Case Study: How a MERIT Report Helped Increase a Slip-and-Fall Settlement by 73%

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | January 23, 2026 | 9 min read

An insurance adjuster challenged the pharmacy costs as inflated and unrelated to injury. A pharmacist-signed MERIT report turned a $42,000 offer into a $73,000 settlement — a 73% increase.

Case Study: How a MERIT Report Helped Increase a Slip-and-Fall Settlement by 73%

When an insurance company challenged the medical necessity and causal relationship of the prescription medications, an experienced PI attorney was running out of options. Then a single pharmacist-signed clinical document changed the trajectory of the entire case. This is the story of how a MERIT Report turned a $42,000 settlement offer into $73,000.

[!KEY] A 58-year-old woman's ankle fracture progressed to CRPS requiring 14 months of specialized medication — a 12-page pharmacist-signed MERIT report defeated every adjuster objection and produced a 73% settlement increase from $42,000 to $73,000.

Case Background

• Attorney: Sarah Chen (name changed), partner at a mid-size PI firm, 14 years of practice
• Client: 58-year-old female, slipped on uncleared ice in a shopping center parking lot
• Injuries: Right ankle fracture (Weber B), subsequent Complex Regional Pain Syndrome (CRPS) diagnosis at 4 months post-injury
• Treatment duration: 14 months of continuous pharmacological management
• Defendant: Shopping center management company (commercial liability policy)

The Problem: An Adjuster With a Playbook

Sarah Chen had built what she believed was a strong case. Her client's ankle fracture was well-documented with imaging, and the subsequent CRPS diagnosis — while complicating the case — was supported by her treating orthopedic surgeon and a pain management specialist.

The pharmaceutical component of the case was substantial. Over 14 months, the client required four concurrent medications:

The total pharmacy costs over the treatment course were substantial. The insurance adjuster made an initial settlement offer of $42,000 — and accompanied it with a four-page letter dismantling the pharmacy component of the claim. The adjuster argued:

1. Causal relationship: The medications, particularly Duloxetine and low-dose Naltrexone, were not directly related to the slip-and-fall injury but to a pre-existing or coincidental condition
2. Inflated costs: The pharmacy charges were excessive for the medications prescribed, and the pricing was not consistent with market rates
3. Experimental treatment: Low-dose Naltrexone for CRPS is not FDA-approved for that indication and should not be compensable
4. Lack of documentation: The claim file contained pharmacy receipts and EOBs, but no clinical narrative explaining why each medication was prescribed, how it related to the injury, or why the specific dosages were chosen

Sarah had seen this playbook before. Adjusters isolate the pharmacy costs, attack each medication individually, and use the lack of clinical narrative to create doubt. The receipts proved the patient bought the medications — but they did not prove the medications were necessary, related, and reasonable.

"I had a stack of pharmacy printouts and no pharmacist willing to write a narrative tying it all together," Sarah later noted. "My client's doctors wrote their own reports, but nobody was addressing the pharmacy side with clinical authority."

The Solution: A MERIT Report

Sarah's firm had recently partnered with LienScripts for pharmacy benefit administration on PI cases. While her current client had obtained medications through a different channel, Sarah requested a MERIT Report (Medication Evaluation & Rationale for Injury Treatment) to provide the clinical documentation her case was missing.

What the MERIT Report Included

The completed MERIT report was a 12-page pharmacist-signed clinical document that addressed every one of the adjuster's objections:

1. Injury-to-Treatment Timeline

The report mapped each medication's initiation date to specific clinical milestones in the patient's recovery. Duloxetine was prescribed exactly when the CRPS diagnosis was confirmed at 4 months — not before, not coincidentally, but as a direct clinical response to a documented complication of the ankle fracture. The timeline made the causal chain visible and unambiguous.

2. Clinical Rationale for Each Medication

For every prescribed medication, the MERIT report provided:

• The clinical indication tied to the specific injury
• The mechanism of action relevant to the patient's diagnosed conditions
• Dosage justification based on clinical guidelines
• Expected duration of therapy and the rationale for continuation or discontinuation

3. Peer-Reviewed Citations

The report included references to published clinical literature supporting each treatment decision:

• Duloxetine's FDA approval for neuropathic pain conditions and its established use in CRPS management per the Journal of Pain Research
• Lidocaine patch efficacy for localized neuropathic pain per American Academy of Neurology guidelines
• Low-dose Naltrexone's growing evidence base for neuroinflammatory conditions, citing studies from Pain Medicine and the European Journal of Pain

4. Standard of Care Comparison

Rather than simply defending the prescribed medications, the MERIT report contextualized them within the standard of care for CRPS. The pharmacist noted that the treatment regimen was actually conservative — many CRPS patients require IV ketamine infusions, spinal cord stimulator implantation, or long-term opioid therapy. The medications prescribed represented a measured, evidence-based approach that avoided far more expensive and invasive interventions.

5. Pharmacist Attestation

The report was signed by a licensed pharmacist who attested to the clinical accuracy of the narrative, the reasonableness of the prescribed medications, and the relationship between the treatment course and the documented injury.

The Results

Settlement Negotiation

Sarah submitted the MERIT report as a supplemental demand package exhibit. Within three weeks, the adjuster's tone shifted. The revised offer progression:

Key Metrics

[!KEY] When a MERIT report shows the CRPS treatment regimen was actually conservative — avoiding IV ketamine, spinal cord stimulators, and long-term opioids — the "inflated costs" objection collapses; the defense's argument shifts from "too much" to nothing defensible at all.

Why the MERIT Report Changed the Outcome

The adjuster's original strategy relied on the absence of clinical pharmacy documentation. Receipts show costs; they do not show medical necessity. By introducing a pharmacist-signed clinical narrative with peer-reviewed citations, the MERIT report eliminated every argument the adjuster had raised:

• Causal relationship? The timeline mapped each medication to specific injury-related diagnoses.
• Inflated costs? The standard-of-care comparison showed the regimen was conservative.
• Experimental treatment? Published literature demonstrated an evidence base for low-dose Naltrexone in CRPS.
• Lack of documentation? The 12-page report was the documentation.

"The MERIT report did something I could not do with receipts and demand letters," Sarah reflected. "It gave the pharmacy costs the same clinical authority that the medical records gave the doctor visits and imaging. The adjuster could not argue with a pharmacist's clinical narrative backed by peer-reviewed citations."

"The MERIT report gave the pharmacy costs the same clinical authority that medical records give doctor visits and imaging — the adjuster could not argue with a pharmacist's narrative backed by peer-reviewed citations."

Key Takeaways

For Attorneys

1. Pharmacy receipts are not enough. Adjusters are trained to attack pharmacy costs as inflated, unrelated, or unnecessary. Clinical documentation — not just financial records — is essential to defend these costs at settlement.

[!TIP] Request a MERIT report proactively before submitting your demand in any case where the adjuster is likely to challenge pharmacy costs — submitting clinical documentation before objections are raised eliminates the defense's entire playbook in one move.

2. A MERIT report is a force multiplier. In this case, a single document contributed to a $31,000 increase in settlement value. The return on investment is not even close.

3. Address objections before they are raised. Sarah submitted the MERIT report proactively as part of her supplemental demand. By the time the adjuster reviewed it, every planned objection was already answered.

4. CRPS and complex diagnoses need extra support. When a case involves conditions that adjusters will label as "unrelated" or "pre-existing," pharmacist-level clinical narrative provides a second professional voice supporting causation.

[!KEY] A pharmacist-signed MERIT report addressing causation, medical necessity, and standard-of-care compliance is the documentation equivalent of a second expert opinion — and it eliminates every argument the adjuster raised before the adjuster can raise it again.

For the Industry

The gap between medical documentation and pharmacy documentation in PI cases has existed for decades. Physicians write detailed reports. Surgeons produce operative notes. Radiologists issue imaging findings. But pharmacy — often the largest non-surgical cost category — has historically been supported by nothing more than receipts and billing statements. The MERIT report closes that gap.

Learn More

• What Is a MERIT Report? A Complete Guide for Attorneys
• Medical Necessity and Clinical Narratives in PI Settlements
• View a Sample MERIT Report
• Attorney Resources: Partner with LienScripts

This case study is a composite based on multiple real cases. Names, identifying details, and specific figures have been modified to protect privacy. Results vary by case.

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