Insurer disputes extent of injury and treatment after rear-ender UIM claim. $985K. San Joaquin County.

Summary

Insurer disputes necessity for lumbar surgery in UIM claim before it pays policy limits in arbitration award.

The Case

Case Name: Michael Gogue v. James River Insurance Company
Court and Case Number: Arbitration
Date of Verdict or Judgment: Tuesday, December 22, 2020
Date of Arbitration Award : Tuesday, December 22, 2020
Date Action was Filed: Thursday, February 06, 2020
Type of Action: Underinsured Motorist, Vehicles – rear-ender
Judge or Arbitrator(s): Robert M. Bennett
Plaintiffs:
Michael Gogue
Defendants:
James River Insurance Company
Type of Result: Arbitration Award

The Result

Gross Verdict or Award: $985,000
Trial or Arbitration Time: 5 days

The Attorneys

Attorney for the Plaintiff:
Wilshire Law Firm by Jonathan C. Teller, Los Angeles.
Attorney for the Defendant:
Bassi, Edlin, Huie & Blum LLP by Joseph B. Adams and Michael Gallagher, San Francisco.

The Experts

Plaintiff’s Medical Expert(s):
Jan Roughan, life care planning.
Stephan Kasimian, M.D., orthopedic surgery.
Defendant's Medical Expert(s):
Stephanie Engler, life care planning.
Robert Rovner, M.D., orthopedic surgery.
Plaintiff's Technical Expert(s):
Enrique Vega, vocational rehabilitation.
Defendant's Technical Expert(s):
Laura Dolan, economics (deposition testimony submitted).

Facts and Background

Facts and Background:
On March 30, 2018, an Uber driver, Michael Gogue (59 years old), was planning to pick up his Uber passenger, in Tracy, when he was rear-ended by an underinsured driver who only had $15,000 of insurance coverage.
Plaintiff's Contentions:
That the collision caused plaintiff's injuries to his neck and back.
Defendant's Contentions:
That plaintiff had a pre-existing degenerative disc condition that was causing him pain, and the surgery was not related to the subject collision. The insurance company also suggested plaintiff was only seeing doctors to obtain medications and he wasn’t truly in enough pain to warrant a surgery.

Injuries and Other Damages

Physical Injuries claimed by Plaintiff:
Plaintiff underwent conservative treatment, but after no relief he underwent an L4-L5 lumbar fusion surgery.

Additional Notes

There was a demand in pre-litigation for $749,999. The last offer was for $650,000.

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Disclaimer

This is not an official court document. While the publisher believes the information to be accurate, the publisher does not guarantee it and the reader is advised not to rely upon it without consulting the official court documents or the attorneys of record in this matter who are listed above.