Insurer disputes extent of injury and treatment after rear-ender UIM claim. $985K. San Joaquin County.


Insurer disputes necessity for lumbar surgery in UIM claim before it pays policy limits in arbitration award.

The Case

  • Case Name: Michael Gogue v. James River Insurance Company
  • Court and Case Number: Arbitration
  • Date of Verdict or Judgment: Tuesday, December 22, 2020
  • Date of Arbitration Award : Tuesday, December 22, 2020
  • Date Action was Filed: Thursday, February 06, 2020
  • Type of Case: Underinsured Motorist, Vehicles – rear-ender
  • Judge or Arbitrator(s): Robert M. Bennett
  • Plaintiffs:
    Michael Gogue
  • Defendants:
    James River Insurance Company
  • Type of Result: Arbitration Award

The Result

  • Gross Verdict or Award: $985,000
  • Trial or Arbitration Time: 5 days

The Attorneys

  • Attorney for the Plaintiff:

    Wilshire Law Firm by Jonathan C. Teller, Los Angeles.

  • Attorney for the Defendant:

    Bassi, Edlin, Huie & Blum LLP by Joseph B. Adams and Michael Gallagher, San Francisco.

The Experts

  • Plaintiff’s Medical Expert(s):

    Jan Roughan, life care planning.

    Stephan Kasimian, M.D., orthopedic surgery.

  • Defendant's Medical Expert(s):

    Stephanie Engler, life care planning.

    Robert Rovner, M.D., orthopedic surgery.

  • Plaintiff's Technical Expert(s):

    Enrique Vega, vocational rehabilitation.

  • Defendant's Technical Expert(s):

    Laura Dolan, economics (deposition testimony submitted).

Facts and Background

  • Facts and Background:

    On March 30, 2018, an Uber driver, Michael Gogue (59 years old), was planning to pick up his Uber passenger, in Tracy, when he was rear-ended by an underinsured driver who only had $15,000 of insurance coverage.


  • Plaintiff's Contentions:

    That the collision caused plaintiff's injuries to his neck and back. 

  • Defendant's Contentions:

    That plaintiff had a pre-existing degenerative disc condition that was causing him pain, and the surgery was not related to the subject collision. The insurance company also suggested plaintiff was only seeing doctors to obtain medications and he wasn’t truly in enough pain to warrant a surgery.

Injuries and Other Damages

  • Physical Injuries claimed by Plaintiff:

    Plaintiff underwent conservative treatment, but after no relief he underwent an L4-L5 lumbar fusion surgery.

Additional Notes

There was a demand in pre-litigation for $749,999. The last offer was for $650,000.