the two (2) fusion surgeries to the neck that occurred following and as a result of the claimant’s 2012 motor vehicle accident. (See the 01/03/2017 testimony of Dr. Jones at pages 4 & 5) It does not appear that Dr. Jones even asked basic questions to determine whether he had a complete history of

Brief Description of Patient: Patient is a 45 year old male who was diagnosed with osteoarthritis of his left knee. The pain in his knee was limiting him from doing his job and his every day activities. The orthopedic surgeon had the patient do physical therapy to see if this would help. The therapy was not helping the patient so the surgeon decided to do a total knee replacement.

I attended a hearing on your behalf in the above-referenced matter before Judge Whispell in the permanency part in New Windsor, New York on 06/29/17. The claimant was present and was represented by attorney Mark Simoni who was appearing of counsel to the claimant’s attorney of record, Bonacic & McMahon.

64(65) yr old Female- MVA- Claimant is a passenger in the sliver Nissan SUV. The Coca-Cola truck was traveling north on Bruckner Blvd when the driver of a sliver Nissan SUV cut from the left side of the Coca-Cola truck colliding with the driver’s side front of the Coca-Cola truck causing it to lose control and drive up over the sidewalk striking the decedent before coming to rest against an apartment building. According to the insurance adjuster for the Nissan the claimant injured her shoulder which has required surgery, she also is complaining of neck and back pain. PIP on the Nissan’s policy is currently paying for CM’s treatment.

Ms. W. took down the insurance company. A driver hit Ms. W while running a yellow light. As a result of the collision, Ms. W suffered from a fractured sternum and sustained a shoulder tear.