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California CRPS lawyer

Serving Marin County and the greater San Francisco Bay Area from our San Rafael office. Synergist Law, P.C. is a boutique California personal injury firm led by Sami Sedghani, Pharm.D., J.D. — an accomplished trial attorney with clinical training. We represent people throughout California living with Complex Regional Pain Syndrome (CRPS) that developed after an injury, surgery, or medical procedure where another party’s negligence is responsible.

Why clinical fluency matters in a California CRPS case

CRPS is among the most defense-contested chronic pain diagnoses in personal injury litigation. The condition is diagnosed clinically — there is no single blood test, no single scan, no laboratory marker that confirms it in isolation. Defense IME physicians know this, and the defense playbook is well-established: attack the diagnostic criteria, argue the pain is “proportionate” to the triggering event (defeating a core element of the diagnosis), label the treatment regimen “excessive,” and suggest the plaintiff is malingering or exaggerating.

Beating that attack requires a plaintiff’s attorney who can speak the medicine in real time — during the plaintiff’s deposition, during the defense IME physician’s deposition, and in front of the jury or arbitrator. Sami’s clinical training (Doctor of Pharmacy, UCSF, before law school) is directly relevant to the sympathetic nervous system pharmacology, the gabapentinoid and opioid regimens that frequently come up, the ketamine infusion protocols used in refractory cases, and the diagnostic reasoning behind the Budapest Criteria. CRPS cases concentrate at firms that can do this work; most plaintiff firms refer them out.

What is Complex Regional Pain Syndrome (CRPS)?

Complex Regional Pain Syndrome — formerly called reflex sympathetic dystrophy (RSD) — is a chronic pain condition that typically develops after an injury, surgery, or medical procedure. It is characterized by continuing pain that is disproportionate to the inciting event, together with sensory changes (allodynia, hyperalgesia), vasomotor changes (skin color and temperature asymmetry), sudomotor and edema changes (sweating asymmetry, swelling), and motor or trophic changes (weakness, tremor, skin and nail changes).

Diagnosis is clinical, based on the Budapest Criteria adopted by the International Association for the Study of Pain (IASP). CRPS ranks among the most painful chronic conditions documented in the medical literature — a fact that is clinically relevant and legally relevant, because jury perceptions of pain severity drive non-economic damages.

CRPS Type 1 vs. CRPS Type 2

  • CRPS Type 1 (formerly reflex sympathetic dystrophy or RSD) develops without an identifiable nerve injury. More common in personal injury litigation and the type defendants most aggressively contest.
  • CRPS Type 2 (formerly causalgia) develops after a specific, identifiable nerve injury — a peripheral nerve laceration, a surgical nerve injury, etc.

Both types present with the same clinical features — allodynia, hyperalgesia, vasomotor changes, sudomotor changes, edema, trophic changes — but differ in the presence of documented nerve pathology.

Common triggering events in California CRPS cases

  • Car accidents — particularly with extremity trauma (wrist, ankle, foot). See our California car accident page.
  • Truck and commercial vehicle collisions — see our truck accident page.
  • Workplace injuries — crush, laceration, repetitive-stress complications
  • Surgical complications — carpal tunnel release, knee arthroscopy, distal radius fracture ORIF, foot and ankle surgery, cervical and lumbar procedures
  • IV infiltration and extravasation injuries — including vesicant drug infiltration
  • Casting, splinting, and immobilization complications
  • Blood draw injuries — median or ulnar nerve injury from phlebotomy
  • Dental procedure complications
  • Pediatric CRPS following trauma or surgery

The Budapest Criteria — how CRPS is actually diagnosed

The Budapest Criteria are the clinical standard for CRPS diagnosis. A diagnosis generally requires:

  1. Continuing pain disproportionate to any inciting event.
  2. At least one reported symptom in three of four categories:
    • Sensory — hyperesthesia and/or allodynia
    • Vasomotor — temperature asymmetry and/or skin color changes and/or skin color asymmetry
    • Sudomotor / edema — edema and/or sweating changes and/or sweating asymmetry
    • Motor / trophic — decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nails, skin)
  3. At least one sign at time of evaluation in two or more of the same four categories.
  4. No other diagnosis better explains the signs and symptoms.

The clinical significance of “disproportionate pain”: a patient who had a routine wrist fracture and healed normally would be expected to have pain for a few weeks that resolves as the bone heals. A patient who develops CRPS after the same wrist fracture continues to have severe, burning, electrical-quality pain long after the fracture has healed — pain that is clinically disproportionate to the original injury. Defense IMEs attack this element directly, arguing the pain is proportionate (and therefore the diagnosis is wrong), or that the patient is exaggerating.

How CRPS gets proven in California personal injury litigation

Proving CRPS in a California case typically requires five documented components:

  1. Budapest Criteria documentation by a qualified pain management physician or neurologist, in contemporaneous chart entries rather than as a retrospective litigation opinion.
  2. A defined triggering event within the accepted temporal window — typically within weeks to a few months of onset.
  3. Supportive diagnostic testing where available — three-phase bone scan showing periarticular uptake, thermography documenting temperature asymmetry, sympathetic nerve block response, autonomic function testing.
  4. Treatment records reflecting the graduated multimodal approach the standard of care requires — physical therapy, pharmacologic (gabapentinoids, SNRIs, opioids where appropriate), sympathetic nerve blocks, and in refractory cases ketamine infusion or spinal cord stimulator.
  5. Expert testimony connecting the triggering event to CRPS onset and refuting the defense IME.

Why insurance defense disputes CRPS diagnoses

Defense strategy in CRPS cases typically centers on four arguments. Understanding them is a prerequisite to building a case that beats them.

  • Attack on the Budapest Criteria. The IME physician will selectively record findings to argue the plaintiff does not meet all four categories.
  • “Subjective pain” argument. The defense will argue that subjective pain reports cannot support a diagnosis without objective imaging — even though no chronic pain syndrome has a single confirmatory test.
  • Overdiagnosis argument. The treating physician “jumped to CRPS” when some other diagnosis explains the symptoms.
  • “Excessive treatment” argument. Multimodal regimens — gabapentinoids, opioids, sympathetic blocks, ketamine infusions — are characterized as support for a malingering theory rather than evidence of condition severity.

These arguments can succeed when the plaintiff’s attorney lacks the vocabulary to rebut them in real time during depositions and at trial. Clinically trained plaintiff counsel can engage directly with the pharmacology, the diagnostic reasoning, and the standard of care — and that often changes outcomes on both the IME’s credibility and the overall damages case.

Damages recoverable in a California CRPS case

There is no reliable “average” CRPS settlement figure because case values vary significantly based on severity, causation strength, treating-physician credibility, available insurance coverage, jurisdiction, and other case-specific factors. What drives value in a documented CRPS case:

  • Economic damages — past medical expenses, future medical costs documented through a life care plan (often including ongoing pain management, injections, infusion therapy, and in some cases spinal cord stimulator implantation and revision), lost wages, and lost earning capacity
  • Non-economic damages — pain and suffering, loss of enjoyment of life, emotional distress; CRPS is among the highest-rated pain conditions in the medical literature, which is directly relevant to a non-economic award
  • Loss of consortium for a spouse
  • Punitive damages — in the narrower category of cases where defendant conduct rose to fraud, malice, or conscious disregard for safety under California Civil Code § 3294

Future medical cost calculations in catastrophic CRPS cases typically involve a life care planner and an economist to project costs over the plaintiff’s expected lifetime and discount future losses to present value.

Deadlines — California statute of limitations in CRPS cases

Personal injury claims arising from a California accident generally must be filed within two years of the injury under California Code of Civil Procedure § 335.1. Medical malpractice claims arising from a CRPS-triggering procedure are governed by CCP § 340.5 — one year from discovery, three-year outer limit. Claims involving a California public entity require a government tort claim within six months under Government Code § 911.2.

CRPS cases are particularly deadline-sensitive because the condition often takes weeks or months to formally diagnose. The clock typically runs from the date of the triggering event, not the date of diagnosis — making early consultation important even when the diagnosis is not yet confirmed.

Fee structure — contingency representation

Synergist Law represents California CRPS clients on a contingency fee basis. Contingency fee: no attorney’s fee unless we obtain a recovery for you. Depending on the terms of your written fee agreement, you may be responsible for case costs we advance even if there is no recovery. Your fee agreement explains this before representation begins. The specific percentage and cost allocation are documented in a written engagement agreement signed before representation begins, as required by California Business & Professions Code § 6147. Initial consultations are free. Case costs — pain management expert, treating physician depositions, life care planner, economist, biomechanical expert where applicable — are advanced by the firm and reimbursed from the recovery.

Marin County and California service area

Based in San Rafael, Synergist Law represents CRPS clients throughout Marin County (San Rafael, Novato, Mill Valley, Larkspur, Corte Madera, Tiburon, Sausalito, San Anselmo, Fairfax, Ross, Kentfield, West Marin) and across the greater San Francisco Bay Area — San Francisco, Oakland, Berkeley, Alameda County, Contra Costa County, San Mateo County, Sonoma County, Napa County, Solano County. CRPS cases are handled statewide.

Frequently asked questions about California CRPS cases

What is CRPS?

A chronic pain condition that typically develops after injury, surgery, or a medical procedure. Characterized by disproportionate pain plus sensory, vasomotor, sudomotor, and motor/trophic changes. Diagnosed clinically under the Budapest Criteria.

Can I sue for CRPS?

If CRPS developed after an injury caused by another party’s negligence, or after a procedure where the standard of care was breached, yes. Common triggers: car accidents, workplace injuries, surgical complications, IV infiltration, casting/splinting complications.

Why do defendants dispute CRPS?

Four main arguments: Budapest Criteria not met; pain is “subjective”; overdiagnosis; “excessive” treatment regimen. Rebuttal requires clinical fluency on the plaintiff’s side.

What is “disproportionate pain”?

The first Budapest Criteria element — pain that persists at a severity clinically disproportionate to the triggering event (e.g., severe burning pain months after a routine wrist fracture has healed).

What does a California CRPS case typically settle for?

There is no reliable average. Value depends on severity, causation strength, documentation, available coverage, and jurisdiction. Life care plans in severe cases document substantial lifetime costs.

How much does it cost to hire a California CRPS lawyer?

Contingency fee: no attorney’s fee unless we obtain a recovery for you. Depending on the terms of your written fee agreement, you may be responsible for case costs we advance even if there is no recovery. Your fee agreement explains this before representation begins. Initial consultations are free.

Related reading

Discuss your California CRPS case

If you were diagnosed with CRPS after an injury, surgery, or medical procedure in Marin County or elsewhere in California, we offer a confidential case evaluation at no cost. Call (415) 835-4448 or use our contact form. Our office is at 1299 4th Street, Suite 301, San Rafael, CA 94901.

(415) 835-4448