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Gamata v. Allstate Insurance Co.4/28/1999
, Plaintiff confirmed that he had previously injured his right foot in 1992, his right shoulder while at work on August 11, 1994, and that he slipped and fell while working on April 4, 1995. Plaintiff did not testify to any neck pain or headaches resulting from these incidents.
Dr. Sheetz opined that treatment of Plaintiff after the denial would be inappropriate because he "[didn't] see any injuries that could be reasonably related to . . . accident." According to Dr. Sheetz, Plaintiff's complaints were motivated by "secondary-gain issues" such as financial gain, and that such "psychosocial factors" should be considered in examining and treating a patient. Dr. Sheetz asserted that after Allstate's denial, further no-fault treatment was not "necessary" and would not have been "appropriate" or "reasonable." During cross-examination, Dr. Sheetz declared that had he been treating Plaintiff, he would have ceased treatment long before Dr. Portner did, because "by agreeing to see a patient under no-fault, you are, in fact, stating that you believe . . . the motor vehicle accident is responsible for his [or her] present symptoms[.]"
At the close of trial, the court decided that Plaintiff had not proven a violation of his right to no-fault benefits because (1) no strong correlation between Dr. Portner's treatment and Plaintiff's improvement existed, (2) any pain relief was only temporary, and (3) Plaintiff was not a "hundred per cent" prior to the subject accident:
All right. Plaintiff has filed a complaint. This is a complaint that was filed on November 18, 1997. Plaintiff claims that . . . Allstate's October 13, 1997 denial of no-fault benefits to Plaintiff . . . constitutes a violation of . . . Allstate's statutory and contractual duties to provide no-fault benefits to or on behalf of Plaintiff[.]
Now[,] preponderance of the evidence, if you look at the testimony that's been presented, we have Dr. Portner's testimony and Dr. Portner in particular says that [Plaintiff's] improvement, he does not know whether it would be due to treatment or the passage of time.
He also says that he's not sure[,] in terms of [Plaintiff's] return to work[,] whether it was due to treatment or passage of time. So even Dr. Portner himself could not say[,] in terms of [Plaintiff's] improvement or his ability to return to work[,] was due to either the treatment or just by passage of time, such that if he had no treatment, whether he could return to work on his own. It's not clear from Dr. Portner's own testimony.
[Plaintiff's] own testimony, in talking about the treatment that he received from Straub from Dr. Portner for the physical therapy, was only temporary relief, does not show a pattern of improvement in that the relief was only temporary for the physical therapy, that he got temporary relief, but that the same day, the pain returned.
Also[,] for the injection[ ] that he got from Dr. Portner, he also said was temporary relief, that the pain still returned after one week, seven to eight days.
So what we have here is we have just temporary relief from [Plaintiff]. [Plaintiff] also says that he wants to be pain free[,] but he himself has testified that even before the automobile accident, he was not hundred per cent and that may have been due to his prior disabilities, but he himself testified that he was not hundred per cent prior to the accident in terms of functioning.
In looking at Dr. Sheets' testimony, Dr. Sheets has looked at all of the prior records and has elicited testimony from [Plaintiff] regarding his prior accident .
In hearing Dr. Portner's testimony, Dr. Portner has said that
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