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Ramone v. United States Postal Service

United States District Court, E.D. California

July 15, 2019

RAYMOND VINCENT RAMONE, et al., Plaintiffs,



         Raymond and Rita Ramone assert the Government is liable for personal injuries they suffered during a car accident with a mail carrier employed by the United States Postal Service. They filed administrative tort claims with the USPS related to their injuries. The Government now seeks to limit the damages to the amount identified in the administrative claims. (Doc. 26) For the reasons set forth below, the Government's motion is GRANTED.

         I. Background

         Plaintiffs allege that on April 24, 2016, they were traveling on State Route 46, “an east-west highway with two lanes in the east direction and one lane in the west direction in the unincorporated area of … Paso Robles, County of San Luis Obispo, State of California.” (Doc. 1 at 3-4, ¶¶ 10, 11) Plaintiffs assert their vehicle, a 2013 Buick Encore, was struck on the right side by a Grumman LLV Truck, operated by Andres Recinos. (Id., ¶¶ 11, 15) Plaintiffs assert that Mr. Recinos “was acting in the course and scope of his employment with the USPS at the time[].” (Id., ¶ 7)

         Plaintiffs reported Mr. Ramone was driving, and Mrs. Ramone was the passenger in the vehicle at the time of the accident. (Doc. 26-3 at 4) Plaintiffs assert that due to “the negligent and careless actions” of the USPS driver, they were “injured in their health, strength and activity, sustaining major injuries causing and continuing to cause plaintiffs great mental and physical and nervous pain and suffering which may result in permanent disability.” (Doc. 1 at 4, ¶ 12) Plaintiffs allege they “were required to and did employ physicians for medical examination, treatment and care for their injuries and did incur medical and incidental expenses in that regard…” (Id., ¶ 13) Further, Plaintiffs contend they “will incur future medical and incidental expenses for the care and treatment of said injuries.” (Id., ¶ 14)

         On October 3, 2016, Plaintiffs submitted tort claims using the Standard Form-95, both of which were signed by their attorney, Greg Muir. (Doc. 26-3 at 4-7) Mrs. Ramone indicated that “[s]he suffered cuts and abrasions to her right elbow, swollen knee, and neck pain.” (Id. at 4) Under the section for identifying property damage, Mrs. Ramone claimed the amount of $18, 067.25. (Id.) In the section for the amount claimed for personal injury, she indicated “claimant still treating[;] unknown at this time.” (Id.) Where asked to specify the total of all claims-and informed “[f]ailure to specify may cause forfeiture of your rights”-Mrs. Ramone indicated the total was “well in excess of $25, 000 according to proof.” (Id.)

         On his tort claim, Mr. Ramone reported he suffered a “[n]eck injury; left shoulder injury; and both left and right hand injuries.” (Doc. 26-3 at 6) He reported the vehicle was owned by his wife, and he did not claim any property damage. (Id.) In the section for identifying the amount sought for his personal injuries, Mr. Ramone indicated “unknown at this time[;] claimant still treating.” (Id.) He also indicated the total claimed was “well in excess of $25, 000 according to proof.” (Id.) Each form also stated: “I certify the amount of claim covers only damages and injuries caused by the incident above and agree to accept said amount in full satisfaction and final settlement of this claim. (Id. at 4, 6) The forms also read, “failure to specify a sum certain will render your claim invalid and may result in forfeiture of your rights.” Id. at 5, 7.

         On October 6, 2016, Cary Pons, with USPS Accident Investigations, contacted Plaintiffs' counsel regarding the documentation provided. (Doc. 28 at 8) Mr. Pons indicated:

Please be advised that your documentation is incomplete and therefore does not constitute a valid claim. Under the provisions of the Federal Tort Claims Act, any claim for personal injury must be supported by evidence that establishes the fact and extent of any injury. Once your client has finished treating, please submit complete itemized bills for medical expenses incurred, or itemized receipts for payment for such expenses. Please submit a written report from the attending physician describing the injury sustained. The report should show the nature and extent of the injury, the nature and extent of the treatment, the prognosis and the period of disability.
The statute of time limitations under the Federal Tort Claims Act is two years. It is therefore required that your properly supported sum certain demand be presented on Standard Form 95, Claim for Damage, Injury or Death, and received in this office no later than two years from the date of loss or injury.
Enclosed please find a blank SF 95, which you should complete and resubmit, in its original form, before the United States Postal Service can take any action to dispose of this claim. If you should require further assistance, please feel free to contact this office.

(Doc. 28 at 8)

         On November 16, 2016, Plaintiffs responded to the letter by submitting “a copy of all billings and medical records for both clients to date, advising that the clients had not completed treatment and could not include any final report from their physicians as to their injuries.” (Doc. 28 at 3; see also Doc. 26-3 at 9-18) The submitted medical records for Mr. Ramone included a report dated September 9, 2016 from Dr. Mark Schamblin, which indicated Raymond had been diagnosed with a cervical spine injury and “full thickness rotator cuff tear, ” for which “a left should arthroscopy with rotator cuff repair, decompression and distal clavicle excision ... [was] recommended.” (Doc. 28 at 2, 11-13)

         The records submitted for Mrs. Ramone included a report dated September 29, 2016 from Southern California Orthopedic Institute, which indicated she “had a long-standing history of neck complaints over the past several years, ” which increased after the accident. (Doc. 26-3 at 15) She reported,

a long-standing history of neck complaints over the past several years. However, they have increased in frequency and severity since being involved in a motor vehicle accident April 24, 2016, five months ago. In the past 5 months, she reports very minimal improvement in her condition spontaneously . . . As a manicurist, she has difficulty with opening objects and grasping objects. She reports that the pain is 3} in severity, dull and sharp in nature.

Id. Imagining showed Rita Ramone had “endstage degenerative disc disease with complete collapse and loos of disc height at ¶ 5-6 and C6-7 with diffuse spondylotic changes, ” and “moderate to severe central and lateral recess spinal canal stenosis...” (Id. at 17) The physician assistant with Dr. Schopler reported,

At this time, given persistence and severity of radicular complaints, we will pursue with a diagnostic and therapeutic cervical epidural steroid injection with pain management specialist, Dr. Parmar. . .
Grounds and basis for the epidural come on the following failed conservative treatment measures to Dated: Persistence of pain for the past several years and specifically over the past 5 months with radicular complaints, failure of pharmacologic treatment, failure of pain management with Dr. Parmar including trigger point injections.

(Id. at 18) She elected to proceed with epidural steroid injections but also discussed “elective definitive surgical intervention ... for an anterior cervical discectomy and fusion” with Emily Fish, PA-C. (Id. at 18) In concluding the contact, PA Fish reported, “All of [Mrs. Ramone's questions and concerns were addressed and answered.” (Id.)

         Along with the supplemental medical records[1]provided in November 2016, the plaintiffs also submitted documentation[2] that by that time, a total of $4, 600 had been spent on medical care for Mr. Ramone and $1, 316 for Mrs. Ramone. (See Doc. 28 at 15) Just weeks after submitting the supplement, Mr. Ramone underwent the surgery for the rotator cuff tear (performed on December 15, 2016) (Doc. 28-1 at 34-35).

         Without submitting any further information related to their claims, Plaintiffs initiated this action on June 20, 2017[3]. (Doc. 1) The USPS denied the claim in writing on June 27, 2017. The letter stated in relevant part:

Your submissions further indicated that your clients were still treating and final medical records would be forthcoming. However, no additional records were submitted to the Postal Service for review and evaluation as required by the applicable regulations (39 CFR 912.7 and .8 (“to exhaust the administrative remedy a claimant shall submit substantial evidence to prove the extent of any losses incurred and any injury sustained, so as to provide the Postal Service with sufficient evidence for it to properly evaluate the claim”)). Given the pending litigation and ...

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