A one-month old infant was involved in a motor vehicle accident. He was appropriately restrained in an infant car seat. He was evaluated in the ER where cervical spine x-rays were performed as a precaution only. The x-rays were negative for fractures, but did show a left vocal cord nodule/tumor. A biopsy was recommended via a laryngoscopy procedure. This was performed and the biopsy was malignant. The infant underwent chemotherapy treatment for the tumor. During the hospitalization, the infant’s voice became quite hoarse and quiet. It was felt that he sustained a vocal cord paralysis on the opposite vocal cord, i.e., the right side. The parents claimed that the accident caused the tumor on the left side to be pushed over onto the unaffected right vocal cord, thereby causing a contusion of some type and paralysis of the vocal cord. Joan reviewed the medical records and felt that there were numerous missing records, including the laryngoscopy procedure note as well as all nursing notes from his inpatient stay. Attempts to retrieve these medical records from the plaintiff’s attorney were met with resistance despite numerous requests. Finally, defense counsel for the insurance company received a court order from a judge requesting the pertinent medical records. The next day, over 900 pages were sent to Joan. The records revealed that it was only after the laryngoscopy procedure that the infant’s voice became hoarse. Nursing notes prior to that procedure documented a strong, vigorous cry, etc. An opinion had previously been provided by the pediatric oncologist indicating that it was possible that the motor vehicle accident caused the baby’s vocal cord paralysis. Joan felt that this was not the expert who was qualified to provide such an opinion. The parents were reluctant to allow the infant to undergo an Independent Medical Examination and therefore, Joan arranged for a Peer/Utilization Review by a Pediatric Ear, Nose and Throat physician. This physician provided irrefutable evidence that any such injury to the vocal cord stemming from the motor vehicle accident, would have produced immediate voice changes and the infant would not have had a documented loud vigorous cry for approximately the first week in the hospital. The hoarseness and vocal cord paralysis were felt to be temporary as a result of the laryngoscopy with trauma to the very delicate tissues surrounding the larynx and vocal cords. The ENT specialist felt that there was a good prognosis for the return of the baby’s voice with time. After discussing the case with the ENT specialist, Joan asked if the parents could provide a videotape depicting the infant’s voice/cry. The parents refused to provide this and decided to settle the claim the next day.