Expert Witness Profiler

Tag: Medical Expenses

  • Orthopedic Surgery Expert’s Testimony on TMJ Injuries Admitted

    Orthopedic Surgery Expert’s Testimony on TMJ Injuries Admitted

    This case concerns alleged personal injuries suffered by Misty Adkins in a motor vehicle accident on August 22, 2023.

    Adkins alleged that she was traveling southbound in Pike County, Kentucky, when Hacker pulled out in front of her, causing her to strike the rear of his vehicle. It is also alleged that Clemon Hacker was driving a truck on behalf of his employer, Gateway Tire Company, Inc., at the time of the accident and was acting within the scope of his employment.

    Rick Lyon‘s report thoroughly outlines Adkins’ medical records on which he relies in crafting his expert report. The Defendants filed a motion to strike Lyon’s testimony and also sought to exclude any evidence or medical expenses related to Adkins’s alleged temporomandibular joint disorder (TMJ) injury, arguing that Lyon is not qualified to offer opinions relating to TMJ injuries because they are outside the scope of his expertise. 

    Orthopedic Surgery Expert Witness

    John Richard Lyon (“Rick”), M.D., is a board-certified orthopedic surgeon and specializes in general orthopedics. He brings over 30 years of experience in orthopedics and sports medicine and has performed medical-legal evaluations for over 10 years.

    Get the full story on challenges to John Richard Lyon’s expert opinions and testimony with an in-depth Challenge Study.

    Discussion by the Court

    Motion to Strike Lyon’s Testimony

    Rule 26(a)(2) also mandates additional reporting requirements depending on the type of expert. Where the expert is “retained or specially employed to provide expert testimony,” as is the case with Lyon, the disclosure must include a written report containing facts or data considered by the witness in forming their opinion and exhibits that will be used to summarize or support them.

    Because Lyon’s March 25, 2025 evidentiary deposition was tantamount to his taking the stand live at trial, Adkins’ introduction of this itemization at the evidentiary deposition without having previously disclosed it was improper. And to the extent it was intended to supplement Lyon’s original report, it was untimely.

    Adkins argued that her untimely supplement was harmless. But this itemization document was a surprise to the Defendants, and since it was used to support Lyon’s trial deposition testimony which will be presented at trial, there is no genuine ability for that surprise to be cured. Moreover, her explanation for the failure to timely disclose this information was insufficient.

    Accordingly, the Court granted Defendants’ motion to strike Lyon’s testimony, to the extent it concerns Adkins’ damages based on the untimely disclosure of her medical bills.

    Motion in Limine to Exclude Evidence of Medical Expenses Relating to TMJ Injury

    Lyon is not qualified to offer opinions relating to TMJ injuries because they are outside the scope of his expertise.

    Adkins argued that Lyon is a board-certified orthopedic surgeon who has more than 30 years’ experience, and that he has treated “thousands of patients” during his career. Lyon often treats and diagnoses patients with conditions outside the scope of his specialty, makes referrals, and follows up with them about their overall health. He often performs IMEs as a retained medical expert, and in that role he is frequently asked to review medical records, perform examinations, author expert reports, and provide testimony outside the scope of his specialty.

    Moreover, Lyon testified that, while he does not usually treat TMJ, he has treated patients with TMJ in the past, made the diagnosis, and referred them out to other doctors who specialize in handling the disorder.

    Based on the foregoing, the Court found that Lyon is qualified to offer expert testimony on TMJ based on his knowledge, skill, and experience.

    Held

    • The Court granted the Defendants’ motion to strike the testimony of Dr. John Richard Lyon, to the extent it concerns Adkins’ damages based on the untimely disclosure of her medical bills.
    • The Court denied the Defendants’ motion to exclude the testimony of John Richard Lyon relating to Adkins’ alleged TMJ injury.

    Key Takeaway

    It is undisputed that TMJ injuries are outside the scope of Lyon’s practice. However, a witness can be qualified as an expert based on their “knowledge, skill, experience, training, or education.”

    Thus, where the proponent meets their burden, the Court has found that physicians or other medical professionals are qualified to offer expert testimony on subjects outside the scope of their practice based on their “knowledge, skill, experience, training, or education.”

    Case Details:

    Case Caption: Adkins V. Hacker
    Docket Number: 6:26cv10
    Court Name: United States District Court, Kentucky Eastern
    Order Date: February 26, 2026
  • Physical Medicine And Rehabilitation Expert Was Allowed to Opine on Future Medical Expenses

    Physical Medicine And Rehabilitation Expert Was Allowed to Opine on Future Medical Expenses

    This case arises out of injuries sustained by Brandon Jensen on his bicycle when he collided with a semi-truck who made a left turn through his lane of travel. The semi-truck was driven by Defendant Michael Beale. Beale was working for Crete Carrier at the time of the accident.

    The Plaintiffs planned to introduce the testimony of Dr. Zachary L. McCormick, their medical expert, who will opine that Jensen’s future medical expenses will cost approximately $777,955.

    McCormick bases his estimates on the “historical cost of care available to me from the University of Utah.” The Defendants argued that the Court should exclude McCormick’s report. 

    Physical Medicine And Rehabilitation Expert Witness

    Dr. Zachary Lennon McCormick, MD is a board-certified specialist in both Pain Medicine and Physical Medicine & Rehabilitation (PM&R).

    He received his MD at the University of Pennsylvania, completed a PM&R residency and fellowship at Northwestern University (The Rehabilitation Institute of Chicago). Following training, he served as a faculty member at the University of California San Francisco. McCormick currently serves as a Professor and Vice Chair of PM&R, Ambulatory Chief Value Officer, Chief of the Division of Spine and Musculoskeletal Medicine, Co-Director of the Endoscopic and Percutaneous Spine (EPS) Destination Care Program, and the Founding Director of the Interventional Spine and Musculoskeletal Research (INSPIRE) program. He founded the Interventional Spine and Musculoskeletal Medicine (ISMM) Fellowship Program at the University of Utah and previously directed this program for 6 years.

    Want to know more about the challenges Zachary McCormick has faced? Get the full details with our Challenge Study report.

    Discussion by the Court

    Just over a week ago, the Utah Supreme Court issued a decision holding that special damages for past medical expenses should be measured by the negotiated—not the gross—charge for services. The Defendants argued that the Court should exclude McCormick’s report for failure to comply with the Utah Supreme Court’s opinion.

    Although McCormick’s report focused on future, not past, medical expenses, the Defendants argued that the same logic applies and that any estimates for future services based on gross charges are inadmissible. The Defendants also maintained that McCormick’s report lacks foundation due to his failure to explain whether his estimates are based on gross charges or other rates.

    The Court held that the Plaintiffs may introduce the expert testimony of McCormick to the extent that his report presents evidence of gross charges for future medical expenses. But the Defendants may present evidence of the standard discount available to self-pay patients for those charges. In addition, the Defendants may raise questions about the foundation for McCormick’s testimony to the extent that his report is based on other measures of future medical expenses. 

    Held

    The Court declines to exclude the expert testimony of Dr. Zachary McCormick but clarified that the Defendants may introduce evidence concerning typical medical billing discounts for self-pay or uninsured individuals.

    Key Takeaway:

    The Court assumes that McCormick’s expert report is based on gross charges. The Court denied without prejudice the Defendants’ challenge to his report to the extent that their challenge is based on the lack of foundation about whether the figures represent gross charges or payer-negotiated charges. The Court will question McCormick about the source of his figures before determining the admissibility of his testimony.

    Case Details:

    Case Caption: Jensen V. Crete Carrier Corporation
    Docket Number: 1:23cv105
    Court Name: United States District Court for the District of Utah, Northern Division
    Order Date: November 10, 2025

    Please refer to the blog previously published about this case:

    Transportation Engineering Expert’s Testimony on Accident Reconstruction Admitted

    Transportation Expert’s Testimony About Safety Considerations Admitted

  • Pain Management Expert Was Allowed to Opine on the Reasonable Value of Medical Expenses

    Pain Management Expert Was Allowed to Opine on the Reasonable Value of Medical Expenses

    Plaintiff Armen Avoyan brought this action against the United States alleging negligence under the Federal Tort Claims Act (“FTCA”), arising out of a motor vehicle accident between the Plaintiff and a United States Postal Service employee, Azad Hovhannesian. 

    The government, however, sought to exclude the testimony of Plaintiff’s expert, Dr. Lawrence R. Miller, as to the reasonable value of medical expenses.

    Pain Management Expert Witness

    Lawrence Ross Miller, M.D., F.I.P.P is a physician who has been board-certified in internal medicine, nephrology, anesthesiology, and pain medicine. He has practiced medicine for three decades, operating multiple locations throughout Los Angeles.

    Get the full story on challenges to Lawrence Miller’s expert opinions and testimony with an in-depth Challenge Study.

    Discussion by the Court

    The government contended that Miller is not a qualified expert pursuant to Federal Rule of Evidence 702 because he lacks specialized training or certification in the area of expense valuation, and that he proffers testimony that is not the product of reliable principles and methods.

    However, the Court found that Miller is a qualified expert because he has several decades’ worth of experience as a doctor setting fees, reviewing bills, working with insurers, and observing market rates. 

    Furthermore, the government objected that Miller did not employ a reliable methodology to determine the reasonable value of Plaintiff’s medical expenses.

    Nevertheless, the Court disagreed. Miller’s methodology of determining what was reasonable consisted of taking the median of the range of possible charges that could be charged for any given medical service.

    Finally, the government objected that Miller did not systematically keep track of the prices he saw, which rendered his methodology unreliable. This objection, however, goes to weight and credibility, not admissibility, and may be explored through cross-examination. 

    The government also noted that Miller has a lien on this lawsuit. Basically, the government appeared to suggest both that Miller may be biased because he is invested in a favorable outcome for the Plaintiff, and that Miller may have artificially high prices that reflect the risk and delay in getting paid. 

    As to the former, Plaintiff and Miller explained that the arrangement means only that Miller will be paid at the conclusion of the lawsuit, not that Miller will be paid only if Plaintiff wins the lawsuit. California courts have permitted this arrangement. As to the latter, Miller admitted this. In any case, both of these subjects also go to weight and credibility, and are appropriately addressed through cross-examination.

    Held

    The Court denied the government’s motion to exclude the testimony of Plaintiff’s expert, Lawrence R. Miller.

    Key Takeaway:

    No one denies that an expert might draw a conclusion from a set of observations based on extensive and specialized experience. In other words, Miller’s experience is sufficient to qualify him to testify as to the reasonableness of medical bills even without special training or education on that topic.

    Case Details:

    Case Caption: Armen Avoyan V. United States of America
    Docket Number: 2:24cv434
    Court Name: United States District Court, California Central
    Order Date: September 05, 2025
  • Orthopedic Surgery Expert Witness Barred From Determining the Reasonable Cost of Medical Expenses

    Orthopedic Surgery Expert Witness Barred From Determining the Reasonable Cost of Medical Expenses

    Plaintiff, Mostafa Natour was injured in a car accident with a United States Postal Services delivery truck. Natour received medical treatment that consisted of imaging studies, chiropractic care, epidural injections, and pain management care. He sought to recover, among other things, his past medical expenses. Natour retained Alex Cruz, M.D. of Abacus Analytics as an expert on causation as well as the reasonableness and necessity of Natour’s medical expenses.

    The Government argued that Cruz’s testimony about the reasonableness of Natour’s medical expenses should be excluded because: (1) Cruz did not employ valid reasoning or methodology and thus offered an unreliable opinion; and (2) Cruz is unqualified.

    Orthopedic Surgery Expert Witness

    Dr. Alex Cruz is a distinguished orthopedic surgeon specializing in spine surgery, with extensive training and recognition in his field. He earned his MD at the University of South Florida, followed by an orthopedic surgical residency and a spine fellowship at Baylor College of Medicine and University of Wisconsin, respectively. Favored for his conservative, patientfocused approach, Cruz excels in performing minimally invasive procedures for a range of spine conditions. His work has earned him significant recognition, and he holds memberships in the North American Spine Society and the American Academy of Orthopedic Surgeons.

    Get the full story on challenges to Alex Cruz’s expert opinions and testimony with an in-depth Challenge Study. 

    Discussion by the Court

    Cruz testified that he did not utilize his own personal knowledge and experience when determining the reasonable cost of Natour’s medical care. Cruz instead relied solely upon the value generated by the Abacus Analytics website.

    To begin with, Cruz’s methodology for determining the reasonable cost of Natour’s medical expenses was very simple: he typed in the CPT code and zip code, and the database generated a range of values. He then used that output in his report. He does not know how the figure was determined. Neither does he know anything about the underlying data. Cruz disregarded his own experience, even when it conflicted with the information that the database was giving him. He cannot explain how the Abacus Analytics website determines the “UCR” value of medical services. At his deposition, he did not “recall how it’s done” or know how the website aggregated the data from the various “industry standard databases.” The Court held that Cruz did not know much about the data within the industry standard databases or the differences between them.

    He stated that his opinions relied on the Abacus Analytics website because he would “rather have [the UCR values] from an objective source” and did not “want to give . . . whatever [he thought was] correct . . . based on [his] own experiences.” Cruz stated that he never tried to make his own determination as to what the usual, customary and reasonable value was. The Court held that Cruz did not compare Natour’s charges to the amounts Cruz charges in his own medical practice or the amounts paid by the various private insurers with whom he works.

    In conclusion, Cruz’s expert opinions are not based on reliable data and are not the product of reliable principles and methods.

    Held

    The Court granted Defendant’s motion to exclude Plaintiff’s retained expert Dr. Alex Cruz.

    Key Takeaway:

    In the context of medical billing, courts have held that an expert’s testimony about the reasonableness of medical expenses may be admitted when the expert utilized reliable databases and explained the methodology for determining the value of the medical care provided. Cruz, however, cannot explain how the Abacus Analytics website determines the “UCR” value of medical services. Cruz did not employ valid reasoning or methodology and thus offered an unreliable opinion.

    Case Details:

    Case Caption: Natour V. United States Postal Service Et Al
    Docket Number: 4:23cv234
    Court: United States District Court, Texas Southern
    Order Date: August 05, 2024