On Oct. 28, 2010, plaintiff Kimberly Rodriguez, 31, a medical biller/treatment coordinator, was stopped in traffic in her 1996 Ford Escort on northbound Interstate 880 in Fremont when her vehicle was rear-ended by a 2010 Toyota Camry that was propelled into her vehicle after being struck by a 2000 Chevy Lumina operated by Austin McKenzie. Rodriguez claimed to her neck. Rodriguez sued Austin McKenzie and the owner of the Chevy Lumina, Stanley McKenzie. Rodriguez alleged that Austin McKenzie was negligent in the operation of the Chevy Lumina and that Stanley McKenzie was vicariously liable for Austin McKenzie’s actions. Stanley McKenzie was ultimately dismissed from the case, and Austin McKenzie conceded liability for the accident., Rodriguez struck her head on the interior of her vehicle and was stunned by the crash. Shortly thereafter, she developed severe nausea, swelling and redness in her hands. As a result, she was transported by ambulance to St. Rose Hospital in Hayward. Following an emergency room course, which proved positive for severe headache radiating into her neck and sharp pain in her back radiating into both hips, Rodriguez was discharged from the hospital with instructions to follow-up with her primary care physician. The following day, she claimed her back pain was so severe that she was forced to return to St. Rose Hospital for further treatment and pain management. Over the ensuing few days, Rodriguez attempted to treat with rest and medication, but her pain persisted and she reported to a chiropractor on Nov. 1, 2010. Upon examination, Rodriguez reported neck pain radiating down her right arm with numbness and tingling in her right hand; severe chest pain with increased with deep breathing; mid- and lower-back pain; and significant sleep disruption secondary to her pain. The chiropractor’s examination revealed active trigger points in the upper trapezius muscle, and significant palpatory pain and spasms in the cervical and lumbar spine. He also noted pain with axial compression, a positive impingement test, and tenderness and bruising over the sternum and costochondral junctions. Thus, the chiropractor diagnosed Rodriguez with a post-traumatic sprains and strains of the thoracic and lumbar spine; a moderate post-traumatic paraspinal spasm; a hyperextension/flexion injury resulting in a cervical sprain/strain; contusions of the chest wall; and post-concussive syndrome. The chiropractor subsequently recommended a course of chiropractic care, including chiropractic manipulation, physiotherapy, ultrasound and electrical stimulation, which Rodriguez began shortly thereafter. Despite Rodriguez’s recommended course of chiropractic care, she failed to obtain any long-term relief and reported to her treating physician, a pain management physician, at Integrated Pain Care, a pain relief clinic in San Francisco. The physician’s initial evaluation demonstrated spasms and acute tenderness on palpation over the right trapezius muscles, and cervical, thoracic and lumbar spine. He also noted severely restricted ranges of motion to Rodriguez’s cervical and lumbar spine. Following his examination, the physician prescribed anti-inflammatories, recommended ongoing chiropractic care, and placed Rodriguez on temporary, total disability. However, at her follow-up appointment with her pain management physician, Rodriguez reported ongoing back and neck pain with radiating pain, numbness and tingling down her right arm into her fingers. She also reported persistent focus, concentration and memory deficits, as well as ongoing sleep disruption. The pain management physician’s examination revealed significant tenderness, multiple trigger points and spasms over the cervical and trapezius muscles. He also noted decreased sensation on the right at the C6 level, C7 dermatomes and a severely restricted range of motion in the cervical spine. As a result of Rodriguez’s persistent pain and radicular symptoms, the pain management physician ordered a cervical MRI, which was performed on Jan. 5, 2011, and demonstrated disc bulges at C3-4 and C4-5 with bilateral neural foraminal stenosis and a large 3.8-millimeter broad-based C5-6 disc herniation with severe bilateral neural foraminal stenosis and cord indentation on the C6 exiting nerve roots. With her positive cervical MRI findings and failure of conservative treatment, the pain management physician recommended a cervical epidural steroid injection, which Rodriguez underwent on Jan. 25, 2011, and March 8, 2011. While Rodriguez claimed she experienced temporary relief from her injections, she alleged her headaches and radicular symptoms continued to persist. As a result, she was finally referred to an orthopedic surgeon on May 26, 2011. Following a comprehensive examination, the orthopedic surgeon concluded that because Rodriguez still experienced substantial symptoms that failed respond to conservative treatment, she was a surgical candidate. He also recommended further testing, including a new MRI, EMG/NC studies and a surgical consultation. Rodriguez ultimately performed all of the orthopedic surgeon’s recommended testing, including an updated MRI at Health Diagnostics on June 21, 2011, and an EMG study on June 23, 2011. On Dec. 2, 2011, Rodriguez consulted with her treating orthopedic surgeon for a second opinion regarding spine surgery. The surgeon performed a comprehensive evaluation, including a review of films, testing and physical examination, and also recommended surgical intervention at C5-6, consisting of an artificial disc replacement/total disc arthroplasty. Rodriguez underwent decompression and C5-6 anterior discectomy with fluoroscopic guidance with her treating orthopedic surgeon at St. Francis Memorial Hospital in San Francisco on Jan. 5, 2012. Following the surgery, Rodriguez began a course of post-operative physical therapy at VibrantCare Rehabilitation on March 30, 2012. However, she was then involved in a subsequent rear-end accident on Aug. 10, 2011, 10 months after the subject accident, and a third rear-end accident in March 2012, while undergoing post-surgical physical therapy. Rodriguez claimed that the total amount of medical expenses she incurred was $177,558. However, all of her medical bills were on liens and neither Howell nor Correnbaum applied. Although Rodriguez claimed she experienced improvement with her symptoms since her surgery, she alleged she continues to have intermittent headaches, pain and limitation with regular activities of daily living. She also claimed she continues to have difficulty lifting and caring for her four children. In addition, Rodriguez claimed she initially missed 23 weeks of work from her job as a medical biller/treatment coordinator, where she earned $838 per week, but that following her surgery, her employer informed her they were no longer able to hold her position and she was terminated. The defense’s neurosurgery expert agreed that all of Rodriguez’s treatments were reasonable and related to her from the crash. Plaintiff’s counsel noted that Judge Stephen Kaus ruled that the defense’s expert in medical billing could not talk about Medicare or worker’s compensation rates and could only testify about actual CPT Code violations, including up-charging and unbundling. However, the defense’s expert in medical billing opined that Rodriguez’s bills should be reduced $10,500, which the jury accepted.