## Facts

- Joanne Simeonidis visited a casino operated by Mashantucket Pequot Gaming Enterprise and sat in a slot-machine chair that suddenly collapsed.
- Simeonidis had a significant preexisting back condition, but she had finished a course of physical therapy three days before the incident and had been told she could continue exercises at home.
- When the chair gave way, Simeonidis twisted and experienced immediate back and leg pain.
- Simeonidis was transported by ambulance for emergency evaluation and treatment and received medication for pain and muscle spasms.
- After the incident, she resumed physical therapy and later received spinal injections.
- Approximately six months after the casino incident, Simeonidis underwent spinal-fusion surgery.
- Simeonidis sued the Gaming Enterprise for negligence in the Mashantucket Pequot Tribal Court, seeking damages that included the costs of the spinal-fusion surgery and related medical care.
- The Gaming Enterprise conceded responsibility for the chair’s condition and conceded payment of Simeonidis’s short-term post-incident medical and transport costs (reported as $3,604.15).
- The parties disputed whether the chair-collapse incident caused the need for the later spinal-fusion surgery, given Simeonidis’s degenerative spinal condition and the medical record.
- Medical testimony on causation was conflicting, and the experts could not state with medical certainty that the casino incident alone made the spinal-fusion surgery necessary.

## Issues

1. Whether a negligence plaintiff with a preexisting degenerative back condition proved, with the required degree of medical certainty, that a casino chair-collapse incident caused the need for a later spinal-fusion surgery and its associated medical expenses.

## Decision

- The court limited damages to those the Gaming Enterprise conceded were caused by the incident (including the ambulance ride and immediate treatment costs).
- The court declined to award the claimed spinal-fusion surgery costs (and related long-term expenses) because Simeonidis did not establish, through sufficiently certain medical proof, that the chair-collapse incident necessitated the surgery rather than the natural progression of her preexisting condition.

## Legal Principles

- A plaintiff bears the burden to prove causation and damages; the defendant’s negligence must be shown to have caused the specific medical treatment for which compensation is sought.
- When the causal link between an accident and later medical treatment is not obvious, expert medical testimony is generally required to connect the event to the treatment with a probability-based medical standard, not mere possibility.
- A defendant may be liable for aggravation of a preexisting condition, but the plaintiff must still prove that the defendant’s conduct actually aggravated the condition and must prove the amount of resulting damages with reasonable certainty.
- Courts may award clearly attributable, temporally connected medical expenses (such as emergency transport and immediate care) while denying later, high-cost treatments when the proof does not reliably tie those treatments to the incident.

## Conclusion

*Simeonidis v. Mashantucket Pequot Gaming Enterprise* addresses damages and medical causation in a negligence case arising from a Foxwoods slot-chair collapse. Although the Gaming Enterprise conceded liability for the chair’s condition and agreed to pay Simeonidis’s immediate ambulance and treatment costs, the court limited recovery and refused to include the later spinal-fusion surgery expenses because the medical proof did not establish with the required degree of certainty that the casino incident caused the need for surgery in light of her serious preexisting degenerative back condition.


Simeonidis v. Mashantucket Pequot Gaming Enterprise, 2013 Mashantucket Trib. LEXIS 8 (2013)