Zoe Thomas v. Cigna HealthCare of California
Published: Feb. 23, 2002 | Result Date: Dec. 14, 2001 | Filing Date: Jan. 1, 1900 |Case number: 721930087297 Arbitration – $349,035
Court
American Arbitration Association
Attorneys
Claimant
Respondent
Gary S. Pancer
(Wilson, Elser, Moskowitz, Edelman & Dicker LLP)
Experts
Claimant
Paul K. Bronston
(medical)
Respondent
Lawrence Miller M.D.
(medical)
Facts
The claimant was shot and left paralyzed by a drive-by shooting in November 1993. After initial rehabilitation,
the claimant requested that the respondent pay for an advanced rehabilitation program using a reciprogaiting
gait orthosis (RGO) brace for ambulation with the PEERS Program in Los Angeles.
After the initial denial by the local PPO, the claimant appealed to the respondent in June
1994. In March 1995, the respondent denied the claim, which was upheld on further appeal in
March 1996, alleging the requested therapy was not medically necessary under the health plan.
Settlement Discussions
The respondent offered a "high-low" of $100,000 to $300,000 prior to the award issuing. The claimant did not respond.
Specials in Evidence
$99,035
Damages
The claimant claimed damages at arbitration over $1.1 million including medicals in the amount of $99,035 for the cost of the advanced rehabilitation therapy, emotional distress for $500,000, punitive damages for $500,000 and attorney fees.
Other Information
<A>Arbitrator Edward J. Costello Jr. of American Arbitration Association denied the claimantÆs request for punitive damages and attorney fees. The respondent offered a "high-low" of $100,000 to $300,000 prior to the award issuing. The claimant did not respond.</A>
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