MedQuest LTD
LAW FIRM LOGO/NAME
SETTLEMENT DEMAND
PRIVILEGED/CONFIDENTIAL COMMUNICATION
October 21, 2016
Mr. Ahmed Quadri
Liberty Mutual Claims
P.O. Box 515097
Los Angeles, CA 90051
Claim Number : 405583600
Our Clients : XYZ and ABC,
Individually and on behalf of EFG, Minor
Your Insured : DDDD and HHHH, Inc.
Date of Loss : April 3, 2016
Dear Mr. Quadri:
This office represents XYZ and ABC, Individually and on behalf of EFG, their minor daughter, concerning injuries they suffered from a motor vehicle collision that occurred due to the negligence of your insured driver on or about April 3, 2016.
FACTS AND LIABILITY
On April 3, 2016, at around 6:55 p.m., XYZ was the restrained driver of her 2014 Infiniti Q80, traveling eastbound on US-175 and exiting the highway west of Woody Road, in Dallas, Dallas County, Texas. ABC and EFG were passengers in XYZ’s vehicle. Your insured driver, DDDD, was driving a 1999 Ford F-150, traveling eastbound on the US-175 service road in the far left lane. XYZ exited the highway using the exit ramp to access the service road. DDDD failed to yield the right of way, despite having a yield sign, and slammed into the right side of XYZ vehicle with the front left of his vehicle.
A Traffic Collision Report was prepared by Texas Department of Public Safety and determined that your insured’s driver caused this collision by failing to yield right of way.
SUMMARY OF PHYSICAL INJURIES
As a result of the collision, XYZ, a 31-year-old woman on the date of loss, sustained the following injuries:
• Cervical, thoracic and lumbar ligamentous, muscular and facet injury
• Cervical and lumbar nerve root irritation
• Lumbar and cervical disc displacement
• Bilateral wrist sprain and strain
• Right knee sprain and strain
• Right ankle sprain and strain
• Left hip sprain and strain
• Spasms
• Dizziness
• Non-allopathic lesions of cervical, thoracic, lumbar, pelvic and sacral regions
• Lumbar and cervical sprain and strain
• Lumbar disc herniations at L4-5 and L5-S1
• Multilevel cervical disc herniation
• Lumbar and cervical radiculopathy
• Acute post-traumatic headache
• Head contusion
• Concussion
• Dizziness
• Insomnia
• Blurred vision
• Post-traumatic stress symptoms
• Anxiety
• Weakness
TREATMENT OF INJURIES
On April 5, 2016, XYZ presented to KKKK Institute of Texas, complaining of headaches, dizziness, and pain in her neck, mid back, low back, bilateral wrist, left hip and leg, and right knee and ankle. She reported the pain level in her neck, mid back and low back as 9/10, left hip as 8/10, and headaches as 7/10. She was in severe distress. There was inflammation in her right lateral malleoli region. She had palpable tenderness and hypertonicity in her neck and back. She was noted to have fixations and tenderness in her bilateral carpal metacarpal regions. She also had tenderness in her right knee and fixations in her left hip. There was painful range of motion in her neck, low back, bilateral wrist, knees, left hip and right ankle. She was examined and diagnosed with cervical ligamentous, muscular and facet injury (847.0), thoracic ligamentous, muscular and facet injury (847.1) lumbar ligamentous, muscular and facet injury (847.2), cervical nerve root irritation (723.4), lumbar nerve root irritation (724.4), lumbar disc displacement (722.10), cervical disc displacement (722.0), bilateral wrist sprain and strain (842.09), right knee sprain and strain (844.9), right ankle sprain and strain (845.00), left hip sprain and strain (843.9), spasms (728.85), headaches (784.0), dizziness (780.4), and non-allopathic lesions of cervical, thoracic, lumbar, pelvic and sacral regions (739.1-739.5). A comprehensive treatment plan consisting of passive and active modalities was tailored to her specific injuries. She was treated with joint mobilization, electrical stimulation, heat and ice packs, and intersegmental traction.
On April 21, 2016, _________, M.D., M.S., obtained MRIs of Ms. Bracamonte’s lumbar and cervical spine at PPPP Diagnostic Imaging. The MRI of her lumbar spine revealed hyper dynamic curvature of the spinal axis due to hyperlordotic curvature. There were multilevel disc herniations, including a 3.3 mm disc herniation at L4-5, and a 4.6 mm disc herniation at L5-S1. The imaging also revealed a fibro osseous stress reaction of the SI joint with pelvic tilt. The MRI of her cervical spine revealed loss of normal cervical lordosis, multilevel disc herniations involving the mid-cervical discovertebral segments, including a 2.5 mm rightward disc herniation at C6-7, and cerebellar ectopia (part of brain pushed out through a hole at the base of the skull).
On May 26, 2016, XYZ presented to _______, D.O., at GGGG Spine Center of Dallas, complaining of persistent headaches, post concussive symptoms, and pain in her neck and low back with numbness and tingling in her bilateral upper and lower extremities. She complained of pain in the back of her head and numbness in her lips and jaw. She had hot spells, changes in vision, blurred vision, vertigo, diarrhea during the periods of dizziness, night sweats, hand trembling especially while in pain, loss of memory, depression and insomnia. She had restricted range of motion and palpable tenderness in her neck and low back. There was decreased sensation in her left upper and lower extremities. She was diagnosed with cervical sprain and strain (847.0), lumbar sprain and strain (847.2), muscle spasms (728.85), lumbar and cervical facet joint and ligamentous injury, lumbar disc herniations at L4-5 and L5-S1 (722.10), multilevel cervical disc herniation (722.0), lumbar radiculopathy (724.4), cervical radiculopathy (723.4), acute post-traumatic headache (339.21), head contusion (906.3), and concussion (850). She was also diagnosed with dizziness (780.4), insomnia (780.52), blurred vision (368.8), post-traumatic stress symptoms (309.81), anxiety (300.00), acute pain (338.11), weakness (780.79) and nausea (787.02). She was advised to continue physical therapy and was instructed to engage in active home therapy and exercises. A Medrol Dosepak, Ibuprofen, Flexeril and Tylenol were prescribed for pain and muscle spasms. The doctor recommended she use a lumbosacral back brace for additional support during periods of prolonged activities. An EMG of her bilateral upper and lower extremities was ordered and performed. She was referred for a neurology consultation and advised to follow-up after the EMG and neurology consult for further evaluation.
From April 6, 2016, until June 22, 2016, XYZ received multiple sessions of chiropractic treatment at KKKK Institute of Texas for complaints of persistent headaches, dizziness, and pain in her neck, mid back, low back, bilateral wrist, left hip and leg, and right knee and ankle. On April 6, 2016, x-rays of her cervical, thoracic and lumbar spine, and right ankle were obtained, revealing cervical and lumbar hypolordosis, vertebral body rotation, and reduced disc height at L5-S1. XYZ was advised to restrict work duties from April 23, 2016 until May 23, 2016. The work restrictions included light lifting and carrying (12 lbs), bending and stooping (0-5/hr) and pushing and pulling (10-24 lbs). She was advised to change the position frequently from sitting, standing, walking, and driving. The treatment rendered was comprised of joint mobilization, electrical stimulation, heat and ice packs, ultrasound, myofascial release, therapeutic activities and intersegmental traction. Essentially, XYZ performed her work duties under duress from pain and stiffness due to her injuries.
On July 29, 2016, XYZ had a final evaluation with _________, D.C., and _________, D.C., at KKKK Institute of Texas, for complaints of persistent headaches, dizziness, and pain in her neck, mid back, low back, bilateral wrist, left hip and leg, and right knee and ankle. The pain in her neck radiated to her right arm, and the pain in her low back radiated to her left thigh, left knee, left calf, left ankle and left foot. Treatments included an initial phase of passive care with application of physiotherapeutic modalities and techniques associated with spinal manipulations, which progressed into active rehabilitation. Active rehabilitation included the application of cardiovascular procedures and resistive range of motion and strengthening protocols. She was diagnosed with multilevel disc herniations of the cervical and lumbar spine (722.0). It was noted there was a high probability that XYZ would suffer from frequent exacerbations. She was advised to perform home exercises and instructed to refrain from heavy lifting, and to perform lifting activities with her knees.
On August 5, 2016, due to persistent symptoms, XYZ had an initial chiropractic treatment evaluation with ________, D.C., at AAAA Chiropractic Clinic for persistent pain in her neck, upper back, and low back. She complained of nausea, dizziness, blurred vision and difficulty concentrating. She was diagnosed with sprain of ligaments of cervical spine, initial encounter (S13.4XXA), other cervical disc displacement, unspecified cervical region (M50.20), contracture of muscle, multiple sites (M62.49), other intervertebral disc displacement, thoracic region (M51.24), sprain of ligaments of thoracic spine, initial encounter (S23.3XXA), sprain of ligaments of lumbar spine, initial encounter (S33.5XXA), and other intervertebral disc displacement, lumbosacral region (M51.27).
XYZ continues to treat with Dr. _______ at AAAA Chiropractic Clinic for persistent pain in her neck, upper back, and low back. Her neck disability index score was 84% and her Oswestry low back disability index score was 78%. The treatment rendered was comprised of gentle adjustive procedures, myofascial release, electrical stimulation, posture pump, manual therapy and mechanical traction. A treatment plan was tailored to her specific injuries. Dr. Leichty uses chiropractic manipulative therapy, physical therapeutic modalities and physical exercises. Our client continues to treat at American Chiropractic Clinic for injuries arising from this incident.
PAST MEDICAL EXPENSES - XYZ
XYZ incurred the following past medical expenses for treatment of injuries suffered due to the collision:
KKKK Institute of Texas, LLC : $7,563.60
Texas MDDX, LLC : $988.40
PPPP Diagnostics, LLC : $4,784.00
DDDD Spine Center of Dallas : $6,300.00
DDDD Pharmacy : $667.10
AAAAA Chiropractic Clinic : $1,537.00
Total Past Medical Expenses : $21,840.10
FUTURE MEDICAL EXPENSES
In all reasonable medical probability, XYZ will require orthopedic referral for evaluation of her neck and back. She will require cervical and lumbar epidural Cortisone injections for pain flare-ups. She will require chiropractic therapy with electrical stimulation, hot/cold packs, ultrasound therapy, myofascial release, therapeutic exercises and mechanical traction to improve the range of motion in her neck and back. She will need pain management consultation to regulate the intake of her medications, including NSAIDs, muscle relaxants and possible epidural steroid injections. She will require neurology referral for evaluation of her headaches and dizziness, followed by a CT scan of her head/brain to rule out structural brain disease. She will require psychological counseling for her symptoms of posttraumatic stress disorder arising from the collision. Drs. Shirzad and Bozeman at Injury Institute stated in their final report that our client will need chiropractic care for the rest of her life, and estimated her future expenses for it at $1,000.00-$1,200.00/ year. American Chiropractic gave an estimate of future chiropractic care at $3,183.00 for 14 weeks of treatment.
Based on her doctors’ statements in her records and average costs in the community, the estimates of her future medical expenses are as follows:
Orthopedics Evaluation : $700.00-$1,000.00
Cervical/Thoracic epidural cortisone injections : $5,000.00-$6,000.00
Lumbar epidural cortisone injections : $6,000.00-$8,000.00
Chiropractic treatment : $1,000.00-$11,800.00/ year
Neurologist consultation : $800.00-$1,200.00
CT Brain : $2,500.00-$3,000.00
Psychological counseling : $1,000.00-$1,500.00
Pain management consultation : $1,500.00-$2,000.00
Total future medical expenses : $18,500.00-$34,500.00
Total future medical expenses will be in the range of $18,500.00-$34,500.00.
LIFESTYLE IMPACT
XYZ is a 31-year-old woman with an average life expectancy of approximately another 51 years. She continues to suffer from headaches and pain in her neck and low back as a result of the collision on April 3, 2016. The pain in her low back aggravates with sitting, standing, and walking. She experiences dizziness because of her constant headaches. She has symptoms of nausea. She suffers from insomnia and inability to fall asleep and stay asleep. She reports difficulty concentrating, and feels a sense of restlessness. She has blurred vision as well. The pain in her neck exacerbates with movements, driving, sleeping, lying down, and sitting at her desk for prolonged periods. The headaches and sleep disturbances make her irritable. She has experienced lost enjoyment and ability to perform domestic activities such as laundry, dishwashing, vacuuming, cleaning, preparing meals, and taking care of her kids and pets. She has experienced lost enjoyment and problems with ability to perform outside activities such as mowing the grass, gardening, washing and maintaining the cars, and cleaning up after the dogs. She has lost enjoyment and the ability to perform educational activities like helping her kids with their homework, and activities such as running, working out, and playing with her kids,
Despite receiving multiple medical interventions, her pain is undiminished. As a result, she will face limitations in all areas of her life for a significant duration of her life. She continues to face severe hardships and is unable to lead a normal and restriction free life without pain and suffering. She is likely to remain hampered for a significant time in the future.
SUMMARY OF DAMAGES – XYZ
Past medical expenses : $21,840.10
Future medical expenses : $18,500.00-$34,500.00
Lifestyle impact/loss of activities : $50,000.00
ABC
SUMMARY OF PHYSICAL INJURIES
As a result of the collision, ABC, 39-year-old man on the date of loss, sustained the following injuries:
• Cervical ligamentous, muscular and facet injury
• Thoracic ligamentous, muscular and facet injury
• Lumbar ligamentous, muscular and facet injury
• Left knee sprain and strain
• Spasms
• Headaches
TREATMENT OF INJURIES
On April 5, 2016, ABC presented to the KKKK Institute of Texas with complaints of headaches, and pain in his neck, mid back, low back and left knee. He rated the pain level in his neck, mid back and low back as 8/10, left knee as 6/10, and headaches as 8/10. On examination, he had tenderness and hypertonicity in his neck and back. Fixations were noted in his left knee. He had painful range of motion in his neck and left knee. X-rays of the cervical, thoracic and lumbar spines were obtained, revealing cervical and lumbar hypolordosis, vertebral body rotation and reduced disc height at L5-S1. He was diagnosed with cervical ligamentous, muscular and facet injury (847.0), thoracic ligamentous, muscular and facet injury (847.1) and lumbar ligamentous, muscular and facet injury (847.2), left knee sprain and strain (844.9), spasms (728.85), and headaches (784.0). He was treated with joint mobilization. He was placed on restricted duty until May 5, 2016. The work restrictions included light lifting and carrying (12 lbs), bending and stooping (0-5/hr) and pushing and pulling (10-24 lbs). He was advised to change the position frequently from sitting, standing, walking, and driving.
On April 14, 2016, ________, M.D., DABR, obtained an x-ray of ABC left knee at MMMM Imaging, which revealed a small joint effusion (fluid) and post-traumatic sprain.
From April 6, 2016, until May 13, 2016, ABC received conservative care and treatment at KKKK Institute of Texas for persistent headaches, and pain in his neck, mid back, low back and left knee. The treatment comprised of joint mobilization, myofascial release, electrical stimulation, heat and ice packs, intersegmental traction, ultrasound and therapeutic activities.
On May 17, 2016, ABC had his final evaluation with _________, D.C., and ______, D.C., at KKKK Institute of Texas, for complaints of persistent headache, and pain in his neck, mid back, low back and left knee. He was treated with joint mobilization and therapeutic activities, and advised to perform home exercises. He was instructed to refrain from heavy lifting, and to perform lifting activities with his knees.
PAST MEDICAL EXPENSES - ABC
ABC incurred the following past medical expenses for treatment of injuries suffered due to the collision:
KKKK Institute of Texas : $4,264.00
Texas MDDX, LLC : $639.80
MMMM Cities Imaging $105.00
Dr. ____________, M.D . : $100.00
Total Past Medical Expenses : $5,108.80
FUTURE MEDICAL EXPENSES
In all reasonable medical probability, ABC will require orthopedic referral for evaluation of his neck, back and left knee followed by MRIs of his cervical, thoracic and lumbar spines. He may require an MRI of his left knee to rule out internal derangements. He may require intra-articular injections to his left knee in case of pain flare-ups. He will require chiropractic therapy with myofascial release, electrical stimulation, heat and ice packs, mechanical traction, ultrasound therapy and therapeutic exercises to improve the strength and endurance of his neck, back and left knee. He will require a neurology referral for evaluation of his headaches followed by a CT scan of his head/brain to assess his condition. Dr. Shirzad estimated future chiropractic care at $900.00/ year.
Based on his doctors’ statements in his records and average costs in the community, the estimates of his future medical expenses are as follows:
Orthopedics Evaluation : $600.00-$800.00
MRI thoracic spine without contrast : $2,300.00-$3,000.00
MRI cervical spine without contrast : $2,200.00-$3,000.00
MRI lumbar spine without contrast : $2,200.00-$3,000.00
MRI left knee : $2,500.00-$3,200.00
Intra-articular cortisone injection to knee : $400.00-$600.00
Chiropractic treatment : $900.00-$4,000.00
Neurology consultation : $400.00-$600.00
CT Brain : $2,500.00-$3,000.00
Total future medical expenses : $14,000.00-$21,200.00
The total future medical expenses will be in the range of $14,000.00-$21,200.00.
LIFESTYLE IMPACT
ABC, a 39-year old man on the date of loss, has been undergoing numerous lifestyle alterations because of the collision, before which he was leading a happy and peaceful life. Since the collision, he has been experiencing headaches and pain in his neck, back and left knee. He avoids vacations because long distance driving causes him persistent neck pain. He has difficulty grooming, bathing and doing his household chores. His neck and mid back pain are exacerbated with bending in any direction and twisting towards the left as well as right. He has increased pain in his neck and back while standing, lifting and walking. He is symptomatic with everyday activities such as climbing up and down the stairs and getting in and out of his car. He is not able to sleep comfortably on his bed because of the pain in his neck and back. The sleep disturbances make him frustrated and irritated during the daytime. He works as a truck driver, and had to take off from his work to attend multiple treatment sessions for his persistent pain and discomfort, causing financial constraints. He is affected in all aspects of his life and is struggling to get back to normalcy.
In summary, the collision has caused a significant imbalance in the physical, mental and social aspects of his life.
SUMMARY OF DAMAGES – ABC
Medical expenses : $5,108.80
Future medical expenses : $14,000.00-$21,200.00
Lifestyle impact/loss of activities : $10,000.00
EFG, MINOR
SUMMARY OF PHYSICAL INJURIES
As a result of the collision, EFG, a 3-year-old child on the date of loss, sustained the following injuries:
• Left thigh contusion
TREATMENT OF INJURIES
On April 7, 2016, __________, M.D., examined EFG for the headache and pain in the back of her neck area. On examination, there was ecchymosis in her left medial thigh region. She was diagnosed with left thigh contusion (924.00). Tylenol was prescribed. She was advised to follow-up as needed.
PAST MEDICAL EXPENSES - EFG
The medical expenses for treatment of the injuries EFG suffered because of the collision amounted to $95.00. Copies of the medical bills are attached and itemized below:
CCCC Pediatrics : $95.00
Total Medical Expenses : $95.00
FUTURE MEDICAL EXPENSES
EFG will require pediatrics follow-up for evaluation of her left thigh contusion followed by an x-ray of her left thigh to rule out any abnormalities. She will be required to continue with NSAIDs for her pain relief. She may require psychological counseling if she develops any symptoms of posttraumatic stress disorder arising from the collision.
The estimates of her medical expenses in the future are as follows:
Pediatrics consultation : $200.00-$300.00
X-ray of left femur : $400.00-$600.00
Pain medications : $150.00-$250.00
Psychological counseling : $400.00-$600.00
Total future medical expenses : $1,150.00-$1,750.00
The total future medical expenses will be in the range of $1,150.00-$1,750.00.
LIFESTYLE IMPACT
Following the collision, EFG had a left thigh contusion that caused her pain and discomfort. Due to pain and discomfort, she is unable to sleep sufficiently. She had difficulty walking because of persistent left thigh pain. She could not play with her peers as she did prior to the collision. Her mother also sustained injuries from the collision, and could not take care of EFG in the same manner as before the collision. EFG has become more anxious due to the lack of her mother’s care. The collision was a shock to the 3-year-old child.
SUMMARY OF DAMAGES – EFG
Medical expenses : $95.00
Future medical expenses : $1,150.00-$1,750.00
Lifestyle impact/loss of activities : $1,000.00
CONCLUSION
Based on the foregoing, in exchange for a full and final release of your insureds, we hereby demand settlement for our clients in the following amounts:
XYZ : $100,000.00
ABC : $35,000.00
EFG, Minor : $3,000.00
These settlement demands shall remain open for 30 days from the date of this letter.
Respectfully submitted,
Brent H. Jones
Attorney At Law
Enclosures
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