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Case Name: Jesus Chavez v. R&R Properties
Handling Attorney: Nicole V. Russo

 

 

Case Summary

Following a three day 19(b) trial, Nicole Russo received a zero award from Arbitrator Carlson. In the case of Jesus Chavez v R&R Properties, the petitioner was claiming that he aggravated a prior left leg injury, resulting in an exacerbation of his complex regional pain syndrome. We worked closely with the claims adjuster and the insured to develop our defense and successfully attack the credibility of the petitioner. First, we thoroughly investigated the petitioner’s prior claim for an injury to the same body part. We were able to subpoena the prior defense file, and meticulously analyzed 1000’s of pages of prior treating records, as well as prior testimony from the petitioner himself, which was used to impeach him in the current trial.

Next, we worked closely with the insured to obtain critical facts that supported our position that the alleged accident was manipulated to coincide with the end of petitioner’s seasonal work. We presented credible testimony from the insured, establishing that petitioner did not report an alleged injury until the day that he came to collect his final paycheck, and that he continued working after the alleged accident for several days, until the work season had ended.

Finally, we supplemented our strong defense with a credible medical opinion from Dr. George Holmes. We armed Dr. Holmes with a large volume of medical records, from before and after petitioner’s alleged date of injury, which documented his over 10-year history of complex regional pain syndrome. Dr. Holmes testified that the prior records enabled him to compare the pre and post date of injury treatment, and that he was able to confidently testify that the alleged work incident did nothing to aggravate the petitioner’s condition. Dr. Holmes also testified that it the fact that petitioner had been treating for CRPS for over a decade was significant because the need for the spinal stimulator and nerve blocks that were being demanded was contemplated even before the petitioner’s alleged date of accident.

At the 19(b) trial, petitioner was seeking future medical treatment, including approval of a 5 day inpatient pain pump implant, nerve block injections, and a spinal stimulator, in addition to unpaid medical bills, nearly two years worth of temporary total disability benefits, and future treatment, the total of which exceeds $1 million.

Because of the early contact with the insured, which raised red flags about the legitimacy of the accident, we were able to initiate an early and successful investigation of prior claims, which we used as the crux of our defense. We also convinced the arbitrator that the excessive medical bills from dozens of emergency room visits were prompted by the petitioner’s drug seeking behavior, and not necessitated by the petitioner’s alleged extreme pain levels and lack of access to approval for treatment. Not only did we secure a zero award, but the trial resulted in a credit being owed to respondent in excess of $18,000.