Expert Article Library

Doctors Duel in Insurance Claim

Case Name: Karla Robinson v. GEICO General Insurance Co. (http://www.ca8.uscourts.gov/opndir/06/05/053191P.pdf)

Court: United States Court of Appeals for the Eighth Circuit; appeal from the District Court for the Eastern District of Missouri

Date: May 19, 2006

Experts: Medical Doctor—Physician—Orthopedic Surgeon—Neurologist. Dr. Thomas Lee, orthopedic surgeon (Plaintiff).Dr. Simon Horenstein, neurologist (Defendant)

Issue: Neurologist’s testimony about plaintiff’s shoulder injury challenged as being beyond the scope of his expertise.

Summary of case: The plaintiff Karla Robinson sued her car insurance company, GEICO, for $75,000 after she was rear-ended by an under-insured driver. Robinson claimed the accident aggravated a previously undiscovered bone spur in her right shoulder that required surgery. The trial judge found in favor of GEICO because plaintiff failed to establish causation.

Role of the experts: The orthopedic surgeon who examined Robinson and operated on her shoulder testified that the accident had caused tendons in plaintiff’s shoulder to swell, and this caused pain when it rubbed against the bone spur.

The defendant’s expert witness, a neurologist, testified that plaintiff’s shoulder pain was probably not caused by the accident because the dense nerves in her shoulder would have reacted with pain right away, not several hours later as she said. The neurologist testified that the car accident likely caused muscle pain, but that the plaintiff’s pr-existing shoulder condition prompted the need for surgery.

Expert analysis: Plaintiff argued that the testimony of the neurologist should not have been admitted because he was not an orthopedic specialist and was testifying outside of his area of expertise.

The Court said the plaintiff’s experts and defendant’s experts do not have to be experts in exactly the same field, only that they must have skill, knowledge, experience, education or training that is useful to the judge or jury. The trial judge was not wrong to find the neurologist’s testimony more credible than the orthopedic surgeon’s testimony because plaintiff had not admitted two previous shoulder injuries to the orthopedic surgeon and had not correctly represented the accident to him. The neurologist’s opinion on onset of shoulder pain was within his real of expertise as a neurologist. The holding of the lower court was affirmed.

Summary prepared by K. Tanner, Student, University of California, Hastings College of Law