$650K Arbitral Award: Insurance Company Tries to Deny Spine Surgery Over Preexisting Condition

Michael Sorich, Esq., and Patrick Richel, Esq., Cavanagh Law Group, Chicago, IL

A 58-year-old man broke his neck after his car was hit by another vehicle and his head slammed into the side window. After months of wearing a cervical collar and undergoing physical therapy, his doctor recommended he undergo a C4-7 anterior cervical discectomy and fusion, animated below.

C4-7 Anterior Cervical Discectomy with Fusion

However, the insurance company refused to cover the surgery, alleging that the Plaintiff’s condition was not caused by the collision. Instead, the company argued that his condition was the result of arthritis that existed in the patient’s cervical spine before the collision. The highest amount the insurance company was willing to pay was $200K for the Plaintiff’s incomplete recovery.

Heading into arbitration, Michael Sorich, Esq., and Patrick Richel, Esq., needed to prove that their client’s condition was the direct result of the collision, which fractured his C6 vertebrae and severely worsened his preexisting arthritis to the point that a discectomy and fusion were vital to his recovery. We delivered an animation that would achieve the following visual objectives:

  • Highlight the Plaintiff’s severely damaged spine using color to emphasize the disc bulges and flattening of the spinal cord.
  • Show how these herniated discs compressed nerves along the spinal cord, causing severe pain and suffering for the Plaintiff beyond mere arthritis.
  • Demonstrate the recommended C4-7 anterior cervical discectomy and fusion.
  • Reinforce the doctor’s testimony that his patient needed this surgery as a direct result of the whiplash that occurred during the collision.

The Plaintiff’s doctor used the animation in arbitration, which helped him show the disc bulges, spinal compression, and surgeries - rather than having to explain these points through complex medical terminology. The presentation ultimately helped the three-person arbitration panel understand why this injury was much more serious than the Defense was alleging. They awarded the Plaintiff a $650K result.

    Part 1: Highlighting the Damaged Spine

    The animation opens with a Color Diagnostic depicting the damaged spine in an MRI. We added color to emphasize important details, such as the disc bulges, the flattening of the spinal cord, and a C3 osteophyte.

    Color Diagnostic of the Plaintiff’s MRI

    Michael Sorich, Esq., Cavanagh Law Group, Chicago, IL
    Having the animation - being able to show the damaged spine and walk people through the complex procedure he would need - really helped the doctor explain how serious this injury was, and I believe it definitely maximized the result.

    Part 2: Showing the Spinal Compression

    The animation then fades into a 3D model of the Plaintiff’s neck followed by an incision that reveals his cervical spine. The camera zooms into one of the vertebrae and focuses attention on a herniated disc to show how it directly caused compression on the spinal cord. As the doctor would testify, this severe compression was the primary reason the Plaintiff needed this surgery.

    Herniated Discs and Spinal Compression

    The myelopathy was caused by that collision, and the surgery I'm recommending is for myelopathy only… He certainly has enough pathology to cause a lot of radiculopathy. But again, what's pushing the surgical recommendations remains this myelopathy problem.
    Testimony by the Plaintiff's Doctor

    Part 3: Demonstrating the Surgery

    After establishing the injury and the spinal compression it caused, the animation walks viewers through the entire surgery he would need as a result of this myelopathy. Seeing this extensive procedure in realistic three-dimensional detail helped drive home the totality of this experience, and the seriousness of this issue.

    C4-7 Anterior Cervical Discectomy with Fusion

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