Case details

Claimant: Hit and run caused need to replace medical device





Result type

Not present

aggravation of pre-existing condition shoulder, back, myofascial syndrome, neck
On Dec. 5, 2017, claimant Michael Manes, a 59-year-old unemployed man, was driving east on Pico Boulevard, in Los Angeles. After passing through the intersection with Fairfax Avenue, his sedan was rear-ended by a white sport utility vehicle with a large front bumper guard. The driver of the SUV immediately fled the scene, and Manes was unable to determine the SUV’s license plate number. Manes claimed to his pelvis, back, neck and left shoulder. Manes sought recovery via the supplementary-underinsured-motorist provision of his own insurance policy, which was administered by Allstate Northbrook Indemnity Co., a division of Allstate Insurance Co. Allstate purported that Manes staged the accident, and then discontinued issuing payments under Mane’s medical payment (MedPay) coverage. The matter proceeded to a binding arbitration. Manes’ biomechanics and accident-reconstruction expert illustrated that the property damage was consistent with the type of vehicle Manes described as having hit him. Allstate’s accident-reconstruction expert opined that Manes’ property damage was inconsistent with a rear-end collision. Instead, the expert opined that the property damage was consistent with contact to a rigid barrier or stationary object, rather than the vehicle described by Manes., After the accident, Manes called 9-1-1 from the scene. He claimed that he suffered an aggravation of pre-existing myofascial to his entire back, neck and left shoulder. He also claimed that the impact of the collision rendered his InterStim generator — an implanted device that was supposed to send mild electrical pulses to stimulate the sacral nerves — to be nonfunctional. Manes was recommended surgery for the replacement of the whole InterStim generator device because of the accident. He claimed that the procedure differed from the replacement of the InterStim’s battery only, which was the surgery that was recommended before the accident. Manes ultimately underwent the surgery and had the InterStim generator replaced. Manes sought recovery of past and future medical costs, and damages for his past and future pain and suffering. Allstate’s counsel contended that since Manes was in another hit-and-run accident in 2016, which increased his medical payments coverage from $5,000 to $25,000, that Manes was fabricating a claim against Allstate so that he would have funds to pay for a necessary surgical procedure that may have been caused by the 2016 accident. Thus, counsel asserted that no surgery was needed for the subject accident, and asked the arbitrator to issue an award of zero dollars.
Matter not filed, CA

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