Accidental Death and Dismemberment Insurance Claims

Michael Horrow Wins ERISA Case For Long Term Disability Insurance Benefits

By | Verdicts and Settlements | No Comments

Case Summary: Attorney Michael Horrow represented a women who became disabled as a result of aggressive cancer treatment. Her insurance company said she was not disabled and stopped paying her disability benefits. Case Results: LINA was ordered to bring Plaintiff current on her benefits, with interest, paid to Plaintiff retroactive from the beginning of the “any occupation” period to the present time.

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Choosing a Lawyer in Southern California

Michael Horrow Wins ERISA Case Against Met Life

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Case Summary: Michael Horrow represented a dentist who became totally disabled and was unable to perform his own occupation. He had purchased private disability insurance for financial protection if he ever became physically unable to practice his occupation. After initially paying disability benefits, the insurance company abruptly stopped paying benefits.

Case Results: MetLife was ordered to bring Plaintiff current on his benefits and pay back benefits, with interest, paid to Plaintiff retroactive from the beginning of the “any occupation” period to the present time.

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Summary of Insurance Claim Form

Michael Horrow Recovers Long-Term Disability Benefits for Client in an ERISA Action in Federal Court

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Michael Horrow represented Otilia Sullivan in an ERISA action in federal court to recover long-term disability benefits. Ms. Sullivan had worked for many years as a loan officer, when she was diagnosed with a benign brain tumor. She underwent radiation therapy, and as a result lost her vision in one eye and developed headaches and a host of other symptoms. Her disability insurer, Prudential, denied her claim.

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California Insurance Bad Faith Decisions

Cabral v. Ralphs – $4.8 Million Jury Verdict Reinstated

By | News And Articles, Verdicts and Settlements | No Comments

Adelelmo Cabral was driving home from work on the Eastbound I-10 freeway when he lost control of his car, crossed several lanes of traffic, and collided with the rear of a Ralph’s tractor-trailer rig that had been parked on the freeway shoulder, about 16-feet from the edge of the right lane. The area where the truck had been parked was marked by CalTrans with an “Emergency Parking Only” sign. The Ralph’s driver had stopped there to have a snack. He chose that specific area because it was shaded. Michael Horrow represented Mr. Cabral’s wife and children in a wrongful-death case against Ralph’s.

At trial, Mr. Horrow obtained a jury verdict in favor of the Cabral family, which found that the Ralph’s driver had been negligent in parking his truck adjacent to the freeway, and he also persuaded the trial court to deny Ralph’s motion for judgment notwithstanding the verdict. On appeal, however, the Court of Appeal reversed the judgment in favor of the Cabral family, finding that Ralphs could not be held liable because its driver owed no duty of care to passing motorists with respect to where he parked his truck alongside the freeway.

The California Supreme Court agreed to hear the case, and reversed the Court of Appeal, reinstating the jury verdict.

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Insurance Policy Lawyer

Welle v. Provident Life & Accident Ins. Co.

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An OB/GYN retained Michael Horrow to represent her in an insurance bad-faith lawsuit in federal court to challenge Provident’s denial of her claim for long-term disability benefits. As part of her bad-faith claim, Mr. Horrow served a discovery request on Provident asking it to provide information about the bonus awards and performance ratings for the employees who denied Welle’s claim. The insurer refused to provide this information, claiming that the request was improper for various reasons. Mr. Horrow challenged this position and the federal court ruled that Provident was obligated to provide the information he had requested, which the court found was relevant to the bad-faith claim and not unduly burdensome or overbroad.

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Los Angeles Insurance Bad Faith Claims

Sullivan v. Prudential Ins. Co. of America

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Michael Horrow represented Otilia Sullivan in an ERISA action in federal court to recover long-term disability benefits. One of the disputed issues in the case was whether the district court should evaluate the plan’s denial of benefits under the de novo or the abuse-of-discretion standard of review. The plan argued that because the “Summary Plan Description” (SPD) document that it provided to plan members to summarize the plan benefits said that the abuse-of-discretion standard applied, the court should apply that standard. But Michael Horrow pointed out that, notwithstanding the statement in the SPD about the administrator having discretion, the plan itself contained no such grant of authority. Mr. Horrow convinced the district court that, in the absence of a grant of discretion in the plan document itself, a statement in the SPD to that effect was insufficient. As a result, the court applied the de novo standard of review.

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Insurance Bad Faith Laws

Cabana v. Reliance Standard Ins.

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April Cabana suffered back and leg injuries in an automobile accident. She succeeded in obtaining long-term disability (LTD) benefits from her employer’s disability plan, which was administered by Reliance. After the accident Cabana received extensive treatment on her back, undergoing two spinal-fusion surgeries. Yet she continued to have severe pain. Reliance agreed that she was totally disabled under the “own occupation” disability standard that applied for the first 24 months of the plan. After the 24-month period, the plan applied an “any occupation” test for total disability, and the plan continued to find that she was disabled. But roughly a year later, the plan changed its finding, found that Cabana was no longer totally disabled, and stopped paying benefits.

Cabana retained Michael Horrow to file an action in federal court under ERISA to reinstate her LTD benefits. He marshalled the evidence of her ongoing pain and medical difficulties, and convinced the district court at trial that Cabana was, in fact, totally disabled and entitled to benefits.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$6,000,000 Recovered By A 15 Month-Old For Negligence In Labor And Delivery

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A child received $6,000,000 in a medical malpractice case which involved negligence in labor and delivery. In this case, the hospital’s labor and delivery nurses caring for the child failed to notify any physician of prolonged fetal distress. By the time of the child’s birth, the fetal heart tracing had been non-reassuring for hours. The child was born severely depressed with no tone, was apneic and lifeless. The hospital paid a total of $6,000,000 in settlement prior to trial.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

Female Doctor Receives $850k Settlement For Wrongfully Denied Disability Benefits For Severe Neck and Spine Pain

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Michael B. Horrow represented an emergency medicine doctor who became totally disabled due to severe neck and spine pain and weakness. She had purchased private disability insurance for financial protection if she ever became physically unable to practice emergency medicine. As her symptoms progressed, she became unable to safely care for her patients. After her claim was denied, Mr. Horrow was hired to fight the insurance company.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

Dentist Receives $850k Settlement For Wrongfully Denied Disability Benefits For Bilateral Carpal Tunnel Syndrome

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Michael B. Horrow represented a dentist who became totally disabled due to bilateral carpal tunnel syndrome suffered after a traumatic fall and repetitive use. He had purchased private disability insurance for financial protection if he ever became physically unable to practice dentistry. As his symptoms progressed, he became unable to perform dental procedures. After his claim was denied, Mr. Horrow took on the case.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

Periodontal Surgeon Receives $1 Million Settlement After Insurer Wrongfully Denies Disability Benefits

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Michael B. Horrow represented a periodontal surgeon who became totally disabled due when he suffered a traumatic hand laceration and digital nerve injury. He had purchased private disability insurance for financial protection if he ever became physically unable to practice as a periodontal surgeon. After his claim was denied, Mr. Horrow filed a lawsuit and recovered $1,000,000.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

Disability Benefits Settlement: $650,000 For Manager With Fibromyalgia After Wrongful Denial Of Benefits

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Michael B. Horrow represented a Senior Manager who became totally disabled due to Fibromyalgia and Chronic Fatigue Syndrome. He was a participant in an employee benefit plan regulated and governed under ERISA. As his symptoms progressed, he became unable to perform his occupation due to cognitive impairment and weakness. When his claim for long term disability benefits was denied by the insurance company, Mr. Horrow took on the case.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

$500,000 For CPA Wrongfully Denied Disability Insurance Benefits

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Michael B. Horrow represented a Certified Public Accountant who became totally disabled due to ocular eye pain, eye fatigue, eye spasms, headaches, insomnia, chronic conjunctivitis, and depression. He had purchased private disability insurance for financial protection if he ever became physically unable to practice as a Certified Public Accountant. After paying disability for twelve (12) years, the insurance company wrongly and arbitrarily terminated his claim and stopped paying him benefits.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

$1.1 Million For Wrongful Denial Of Product Recall Insurance Benefits

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Michael B. Horrow represented a California corporation that was wrongfully denied benefits under a product recall insurance policy. It had purchased the insurance policy for financial protection in the event there was a loss due to product tampering or product contamination. After paying policy premiums for over a year, product contamination was identified. When its claim for recall benefits was denied, Mr. Horrow fought to recover the benefits.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

$600,000 Settlement For Wrongful Denial Of Disability Claim For Fibromyalgia

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Michael B. Horrow represented a Senior Manager IT Consultant who became totally disabled due to Fibromyalgia. He was a participant in an employee benefit plan regulated and governed under ERISA. As his symptoms progressed, he became unable to perform his occupation due to the progressive decline in cognitive function. When his claim for long term disability benefits was denied by the insurance company, Mr. Horrow took on the case.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

$1 Million For Wrongful Denial Of Coverage For Breast Cancer Testing

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Michael B. Horrow represented a woman whose insurance company unreasonably denied her coverage for breast cancer testing. The insurance company wrongfully refused to provide coverage for testing based upon an internal assessment that such testing was not medically necessary, despite the her physician’s order. Nearly one year later, she was diagnosed with invasive breast cancer.

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Insurance Bad Faith Claims Attorney, Michael B. Horrow

$1.8 M For Unreasonable Termination Of Disability Benefits

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Michael B. Horrow represented an Optical Designer who became totally disabled due to degenerative disease in his back and hips. He had purchased private disability insurance for financial protection if he ever became physically unable to practice his occupation. Due to the severe pain caused by his conditions, he was unable to continue working in his occupation.

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Donahue Horrow in Forbes

$1.9 Million In Settlement To OB/GYN For Wrongfully Denied Disability Insurance Claim

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Michael B. Horrow represented an obstetrician/gynecologist (“OB/GYN”) who became totally disabled due to injuries caused by a traumatic bike accident. She had purchased private disability insurance for financial protection if she ever became physically unable to practice as an OB/GYN. After undergoing multiple surgeries, her symptoms continued to worsen and she was unable to safely care for her patients. After the insured’s claim was denied, Mr. Horrow took on the case.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$2.4 Million Settlement For Improper Use Of Vaccum In Infant’s Delivery Causing Brain Bleed And Injury

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Thomas E. Donahue’s clients received $2,400,000 in medical malpractice case. The case involved a term pregnant woman who was in the hospital and in labor. The labor became complicated when the child failed to descend in the birth canal.

The obstetrician attempted, inappropriately, to deliver the child by using a vacuum. The child could not be delivered and a c-section was ordered. The child was born in good condition but his condition quickly deteriorated after delivery and was taken to the Neonatal Intensive Care Unit (NICU). The child then started experiencing breathing problems and seizures. The nurse failed to call the pediatrician in a timely manner and when the pediatrician arrived the child had to be intubated (a tube placed in the trachea to help the child breath.)

Investigation and discovery revealed that the use of the vacuum extractor was inappropriate and caused bleeding in the childs brain. The hospital, obstetrician, and pediatrician settled the case for $2,400,000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$1.85 Million Settlement Against OB/GYN For Infant Brain Injury

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In 2004, a case managed by Thomas E. Donahue involving a child with severe birth injury as a result of the negligence of the Obstetrician for delaying delivery settled for $1,850,000. Discovery revealed during the case that the Obstetrician failed to recognize that the fetus was in distress and caused the baby to sustain brain injury. The obstetrician and her medical group settled the case for $1,850,00.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$2.68 Million Settlement Against Hospital And Obstetrician For Failure To Deliver Fetus In Distress In Timely Manner

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In 2003, Thomas E. Donahue’s clients received $2,680,000 from a hospital and obstetrician for their failure to timely deliver a fetus in distress. The case involved a term pregnant woman who was admitted to the hospital for induction of labor. The patient was given medication to induce and the labor proceeded without complications. However, the expectant mother started experiencing uterine hyperstimulation (a condition in which the contractions occur too frequently and cause stress on the fetus.)

The nursing staff failed to timely address the hyperstimulation by calling the Obstetrician immediately and give medication to slow the contractions. The nurse eventually called the Obstetrician, but failed to fully inform him of the true nature of the emergency and failed to tell him to come to the Hospital immediately. By the time the Obstetrician arrived at the Hospital, the fetus was in distress and required delivery by emergency c-section. The child suffered brain injury from a extended period of oxygen deprivation. The Obstetrician and the Hospital paid a total of $2,680,000 in settlement prior to trial.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$4.5 Million In Medical Malpractice Case For Failure To Diagnose Placental Abruption

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In 2004, Thomas E. Donahue’s clients recovered $4,500,000 from a hospital as a result of malpractice by the nursing staff. The case involved a term pregnant mother who was at home when she started experiencing contractions. However, shortly before she arrived at the hospital the pain became severe and unrelenting. She went immediately went to labor and delivery and told the admitting nurse that she had severe pain and that something was wrong.

The nurse failed to call the obstetrician and proceed as though there was no emergency. After a significant delay, the nurse started monitoring the fetal heart rate and saw the fetus was in distress. The nurse notified the obstetrician.

Prior to the attending obstetrician’s arrival at the hospital, another obstetrician on the unit intervened and delivered the child by c-section and saved the child’s life. Unfortunately, the child suffered severe brain injury from a lack of oxygen and requires round the clock and will be permanently disabled for life. The child and his parents received $4,500,000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$5 Million Settlement In Brain Injury Case To 6 Month Old Baby Due To Post-Surgery Dehydration

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In 2006, a case handled by Thomas E. Donahue was settled for $5,000,000. This case involved severe and permanent brain injury to a 6 month old baby who suffered cardio pulmonary arrest in a Pediatric Intensive Care Unit following open heart surgery. Investigation revealed that the child became severely dehydrated as a result of the negligence of attending and resident physicians and hospital personnel. The dehydration caused the child to arrest which caused severe and permanent brain injury from oxygen deprivation and required round the clock nursing care. The case was vigorously defended and the defendants retained some of the most qualified experts in the country who testified that the defendants were not negligent and not the cause of the child’s arrest and that the child was not, in fact, dehydrated. Despite this testimony from the defense experts, Defendants settled the case prior to trial. The child now has the resources to pay for the medical care he requires.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$1.979 Million For Obstetrician Medical Malpractice Settlement For Infant Brain Injury And Cerebral Palsy

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Thomas E. Donahue handled a case involving severe birth injuries to a newborn that resulted on in cerebral palsy and is now totally and permanently disabled. In 2004, the pregnant mother was taken to the emergency department in labor and with suspected seizures. The obstetrician was called but arrived more than one half hour later and after the baby delivered.

The baby was born severely depressed and was resuscitated. Although the initial focus of the case involved negligence by the obstetrician for delay in delivering a fetus in distress, investigation revealed that there was negligence in resuscitating the baby which caused further injuries and resulted in a much larger settlement. The case was settled for a total of $1.9 million dollars.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$2.9 Million Med Mal Settlement For Hospital and Obstetrician Negligence

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Clients of Thomas E. Donahue received $2,900,000 in medical practice case against Hospital and Obstetrician. The case involved a term pregnant patient who came to the Hospital in labor. The labor proceeded without complications until the fetal monitor was unable to register a fetal heart rate. The nurse failed to recognize that heart rate was not registering for more than one half hour. After the nurse adjusted the fetal monitor, the heart rate was abnormal, but the nurse again delayed calling the Obstetrician and when the Obstetrician did arrive the baby was in severe distress requiring an emergency c-section. The baby was born severely brain damaged. The clients received $2,900,000 from the Hospital and Obstetrician.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$1 Million in Settlement Against Obstetrician For Failure To Diagnose Pre-Eclampsia

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Thomas E. Donahue litigated a case for a young adult woman who suffered brain injury as a result of her Obstetricians failure to diagnose and treat Pre-Eclampsia. The client was pregnant and was about one month from her due date when she began experiencing headaches and swelling in her arms and legs. During her last prenatal appointment a urinalysis revealed she had protein in her urine.

Despite signs and symptoms of pre-eclampsia, the obstetrician did nothing to diagnose her condition. Within days of that last visit, the patient suffered a hemorrhagic stroke, and suffered brain injury. The child was delivered and, although had difficulties after birth, did fine thereafter. The Obstetrician agreed to a settlement for $1,000,000 which was the limits of his insurance policy.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$1.2 Million Recovered in Lawsuit For Wrongful Death Due to Hospital Malpractice

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A wrongful death case was litigated by Thomas E. Donahue and involved an adult woman who presented to the Emergency Department complaining of abdominal pain and vaginal bleeding. X-rays and blood tests confirmed there was ongoing bleeding and the patient was anemic and needed surgery. However, the Emergency Medicine Physician and Hospital delayed several hours giving a blood transfusion and delayed calling the patients obstetrician to do surgery to stop the bleeding. The patient, after many hours of bleeding, went into shock and needed resuscitation. However, efforts to revive her were unsuccessful. The patient left behind a husband and two children. The Physician paid his $1,000,000 policy and the Hospital paid $200,000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

$1.075 Million Settlement With Vascular Surgeon and Hospital In Wrongful Death Case

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In 2006, Thomas E. Donahue litigated a case of wrongful death against a vascular surgeon and hospital wherein an adult woman died during the attempted removal of an inferior vena cava filter that was initially placed to prevent a pulmonary embolism (where a blood clot forms and reaches the lungs.) The filter was placed to catch further clots from moving from the lower extremities and going to the lungs.

The surgeon attempted to remove the filter and, in doing so, negligently punctured the patients heart causing hemorrhage, shock, and death. The surgeon settled for his insurance policy limits of $1,000,000 and the Hospital paid $75,000 despite no evidence that the hospital was negligent.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

Medical Malpractice – $3 Million For Post-Anesthesia Error

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A young woman gave birth by c-section and was taken to the Post-Anesthesia Care Unit. Shortly after her arrival in PACU her pulse increased and blood pressure dropped. A blood test confirmed she was bleeding internally. However, the hospital and physicians delayed giving her a blood transfusion and re-operating. She went into shock and suffered cardio pulmonary arrest. She was resuscitated, but sustained a severe anoxic brain injury (lack of oxygen) and remained in a coma. Plaintiffs experts testified that the delay in giving blood products and re-operating caused her brain injury and that the horrific outcome was preventable. The case was settled prior to trial for $3,000,0000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

Medical Malpractice – $2 Million For Failure to Diagnose Hydrocephalus

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In 2006, Thomas E. Donahue litigated a case involving a 50 year old woman in a coma as a result of a failure to diagnose and treat hydrocephalus (excess fluid on the brain). The case settled as to the primary care physician for $2,000,000 the maximum available insurance proceeds. For about one year, the plaintiff presented to her primary care doctor with complaints of headaches, vomiting and dizziness and the primary care practitioners failed to diagnose that she had hydrocephalus.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

Medical Malpractice Settlements – $3.05 Million For Hospital Negligence

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In 2005, a case handled by Thomas E. Donahue involved an adult woman who suffered bleeding in her brain which was successfully treated surgically. A temporary tracheostomy was placed and she was recuperating in a subacute facility. In the middle of the night her primary care nurse found her unresponsive in her bed with her tracheostomy removed. The patient was resuscitated, but had sustained a moderate brain injury from a lack of oxygen. Investigation during the case revealed that the Hospital had no functioning call light system, as required by State Law, which the patient could use to call for help in an emergency. The call system was required by law and the facility was fined by The Department of Health Services for their violation of law. The patients attending physician, the charge nurse and Hospital agreed to a total settlement in the amount of $3,050,000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

Medical Malpractice Settlements – $2.375 Million For Anesthesiologist Error

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A young child suffered an anoxic brain injury as a result of the negligence of the Hospital and Anesthesiologist following routine surgery. The child was intubated after surgery and was being transported to the Pediatric Intensive Care Unit (PICU). On the way to the PICU, endotracheal tube became dislodged and the child could not breath. The Anesthesiologist and Hospital personnel failed to timely recognize the problem and the tube was not replaced until the surgeon arrived in response to a Code Blue. The child was revived but suffered brain injury. The Hospital and Anesthesiologist settled for $2,375,000.

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Thomas Donahue, Los Angeles Medical Malpractice Attorney

Medical Malpractice Settlements – $1 Million For Plastic Surgery Anesthesiologist Error

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n 2006, Thomas E. Donahue handled a case in which a young adult woman went to an outpatient plastic surgery center to have fat injected into her brow line to remove wrinkles. The procedure was supposed to be simple and under local anesthesia and the patient was scheduled to go home shortly after the procedure. Unfortunately, shortly after anesthetic medication was administered, the patient suffered cardio pulmonary arrest and was resuscitated. Unfortunately, the negligence in resuscitation caused the patients brain to be deprived of oxygen causing permanent injury. Shortly after the case was filed the surgeon agreed to settle the case for the total amount of her insurance policy limits of $1,000,000.

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