I. LIABILITY. Sample

Transcription

1 1

2 I. LIABILITY 2

3 1. LIABILITY SUMMARY On December 8, 2017, at approximately 10:23 AM, Mr was the restrained operator of a black 2010 Jeep Wrangler traveling southbound on the median lane of As our client was approaching the intersection, the at-fault driver, operating a white 1998 Ford Econoline intersection and pulled out into our client failed to yield at the lane of travel near the intersection and failed to yield the right of way to our client s vehicle. Despite desperate efforts to avoid a collision by applying brakes, collided against the defendant s vehicle. The investigating officer found the defendant, at fault for the accident and cited him for failure to yield/stop at a yield intersection; operating while driving license was suspended/canceled/revoked, 1 st conviction; attaching tag (license plate not assigned) and for no proof of insurance. Please find attached herein the Traffic Crash Report as Exhibit 1. Our Client s vehicle sustained extensive damage exorbitantly amounting to attached herein the property damage report as Exhibit 2. Please find The defendant breached the duty of care to operate his vehicle in a safe and reasonable fashion when he acted unreasonably, carelessly, recklessly, and negligently under the circumstances, thereby forcefully causing this collision. The defendant failure to keep a proper lookout for conditions of the road violated statutes and resulted in the collision. conduct constitutes negligence which is the proximate cause of the subject accident and the injuries and damages sustained by Mr.. Per the supportive documentation, Our Client was obeying all laws at the time of the accident and was acting reasonably under the circumstances, consequently alleviating any comparative negligence issues. Based on the foregoing, and based on the provided documentation, it is abundantly clear that liability solely rests with the defendant. Liability is indisputable in this case. 3

4 2. ACCIDENT REPORT Below you will find the Police Department s Investigating Officer s Narrative Opinion of What Happened: The defendant is vehicle 1: 4

5 3. DIAGRAM OF COLLISION SCENE PLA 5

6 4. AERIAL VIEW OF COLLISION SCENE 6

7 5. PHOTOGRAPHS OF COLLISION SCENE 7

8 8

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10 6. PHOTOGRAPHS OF FIREFIGHTERS & PARAMEDICS AT THE COLLISION SCENE 10

11 11

12 II. DAMAGES 1. MEDICAL CHRONOLOGY OF A. SUMMARY OF INJURIES As a result of the defendant s negligence, our Client has suffered the following injuries: Acute neck pain Cervicalgia Sprain of ligaments of cervical spine Cervical strain Segmental and somatic dysfunction of cervical region Herniated cervical disc Cervical disc displacement in mid-cervical region Cervical disc herniation with significant central stenosis Cervical radiculopathy Right shoulder pain Pain in thoracic spine Low back pain Lumbar intervertebral disc displacement Sprain of ligaments of lumbar spine Herniated lumbar disc Segmental and somatic dysfunction of lumbar region Lumbar disc herniation at L4-L5 and L5-S1 Lumbar annular tear at L4-L5 Lumbar strain possibly with left-sided facet joint injury Lumbar strain with possible facet mediated pain Other specified dorsopathies in lumbar region Left hip pain Myalgia Myositis Muscle spasm Headaches 12

13 HEADACHES 13

14 CERVICALGIA/NECK PAIN HERNIATED CERVICAL DISC 14

15 RADIATING PAIN FROM NECK 15

16 RIGHT SHOULDER PAIN 16

17 LOW BACK PAIN 17

18 LUMBAR ANNULAR TEAR HIP PAIN 18

19 B. TREATMENT Musculoskeletal back pain, dorsalgia Musculoskeletal back pain, dorsalgia -EMS 12/08/2017 -ED 12/08/2017 Acute neck pain Acute neck pain -EMS 12/08/2017 -ED 12/08/2017 -Hospital 12/08/2017 -Chiropractic Therapy 12/13/ /06/2018 -Physical Therapy 05/21/ /06/2018 Right shoulder pain Low back pain Right shoulder pain -ED 12/08/2017 -Hospital 12/08/2017 Low back pain -Chiropractic Therapy 12/13/ /06/ Physical Therapy. 05/21/ /06/2018 Sprain of ligaments of lumbar spine Sprain of ligaments of lumbar spine -Chiropractic Therapy- 12/13/ /06/2018 -Physical Medicine- 01/30/ /06/2018 -Chiropractic Therapy- 03/13/ /28/2018 Sprain of ligaments of cervical spine 19 Sprain of ligaments of cervical spine -Chiropractic Therapy- 12/13/ /06/2018 -Physical Medicine- 01/30/ /06/2018

20 -Chiropractic Therapy- 03/13/ /28/2018 Pain thoracic spine Pain thoracic spine -Chiropractic Therapy 12/13/ /06/2018 Myalgia, myositis, muscle spasm Myalgia, myositis, muscle spasm -Chiropractic Therapy 12/13/ /06/2018 -Physical Medicine- 01/30/ /06/2018 Herniated cervical disc Herniated cervical disc -Physical Medicine- 01/30/ /06/2018 Herniated lumbar disc Herniated lumbar disc -Physical Medicine- 01/30/ /06/2018 Other specified dorsopathies, lumbar region Other specified dorsopathies, lumbar region -Chiropractic Therapy 03/13/ /28/2018 Segmental and somatic dysfunction of cervical region Segmental and somatic dysfunction of cervical region -Chiropractic Therapy 03/13/ /28/2018 Segmental and somatic dysfunction of lumbar region Segmental and somatic dysfunction of lumbar region -Chiropractic Therapy 03/13/ /28/2018 Post-traumatic low back pain 20 Post-traumatic low back pain -Physical Medicine- 01/30/ /06/2018

21 Lumbar disc herniation L4-5 and L5-S1 Lumbar disc herniation L4-5 and L5-S1 -Physical Medicine- 01/30/ /06/2018 Lumbar annular tear at L4-L5 Lumbar annular tear at L4-L5 -Physical Medicine 01/30/ /06/2018 Herniated nucleus pulposus-cervical region Herniated nucleus pulposus-cervical region -Office Visit- 04/03/ /04/2018 Other intervertebral disc displacement, lumbar region Other intervertebral disc displacement, lumbar region -Office Visit- 04/03/ /04/2018 Headaches Headaches -Physical Therapy. 05/21/ /06/2018 Left hip pain Left hip pain -Physical Therapy 05/21/ /06/

22 2. TREATMENT ILLUSTRATIONS A. Manual Therapy B. Electrical Muscle Stimulation C. Chiropractic Manipulation 22 D. Ultrasound E. Mechanical traction

23 F. Therapeutic Exercises G. Cervical Epidural Steroid Injection 23

24 H. Lumbar Epidural Steroid Injection 24

25 3. SUMMARY OF TREATMENT OF INJURIES First Date of Treatment Last Date of Treatment December 8, 2017 September 6, 2018 A. EMERGENCY MEDICAL SERVICES December 8, 2017 On December 8, 2017, immediately after the accident, paramedics from responded to the call and arrived at the scene of the accident. Mr. complained of low back pain, since the aforementioned accident. He rated his pain as 6.5 on a pain scale of 10. Mr. was then transported via ambulance with complete spine precautions to the emergency department at for the injuries sustained in the accident. (On the left you will find the photo of the EMS treatment rendered to Mr. at the scene of the accident which I offer for a better understanding of my client s injuries sustained in the motor vehicle crash at issue today.) Medical Bills $ 25

26 B. EMERGENCY DEPARTMENT TREATMENT December 8, 2017 ( ) On the same day, Mr. was evaluated by,, in the emergency department at for the treatment of injuries sustained in the aforementioned accident. He complained of pain in his neck, right shoulder and right side of his low back, since the aforementioned motor vehicle accident. He rated his pain as 7 on a pain scale of 10. He had a C-collar in place. A physical examination demonstrated tenderness in the posterior side of his right shoulder. A CT of his cervical spine and X-rays of his right shoulder were ordered and performed. The studies were unremarkable for any significant finding. Following complete examination, Mr. was diagnosed with acute neck pain and right shoulder pain secondary to the motor vehicle collision. (On the left you will find an illustration of an acute neck pain which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today.) During the course of emergency care, Mr. was given Ibuprofen orally for pain. He was discharged with prescriptions for Cyclobenzaprine and Naproxen. He was advised to follow-up with Dr. of Orthopedic Surgery in three to five days. He was provided a work release note excusing him from work from December 8, 2017 through December 9, Mr. was advised to return to the emergency room, in case of worsening symptoms. Medical Bills $ 26

27 C. CHIROPRACTIC CARE December 13, 2017 through February 6, 2018 ( ) On December 13, 2017, Mr. presented to at for evaluation and to begin a course of chiropractic care. He complained of frequent moderate to severe worsening sharp, aching pain in his neck and mid/low back. He rated his pain as 6 to 7 on a pain scale of 10. His neck pain radiated to both sides of his head. His pain symptoms occurred with lifting, sitting and exercising. A physical examination demonstrated tenderness, hypertonicity and muscle spasm/tension on bilateral sides of spine; multiple active trigger points in the spine associated with consistent referred pain; trigger points on paracervical bilateral, parathoracic bilateral, paralumbar bilateral, levator scapulae bilateral, quadratus lumborum bilateral and rhomboid bilateral; moderately reduced cervical/thoracic/lumbar range of motion with pain; and positive cervical compression test. His foraminal compression test, shoulder depression maneuver, Bechterew s sitting test and Yeoman s test were positive bilaterally. His Kemp s test and straight leg raising test were positive on the left. Following a series of tests and complete physical examination, Mr. was assessed with sprain of ligaments of cervical/lumbar spines; low back pain; cervicalgia; pain in thoracic spine; and myalgia. (On the left you will find an illustration of cervicalgia due to cervical sprain which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today.) Mr. was recommended to undergo chiropractic care thrice a week for four weeks. A treatment plan consisting of ultrasound, chiropractic manipulation, electrical stimulation, therapeutic exercises, hot/cold packs and home exercise program was devised to decrease Mr. s pain and to improve his strength and flexibility. Mr. received 12 sessions of chiropractic care from December 13, 2017 to February 6, Medical Bills $ 27

28 D. OFFICE VISIT January 30, 2018 On January 30, 2018, Mr. presented to at for complaints of constant pain in his neck and back. He rated his pain as 6 on a pain scale of 10. His pain symptoms worsened with exercises. A physical examination demonstrated decreased range of motion in his neck and back. Upon examination, Mr. was assessed with Neck pain; Unspecified myalgia/myositis; Muscle spasm; and, Lumbar sprain Dr. Cusumano opined that Mr. had an emergency medical condition with acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to Mr. s health, serious impairment of bodily functions or serious dysfunction of any bodily organ or part. He was recommended an MRI of his cervical/ lumbar spines. Mr. was advised to return to the clinic in two weeks status post the MRIs. OFFICE VISIT February 15, 2018 On February 15, 2018, Mr. returned to Dr. at for reevaluation. The MRI of his cervical/lumbar spines were reviewed. A physical examination demonstrated pain with decreased cervical/lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; herniated cervical disc and herniated lumbar disc. He was referred to Dr.. Mr. was advised to follow-up in the clinic in one month for reevaluation. OFFICE VISIT March 20, 2018 On March 20, 2018, Mr. followed up with Dr. at for complaints of back pain. A physical examination demonstrated pain with cervical/lumbar range of motion and decreased lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; herniated cervical disc; and herniated lumbar disc. He was referred to Dr. for possible lumbar epidural steroid injection. Mr. was advised to return to the clinic in six weeks for continued care. 28

29 OFFICE VISIT April 3, 2018 On April 3, 2018, Mr. presented to at for complaints of low back pain. He complained of worsened, aching, throbbing, tight, stiff low back pain since the aforementioned motor vehicle collision. He rated his pain as 7 on a pain scale of 10. His pain symptoms worsened in the morning and during the day. His pain symptoms exacerbated with lifting, bending and standing. A review of his systems was positive for sleep disturbance. A physical examination demonstrated tenderness over the midline of the cervical spine; decreased cervical range of motion; minimal tenderness of nuchal ridge; pain with restricted lumbar range of motion; and positive facet loading on the left. The MRI of his cervical/lumbar spines dated 02/12/2018 were reviewed. Upon examination, Mr. was assessed with post-traumatic low back pain; lumbar disc herniation at L4-L5 and L5- S1; and lumbar annular tear at L4-L5. (On the left, you will find an illustration of what an annular tear looks like which I offer for a better understanding of my client s lumbar injuries sustained in the motor vehicle crash at issue today.) Dr. opined that Mr. s symptoms were related to the motor vehicle accident that occurred on December 8, 2017, since he had no prior symptoms. He was recommended an intralaminar epidural steroid injection at left L5-S1. He was recommended of possible surgical treatment, in case of persisting symptoms. After informed consent was obtained, epidural steroid injection was administered through the interlaminar space of left L5-S1 under local anesthesia, using fluoroscopic guidance, in sterile conditions. Mr. tolerated the procedure well. He was discharged under stable conditions. Mr. was advised to return to the clinic in two weeks for repeat procedure. 29

30 (On the left you will find an illustration of an epidural steroid injection with injection needle visible in the epidural space which I offer for a better understanding of the procedure my client underwent due to the negligence of the defendant in causing the motor vehicle crash at issue today. Please allow this illustration for a better understanding of epidural steroid injection reported above.) (See Procedure note attached for your convenience.) OFFICE VISIT April 24, 2018 On April 24, 2018, Mr. returned to Dr. at for followup evaluation. He complained of pain in his neck and back. A physical examination demonstrated pain with cervical/lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; and herniated cervical/lumbar discs. He was advised to follow-up with Dr. as scheduled. Mr. was advised to return to the clinic in six weeks for reevaluation. OFFICE VISIT May 1, 2018 On May 1, 2018, Mr. followed up with Dr. at for second lumbar epidural steroid injection. He complained of increased cervical pain since the aforementioned motor vehicle collision. He had worsened pain on the right side of his neck. The pain on the left side of his neck worsened with prolonged standing and inactivity. A physical examination demonstrated bilateral tenderness of nuchal ridge; increased tonicity of cervical paravertebral muscles; pain with left-sided lumbar facet load; and positive Faber s test on the left. Upon examination, Mr. was assessed with posttraumatic cervical/lumbar pain; cervical disc herniation with significant central stenosis; cervical strain; lumbar strain possibly with leftsided facet joint injury; and lumbar disc herniation. (On the left, you will find an illustration of what facet joint injury looks like which I offer for a better understanding of my client s lumbar injuries sustained in the motor vehicle crash at issue today.) 30

31 Mr. was recommended a cervical epidural steroid injection initially followed by a left lumbar diagnostic facet medial branch nerve block. Mr. was advised to return to the clinic for the scheduled procedure. OFFICE VISIT May 31, 2018 On May 31, 2018, Mr. returned to Dr. at for the scheduled injection. After informed consent was obtained, Mr. was transferred to the procedure room for the scheduled injection. 40mg of Triamcinolone with 4cc of preservative-free normal saline was administered into the interlaminar space of C6-C7, under local anesthesia, using fluoroscopic guidance, in sterile conditions. Mr. tolerated the procedure well. Mr. was discharged home under stable conditions. OFFICE VISIT June 12, 2018 On June 12, 2018, Mr. followed up with Dr. at for reevaluation. He complained of pain in his neck and back. His cervical epidural steroid injection failed to provide adequate relief. His back pain interfered with his functionality and quality of life. A physical examination revealed pain with cervical/lumbar range of motion; and decreased lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; and herniated cervical/lumbar discs. He was advised to follow-up with Dr. as scheduled for lumbar facet injection. Mr. was advised to return to the clinic in six weeks for reevaluation. OFFICE VISIT July 31, 2018 On July 31, 2018, Mr. returned to Dr. at for reevaluation. He complained of pain in his neck and back with occasional numbness and tingling in his left upper extremity. A physical examination revealed pain with decreased cervical/lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; and herniated cervical/lumbar discs. He was advised to follow-up with Dr. Mr. was advised to return to the clinic in one month for follow-up care. OFFICE VISIT August 21, 2018 On August 21, 2018, Mr. returned to Dr. at for followup evaluation. He complained of persistent cervical symptoms with newly onset radicular 31

32 symptoms radiating to his left upper extremity. He also complained of continued low back pain. A physical examination demonstrated decreased cervical range of motion; positive left Spurling s maneuver; weakness with left finger-thumb grip; mild decreased sensation in C6-C7 dermatomes. Upon examination, Mr. was assessed with posttraumatic cervicalgia; cervical/lumbar disc herniation; cervical radiculopathy; persistent low back pain; and lumbar strain with possible facet mediated pain. (On the left, you will find an illustration of what cervical radiculopathy looks like which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today.) Mr. was provided a prescription for Medrol Dosepak 4mg. He was recommended a repeat MRI of his cervical spine. Dr. opined that Mr. would most likely require surgical treatment of his cervical spine. Mr. Weylie was advised to return to the clinic for continued care. OFFICE VISIT September 6, 2018 On September 6, 2018, Mr. returned to Dr. at for the scheduled injection. He complained of pain in his neck and back with occasional numbness and tingling in his left upper extremity. A physical examination revealed pain with decreased cervical/lumbar range of motion. Upon examination, Mr. was assessed with neck sprain; lumbar sprain; and herniated cervical/lumbar discs. He was advised to follow-up with Dr. for continued medical care. Mr. was advised to return to the clinic on as-needed basis. Medical Bills $ 32

33 E. DIAGNOSTIC STUDY (MRI of Cervical/Lumbar Spines) February 12, 2018 ) On February 12, 2018, at the referral of Dr., Mr. presented to MD at for MRI of his cervical/lumbar spines. The MRI of his cervical spine revealed: 1) Multilevel disc herniations most pronounced at C5-C6 impinging the ventral cord resulting in severe central canal stenosis as well as severe bilateral foraminal stenosis impinging the exiting bilateral C6 nerve roots. 2) C4-C5 disc herniation impinging the ventral cord resulting in severe central canal stenosis. 3) Disc herniation at C2-C3 with mild central canal stenosis. (On the left you will find an illustration of what a disc herniation looks like which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today and reported in his cervical MRI above.) (See MRI report attached for your convenience.) 4) Disc bulge at C3-C4 with mild central canal stenosis and moderate bilateral foraminal stenosis abutting the exiting bilateral C5 nerve roots. 5) C6-C7 disc bulge with mild central canal and mild bilateral foraminal stenosis. The MRI of his lumbar spine revealed: 1) Multilevel disc herniations. A right lateralizing disc herniation impinging the traversing right L2 nerve root in the subarticular recess at L1-L2. 2) Central disc herniation with annular fissure/tear abutting the traversing bilateral L5 nerve roots in the subarticular recess at L4-L5. 33

34 (On the left you will find an illustration annular fissure/tear which I offer for a better understanding of my client s lumbar injuries sustained in the motor vehicle crash at issue today and reported in his lumbar MRI above.) (See MRI report attached for your convenience.) 3) Right lateralizing disc herniation abutting the traversing right S1 nerve root in the subarticular recess at L5-S1. 4) Disc bulge at L3-L4 resulting in bilateral foraminal stenosis. (Above, you will find an illustration of what a disc bulge and herniated disc looks like which I offer for a better understanding of my client s cervical/lumbar injuries sustained in the motor vehicle crash at issue today and reported in his cervical/lumbar MRIs above.) (See MRI report attached for your convenience.) Medical Bills $ 34

35 F. CHIROPRACTIC CARE March 13, 2018 to March 28, 2018 ( ) On March 13, 2018, Mr. presented to at for evaluation and to begin a course of chiropractic care. He complained of constant discomfort and acute dull, aching pain in his anterior head/posterior head(headache)/right anterior trapezius/shoulder/right posterior trapezius/right posterior shoulder/right mid thoracic region and left lumbar/lumbar/right lumbar/left sacroiliac/left posterior pelvis and hip/left buttock. He also had acute pubic pain since the aforementioned collision. He rated his pain as 5 on a pain scale of 10. His pain symptoms aggravated with any movement. He reported difficulty with employment, lifting, sitting, getting to sleeping, staying asleep, using a computer, bending over, car driving, exercising and participating in yard work. A physical examination demonstrated moderate to severe muscle spasms in left anterior trapezius, left anterior shoulder, left chest, right side of neck, right posterior trapezius, right posterior shoulder, right mid thoracic, left lower thoracic, left lumbar, lumbar, right lumbar and left sacroiliac region. The examination also revealed decreased cervical/thoraco-lumbar range of motion and decreased range of motion of right shoulder. Following a series of tests and complete physical examination, Mr. was assessed with: Sprain of joints and ligaments of neck; Sprain of ligaments of lumbar spine; Other specified dorsopathies in lumbar region; Other muscle spasm; Cervical disc displacement in mid-cervical region; and, Segmental and somatic dysfunction of cervical/lumbar region. Mr. was recommended to undergo chiropractic care. A treatment plan consisting of myofascial release, mechanical traction, chiropractic manipulation, electrical stimulation, ultrasound, low-level light therapy (LLT)-cold laser; paraffin bath; infrared; decompression; massage, vasopnuematic devices; hot/cold packs and home exercise program was devised to decrease Mr. s pain and to improve his strength and flexibility. Mr. received three sessions of chiropractic care from March 13, 2018 to March 28, Medical Bills $ 35

36 G. PAIN MANAGEMENT April 3, 2018 ) On April 3, 2018, Mr. presented to at for complaints of pain in his neck and back, since the aforementioned motor vehicle collision. He had a sense of heaviness in his legs and transitional pain in his low back. He rated his pain as 6 on a pain scale of 10. His pain symptoms exacerbated with sitting. He had pain with rising from seated position as well. The MRI of his cervical/lumbar spines dated 02/12/2018 were reviewed. A physical examination of his spine revealed tenderness of his cervical/thoracic/lumbar spines accompanied with pain and limited range of motion; lumbar muscle spasm; and mild loss of lumbar lordosis. His clonus test was positive. (On the left, you will find an illustration of what loss of lumbar lordosis looks like which I offer for a better understanding of my client s lumbar spine injuries sustained in the motor vehicle crash at issue today.) Upon examination, Mr. was assessed with cervical herniated nucleus pulposus and lumbar intervertebral disc displacement. Dr. opined that Mr. s compromised function was the result of the trauma sustained from the aforementioned motor vehicle collision and was a permanent condition. Dr. opined that the MRI findings were certainly the result of the aforementioned motor vehicle collision and the cause of Mr. s pain, disability and a new permanent condition. He was recommended injection and a possible decompression and fusion at C5-C7. He was also recommended a medial branch block on the right L3-S1 as a diagnostic and potentially therapeutic procedure for radiofrequency ablation. Mr. was advised to return to the clinic for the scheduled medial branch block. 36

37 FOLLOW-UP VISIT September 4, 2018 ( ) On September 4, 2018, Mr. presented to at for consultation. He complained of pain in his neck radiating to his left shoulder and arm. His associated symptoms included upper extremity weakness. He reported difficulty with activities due to pain. The MRI of his cervical spine dated 08/24/2018 was reviewed. The MRI of his lumbar spine dated 02/12/2018 was also reviewed. A physical examination of his spine revealed tenderness of his cervical/thoracic/lumbar spines accompanied with pain and limited range of motion; lumbar muscle spasm; and mild loss of lumbar lordosis. Upon examination, Mr. was assessed with cervical radiculopathy; and lumbar intervertebral disc displacement. Dr. opined that the MRI findings were certainly the result of the aforementioned motor vehicle collision and the cause of Mr. s pain, disability and a new permanent condition. He was recommended a medial branch block at right L3-S1 levels as a diagnostic and potentially therapeutic procedure for radiofrequency ablation. He was recommended to undergo Anterior cervical discectomy and fusion (ACDF) at C5-C7. The charges for Dr. s fees was estimated to be $39, Mr. was advised to return to the clinic for the scheduled procedure. (On the left you will find an illustration of the recommended surgery-anterior cervical discectomy and fusion which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today.) Medical Bills $ 37

38 H. PHYSICAL THERAPY May 21, 2018 to August 6, 2018 ) On May 21, 2018, Mr. presented to at for evaluation and to begin a course of physical therapy. He complained of daily foggy occipital headaches. He also had constant predominantly right-sided pain, tightness and achiness in the left side of his neck and upper trapezius. He had constant predominantly left-sided low back pain/stiffness radiating to his gluteal region. He reported tightness/pain in his left anterior hip/hip flexor with certain movements. A physical examination demonstrated tenderness and pain with palpation of C1-T5 and L1-L5. Tenderness, pain and increased muscle tone was noted over right upper trapezius/cervical region, right subcranial region and bilateral lumbar paraspinals during examination. Following a series of tests and complete physical examination, Mr. was assessed with: Headaches, Neck pain, Low back pain; and, Left hip pain He was recommended to undergo physical therapy one to three times a week for four to eight weeks. A treatment plan consisting of mechanical traction, soft tissue mobilization, joint mobilization, therapeutic exercises, body mechanics training/joint protection and home exercise program was devised to decrease Mr. s pain and to improve his strength and flexibility. Mr. received 13 sessions of physical therapy from May 21, 2018 to August 6, Medical Bills $ 38

39 I. DIAGNOSTIC STUDY (MRI of cervical spine) August 24, 2018 ( ) On August 24, 2018, at the referral of Dr., Mr. presented to at for MRI of his cervical spine. The study revealed: 1) Straightening of normal curvature of the cervical spine with possible association with ligamentous injury, muscle spasm or sprain. (On the left you will find an illustration of straightened cervical curvature which I offer for a better understanding of my client s cervical injuries sustained in the motor vehicle crash at issue today and reported in his cervical MRI above.) (See MRI report attached for your convenience.) 2) Broad central disc bulge with left greater than right neural foraminal narrowing at C6-C7. 3) Broad central disc herniation contacting the anterior spinal cord and narrowing the central canal to 7mm with right greater than left neural foraminal narrowing at C5-C6. 4) Central disc protrusion contacting the anterior spinal cord and narrowing the central canal to 8mm with bilateral neural foraminal narrowing at C4-C5. 5) Shallow central disc bulge narrowing the central canal to 9.5mm with some bilateral neural foraminal narrowing at C3-C4. 6) Shallow central disc bulge narrowing the central canal to 9.5mm at C2-C3. Medical Bills $ 39

40 4. MEDICAL SPECIALS TOTAL: $ 5. DISABILITY AND LOST WORK Mr. is self-employed as a. Please be advised that this accident has been extremely traumatic for Mr. In addition to being unable to complete his daily activities without pain and discomfort for approximately 39 weeks, his work life is affected. Also, Mr. continues to experience pain in his neck and back, which he did not experience prior to the accident on December 8, Prior to his aforementioned injury on December 8, 2017, Mr. energetic individual, as evidenced in the pictures below: was a very active and 40

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43 As a result of this accident, Mr. was partially disabled from December 8, 2017 to September 6, 2018 (a period of 39 weeks). Partial disability includes a modification of work duties, daily activities, and any other activities that may aggravate or reproduce one s symptoms. As a result of this accident, Mr. incurred medical bills in the amount of $ and continues to experience residual pain to date and continuing. Also Mr. incurred out of pocket expenses in the amount of $ Mr. 6. DAMAGES - INJURY s past general damages are determined by the nature, extent and duration of his injury. Considering the extent and duration of his injuries, the total injury damages equal $. Mr. s claim for past and general damages is based on similar insurance settlements and jury awards within his jurisdiction, and is very reasonable considering the loss of enjoyment of life that he has suffered and may continue to suffer for the rest of his life. 7. DAMAGES PAIN, SUFFERING AND MENTAL ANGUISH As a result of the accident, Mr. has had to experience a daily routine of waking up and not knowing how he would feel or what he might be able to do physically. His injuries have forced him to forgo hobbies, and he has had to rely on the help of his family to handle a significant portion of his personal responsibilities. This not only caused him daily pain and suffering, but it also wreaked havoc to his personal and professional life. If the collision had not happened, he could have saved his resources and time for better purposes, instead of vainly spending them on medical treatment. 43

44 Overall, the collision on December 8, 2017 has significantly impacted Mr. s life and will continue to hamper him for the rest of his life. His future loss of income is at a minimum of $ per year for years, equaling $. Mr. damages for pain, suffering and mental anguish are $. Mr. 8. FUTURE MEDICAL EXPENSES will incur medical expenses in the future related to the injuries he sustained in this collision. Future medical treatments are addressed below. Mr. continued to experience ongoing pain in his neck. He will, therefore, require surgery in the form of anterior cervical discectomy and fusion at C5, C7 levels, and possible additional levels, with allograft. The cost of the surgery is estimated as below: The estimated cost for the anesthesia is: $ The estimated cost for the surgery is: $ The estimated cost for Physician charges: $ Total: $ 44

45 CONCLUSION Mr. claims total compensation in the amount of $ to make him whole for the damages he has sustained as a result of the negligence on behalf of the defendant. A summary of Mr. s damages are as follows: s SUMMARY OF DAMAGES Past Medical Expenses: $ Future Medical Expenses: $ Out of Pocket Expenses: $ Future Loss of Income: $ Past Pain & Suffering Loss of Activities and Life Impact: $ Future Pain & Suffering Loss of Activities, Life Impact: $ Loss of Consortium: $ Total Damages: $ Our firm has consulted with Mr. reviewed his medical bills, records, and other evidence. In light of Mr. s pain and continuing suffering, disability period, medical expenses and other constraints this accident has had on his daily life, we hereby make a demand in the amount of $. 45

46 List of Exhibits S. No Name 1. Police Report 2. Property Damage Out of Pocket Expenses 14. Future Medical Expenses *Please refer to the reports, medical records and medical bills, attached here to as Exhibits1-14, for complete information. 46