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Hand v. Royal Insurance Company of America12/19/2002
ting symptoms, I do not believe the surgery was a result of the fall. (Id.)
As noted earlier, on September 6, 2001, Dr. Weinert wrote to Royal Insurance's claims adjuster, opining that claimant's condition and surgery were not related to the July 2nd incident and that the incident merely "caused a slight aggravation of her symptoms." (Ex. 7 at 17.) His full letter reads as follows:
September 6, 2001
Sandy Scholl Putman and Associates 321 SW Higgins Missoula, MT 59803
Re: HAND, PAM CLAIM # 2S023481
Dear Ms. Scholl,
I am in receipt of your letter of 9-4-01 and will address your questions accordingly:
1. Ms. Hand suffers from significant degenerative arthritis with posterior osteophytic spurring at C3-4 and C5-6 levels, causing corresponding spinal canal stenosis with additional disk bulges at C4-5 and C6-7 levels. It is felt that the significant arthritic change and spinal stenosis was a preexistent condition, as Ms. Hand has been complaining of numbness and tingling in the upper extremities for quite some time despite normal EMG and nerve conduction testing. Therefore, I do believe that Ms. Hand's need for surgery pre-exists her injury of 7-2-01, although that injury may have caused a slight aggravation to her symptoms.
2. It would appear that Ms. Hand require surgery prior to July 2, 2001, as the large osteophytic spurs, no doubt, were a preexistent condition to her 7-2-01 injury and spinal stenosis was preexistent.
3. The MRI was indicated for Ms. Hand's persistent symptoms of bilateral arm numbness and tingling, as well as chronic neck pain and upper back pain.
4. Ms. Hand complained of increased neck and arm pain, as well as intractable headaches and bilateral arm numbness prior to her arm injury of 7-2-01.
If you have questions or concerns regarding this letter, please do not hesitate to contact me.
Sincerely,
Allen M. Weinert, M.D. (Id.)
Dr. Rizzolo reviewed Dr. Weinert's letter and concurred, writing:
I recently reviewed the September 6, 2001 correspondence form Dr. Weinert to yourself [the claims adjuster]. I believe he is in the best position to determine what the patient's pre-injury symptoms were. Based on his recent correspondence, it is my opinion the patient's symptoms are not work-related, they are in fact related to her pre-existing degenerative changes. (Ex. 9 at 4.)
In his deposition, Dr. Weinert testified that neck surgery would have been required absent the July 2nd incident. (Weinert Dep. at 28.) He noted that pre-July 2nd the claimant had significant stenosis which put her at risk for spinal cord injury . (Id. at 27.) He was asked whether the July 2nd incident aggravated her condition and indicated that she did suffer some increased pain following the incident. (Id. at 32.) When asked further about the aggravation, he testified as follows:
A: It's difficult to say. We know that people with spinal stenosis are at risk for spinal cord injury if they suffer a trauma. In other words, if someone with spinal cord -- cervical spinal cord stenosis were to go skiing and suffer a hard fall, obviously, they're more susceptible to injury to the spinal cord than someone that doesn't have that because they have very little room for that cord to move, and it's much more susceptible to contusion of the cord or bruising or injury; and, in fact, high risk for becoming quadriplegic.
So with a significant trauma, they are at risk for injury that a normal person without that condition, the condition being spinal stenosis, would not be at risk for.
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