Personal Injury Blog

I once heard a comedian say that a “mild” heart attack is one that happens to somebody else.  Boy, isn’t that true!  Because when it happens to you it is anything but “mild”.

Does the same logic hold true for a brain injury? Does a “mild” brain injury only happen to somebody else? The answer is no.  But, surprisingly, you may not even know that you have a mid traumatic brain injury.  And, more surprisingly, the emergency room where you are seen may not be able to tell you that you have one.

Now, before we continue, we need to understand the difference between a “head” injury and a “brain” injury.  You may hear the terms used interchangeably, but they are very different.  A head injury is one that is clinically evident on physical examination – you can see it.  There are cuts, bumps, bruises, blood – visible evidence that an injury has occurred.  A brain injury, on the other hand, refers specifically to injury to the brain itself that cannot be seen by the naked eye on physical examination and is often not clinically evident.  The distinction between a head injury and a mild traumatic brain injury is critically important because when a brain injury goes undiagnosed 5% to 15% of patients may have compromised function one year or more after their injury.

Realizing that many mild traumatic brain injuries do go undiagnosed because there is no apparent head injury, The Centers for Disease Control (CDC) and the American College of Emergency Physicians (ACEP) convened a multidisciplinary panel to revise clinical diagnosis guidelines to help improve the diagnosis, treatment, and patient outcomes for mild traumatic brain injury patients.  With more than one million emergency department visits annually for brain injuries in the United States alone, the impact of an undiagnosed brain injury can be tremendous.  

Generally, the diagnosis of a mild traumatic brain injury can be made when at least one of the following criteria has been met:

1) Any period of loss of consciousness lasting 30 minutes or less
2) Any period of observed or self reported dysfunction of memory (amnesia) around the time of the injury
3) Any alteration of mental state at the time of the injury (feeling dazed, confused, disoriented)

The challenge of the emergency room physician and nursing staff is identifying which patients with a probable mild traumatic brain injury require extended diagnostic treatment to prevent further damage and which patients can be safely sent home.  The revised diagnostic guidelines answer the additional critical questions:

Which patients with mild traumatic brain injury should have a non-contrast head CT scan in the Emergency Department?
Is there a role for head MRI over non-contrast CT in the Emergency Department evaluation of a patient with acute mild traumatic brain injury?
In patients with mild traumatic brain injury, are brain-specific serum biomarkers predictive of an acute traumatic intracranial injury?
Can a patient with an isolated mild traumatic brain injury and a normal neurologic result be safely discharged from the Emergency Department if a non-contrast head CT sc an shows no evidence of intracranial injury?

It is widely believed that these new and enhanced guidelines will make a difference in the diagnosis and early treatment of brain injuries. For more information on the new guidelines, visit http://www.acep.org/practres.aspx?id=8814

A South Boston man who survived a traumatic brain injury returned with his family to the Virginia Commonwealth University Medical Center to present a $15,000 gift and to thank the doctors and health care providers who helped with his rehabilitation.

The donation was made in December at the annual holiday party for the Department of Physical Medicine and Rehabilitation.

On April 25, 1998, J.F. “Jeff” Gill was farming a piece of property in Lunenburg County when a cable that was towing machinery broke off, flew into the side of his head and left him with a traumatic brain injury.

Gill’s mother said surgeons at VCU Medical Center had to remove a fist-sized amount of damaged brain tissue, but the procedure saved her son’s life. Afterward he remained in a coma for six weeks. Barbara Gill said she expected her son would not be able to function independently, would never walk and would need a respirator for the rest of his life.

Gill endured more than four years of therapy and rehabilitation to beat the odds and regain a great deal of independence.

“He is walking, talking, dressing himself and has resumed farming,” said Barbara Gill. “Jeff operates machinery and even drives a tractor. We really are so grateful to Dr. Cifu and Dr. Kreutzer and everyone at VCU who was a part of his rehabilitation.”

Gill received a settlement from worker’s compensation, and his attorneys, Chip Kalbaugh and Brooke Anne Hunter, arranged to contribute a portion of his legal fees for the donation.

David X. Cifu, M.D., chair of Physical Medicine and Rehabilitation, announced that the department would match the $15,000 gift to establish the J.F. Gill, Jr. Lecture each year to promote public awareness of traumatic brain injury.

“We already host an annual three-day conference on traumatic brain injury and I think this new lecture can be a signature item to bring attention to the rehabilitation needs of people with brain injury,” Cifu said.

“Jeff and his family never gave up and that is a big piece of it,” he said.

The VCU Department of Physical Medicine and Rehabilitation is ranked among the top 20 programs in the country by U.S. News and World Report. The department has grant funded research investigating traumatic brain injury, spinal cord injury, return-to-work for people with disabilities and pain management. Other department programs focus on stroke, neural tumors, pediatric disability, pulmonary rehabilitation, limb deficiency and sports medicine.

(via vcu.edu)

The three “must do’s” when selecting a burn injury attorney to handle your burn injury case are:

1. Make sure to HIRE A DAMN GOOD LAWYER!
2. Make sure your burn injury LAWYER UNDERSTANDS THE COMPLICATIONS OF BURN INJURIES and the long term needs of burn injury victims
3. Make sure your burn injury LAWYER HAS THE STABILITY AND FINANCIAL RESOURCES to fund burn injury litigation

MAKE SURE YOU HIRE A DAMN GOOD LAWYER!

Burn injuries are caused by many different things. There is not one type of burn injury case. While your burn injury is the result, the causes of the burn injury are varied. To illustrate this point with real world examples, here is a summary of a few burn injury cases I have litigated over the years in Virginia:

Gas tank rupture – A meter maid was operating a three wheeled vehicle when she rounded a curve a flipped over. The gas cap dislodged and fuel spilled into the passenger compartment of the vehicle where the driver was trapped. Heat from the engine ignited the gasoline and an intense fire ensues, badly burning and disfiguring the driver.

Smoke detector failure – A rental house caught fire in the middle of the night. The smoke detector did not alarm. One occupant was awakened by the flames and escaped. The second occupant was disoriented by the smoke, but eventually made her way to the front door. Unfortunately, the front door was dead bolted and no key was in the lock. The flames trapped her and she was found badly burned, huddled in a corner by the locked door.

Power line electrocution – A man was painting his tin roof with a roller on an extension pole. When he drew back to bring the roller closer, the pole contacted the overhead power lines carrying 18,000 volts of energy. The man literally had both arms and both legs dislodged from his body on contact before he fell from the second story roof onto the ground.

Roofing glue ignited by welding spark – A roofer was applying highly flammable glue to a rubber membrane roof. A welder was working on the same project nearby. A welding spark ignited the glue vapors and a fire/ explosion broke out around the roofer badly burning him.

Convenient store explosion – A gasoline tanker truck was filling the UST’s of the store. The UST’s were vented alongside the store building just above the roof line. During an earlier remolding of the building a facade was installed at the roof line to hide it, which unfortunately trapped the fumes on the roof. Someone went in the store’s bathroom and activated the exhaust fan. Gasoline vapors are heavier than air, so they sunk into the bathroom and eventually filled the store. The cashier rung up a sale and a massive explosion occurred blowing the occupants through the store windows and into the parking lot.         

Scalding bath water – A babysitter drew a bath of water for an 8 year old boy. As the boy was disrobing while sitting on the edge of the tub, he slipped and fell in.  A new hot water heater had been recently installed in the apartment complex and the hot water setting was improperly set at too high. The boy was instantly scalded and suffered serious burn injuries.

So, you see that your burn injury attorney must first be a damn good lawyer, experienced in handling many complex cases. How do you figure that out? One way to find out if you’re on the right trail is to search the lawyer on Martindale.com. Martindale-Hubbell has been rating lawyers for years and is recognized in the legal world as the unbiased source for lawyer evaluation. It reports how other lawyers and judges rate the lawyer. An AV Peer Review Rating is the highest rating and reflects that the lawyer has reached the height of professional excellence, has practiced for many years, and is recognized for the highest levels of skill and integrity. To compliment Martindale-Hubbell I recommend you review the lawyers personal CV, or resume. Do they appear to have the experience you want? Are they a member of the Million Dollar Advocates Forum, which indicates they have successfully represented a client in a case where they obtained at least a one million dollar result? Last, interview them. Ask tough questions. Not only are their answers important, but you have to like them. If you don’t like them then odds are a jury won’t either.

UNDERSTANDING THE COMPLICATIONS OF BURN INJURIES

I have seen over and over again lawyers who simply focus on the fact that the clients skin is burned as the basis of their claim and not the other, often more critical, aspects of the burn injury. Wound infection, scar and skin contracture management, respiratory limitations, amputations, sensitivity to light and household chemicals, etc, make a burn injury victim’s life unique. Make sure your burn injury lawyer understands this. Make sure your burn injury lawyer has experience dealing with this.

Here is an example of one such thought process that should be second nature to your burn injury attorney:  If the burn injury victim has lost an ear or nose, are prosthetic devices available? If so, how long will they last? Will the victim need three or four new ones throughout the course of their life? What other procedures, now and in the future, must the victim undergo to prepare for them? Will posts need to be installed to receive the prosthetics? Will the posts ever need to replaced or adjusted? Are the risks of infection too great? What are the projected costs of all of this now and over the course of the victim’s life? Will the costs be more in 5 years, 10 years? What amount of money do I need today to guarantee these costs are covered throughout my client’s lifetime, and has a qualified Economist or Accountant confirmed the figures?

The same analysis holds true for prosthetic limbs, plastic or reconstructive surgery, home modifications, wheel chairs, respiratory management, psychological counseling, etc. Many, many factors need be considered before knowing the full financial impact that a burn injury will have on the life of a burn injury victim. Your burn injury attorney must know how to supervise a full and comprehensive life care plan for you to assure financial security as you recover and live a productive life. Your burn injury attorney must know how to manage your medical and recovery team.

STABILITY AND FINANCIAL RESOURCES

This is last in order, but certainly not least. The worst thing for your burn injury case is a lawyer who does not have the business stability and financial resources to do everything necessary on your case, and the ability to stand toe to toe with big insurance companies and businesses who will try and outspend you. It will generally cost thousands of dollars to properly investigate and litigate a burn injury case. The main reason is that burn injury cases are expert heavy. By that I mean that expert witnesses are needed to prove how and why a burn injury occurred. The plaintiff, or burn injury victim, has the burden of proving who is responsible and why. Unless it is freely admitted, which is extremely rare, experts need to be hired to prove the case. Oftentimes multiple experts are needed. Engineers, Life Care Planners, and Doctors are a few necessary members of the burn injury victim’s team in almost every case.

So what do you ask the burn injury lawyer? Three things. 1) How long has your firm continually been in business? 2) Are you prepared to advance all costs and expenses necessary to successfully prosecute my case? 3) Do you have proof that you have the financial ability to do that? 4) Will you advance all costs throughout the case and deduct those from my recovery when the case concludes? 5) Do you have malpractice insurance?  6) What is the amount of your malpractice insurance and may I have a copy of the declarations page of your policy confirm it?    

These questions will not be offensive to a seasoned and qualified burn injury lawyer. The malpractice insurance question is critical to ask. Not all states require lawyers to have malpractice insurance. Not all lawyers who have malpractice insurance have enough. Example: What happens if you a three million dollar case. Your lawyer makes a simple mistake and your case is lost. Your lawyer freely admits his mistake and tells you to make a claim against him, which he will not contest. You do so and find out he has a one million dollar insurance policy……… ASK THE QUESTIONS!  

The death of a loved one as a result of another person's wrongful act is always a sudden and traumatic event.  It is incredibly emotional and stressful for those who have been left behind.  The last thing that you want to think about while going through this difficult time is ensuring that your loved one's family members are adequately compensated for their loss.  That is why it is extremely important to choose the right attorney to represent you in making a wrongful death claim.

Wrongful death cases are very emotional which is why it is important to have a wrongful death attorney who can explain the nature of the claim in very objective, legal terms and who knows what kind of recovery the family members can expect.  For example, I have had many clients think that in a wrongful death lawsuit they are entitled to recover an amount of money that represents the value of the decedent's life.  However, under Virginia law, the recoverable damages in a wrongful death lawsuit are actually those money damages designed to compensate the surviving family members for their loss.  For example, under Virginia law, beneficiaries are entitled to receive compensation for their sorrow and mental anguish, the loss of companionship, comfort and advice as a result of their loved one's death, and the lost income of their loved one in addition to funeral and medical expenses incurred.  What a fair and just amount is in any given case varies greatly depending on the circumstances of the case. An experienced wrongful death attorney knows what facts and circumstances can effect the value of the client's claim and can provide advice to the client as to what amount a jury would likely award under the circumstances of each individual case.

Additionally, the legal aspects of a wrongful death case can be extremely complex which is why it is important to choose a wrongful death attorney with experience who can navigate these legal issues for the client.  Even before a lawsuit is filed, the attorney needs to determine the beneficiaries who are entitled to recover under the law, who the responsible party or parties are who caused the decedent's death, what the limitations period for filing the lawsuit is, in which court the lawsuit should be filed, and whether there is any available insurance coverage.  

Then, once a lawsuit is filed, the litigation process becomes extremely involved.   I have handled several wrongful death cases where it took many months, many hours of legal research, hours of deposition testimony and multiple hearings before the Court before it could even be determined whether the beneficiaries had a right under the law to sue the party whom they felt was responsible.  For example, if the wrongful death occurred at work, there is no right of recovery against an employer other than obtaining worker's compensation benefits.  Once it is determined that such a right to sue exists, it needs to be determined whether the responsible party will likely be found liable to pay damages by a Court of law and if so, the amount of damages that can be proven.  This process can take months of investigation and will very likely entail the employment of experts with various areas of specialty.  Some experts who may be needed depending on the case are engineers, accident reconstructionists, economists, accountants, medical experts, and biomechanical experts.  An experienced wrongful death attorney will be able to determine what evidence needs to be established at trial to secure a recovery for the client and what experts are needed to help establish and interpret that evidence.

The right wrongful death attorney, like the attorneys at Kalbaugh, Pfund & Messersmith, will not only be capable of skillfully handling all of the complex legal issues associated with the client's wrongful death claim to ensure the most fair and just recovery possible, but will also be extremely sensitive to the individual client's needs during this emotional and stressful time.

Million dollar television and radio campaigns, a celebrity spokesman, and huge yellow page ads give you very little information about the skill and qualifications of a particular personal injury attorney. In fact, some of the best personal injury attorneys do not advertise at all. Instead, they get their cases from referrals by other attorneys and prior clients. So, how do you weed through all of the gimmicks and glossy advertisements to find a good attorney who will maximize your recovery after you’ve suffered a personal injury?

Look for an attorney who specializes in personal injury cases.
Personal injury law is complicated. You should find an attorney who devotes his or her practice to personal injury law, rather than someone who dabbles in these types of cases. If you are lucky enough to find an attorney who began his or her practice defending insurance companies then you are way ahead of the game. Insurance defense attorneys know what insurance companies look at when they evaluate personal injury cases. They know how to get a case moved through the insurance company’s various levels of review done before any settlement offers are made, and they have established relationships with insurance adjusters. Once an insurance defense attorney begins handling claims on behalf of the injured person, they are usually very well equipped to get the most compensation for an injured person’s claim. Essentially, these former defense attorneys take the knowledge they have gained by working for the insurance companies and use it to maximize the recovery for the personal injury client.

AV Rated by Martindale Hubble.
Choose a law firm and/or attorney that is rated by Martindale Hubble. Martindale Hubble is a legitimate and respected legal publication that rates lawyers and law firms based on the results of questionnaires completed by lawyers. The ratings are based on an attorney’s reputation, skill, and results as judged by other attorneys. An AV rating is the highest possible rating and reflects that a lawyer and/or his law firm is well-respected by the legal community.
 
Experience, a Good Communicator, and Someone You Like.
Next, conduct an interview of the prospective personal injury attorney. A personal injury case can take several years from the date of your injury until the conclusion of your case. You will spend a lot of time communicating with and putting your faith in an attorney who will guide you through the insurance claims handling process and the litigation process. So, you should try to find someone that you like and who is a good communicator. The attorney should have years of experience in handling cases just like yours. Don’t be afraid to ask how many cases the attorney has handled and how many have gone to trial versus settled. Most personal injury cases settle. But, you want to make sure you have someone who is capable of taking the case to trial if it is necessary.

Personal attention.
Finally, you should look for an attorney who will handle your case on a day to day basis. The law firms with multi-million dollar advertising campaigns generally have many more cases than individual lawyers can handle. That means that you case will likely be managed by a paralegal or legal assistant. You may never have any contact with an attorney at the firm. To avoid this situation, look for a personal injury attorney who is selective about the number and types of cases he or she accepts. You should have access to your attorney at any time and you should be given the name and phone number of any support staff who will be working on your file.

Traumatic brain injuries can have devastating consequences for its victims and their families.  The severity of brain injuries can vary greatly ranging from very severe brain injuries causing coma or even death to mild traumatic brain injuries or concussions that may result in temporary symptoms of short-term memory loss or problems with focus and attention.  Although some traumatic brain injuries are classified as "mild," they can actually have significant, and sometimes permanent, effects.  The problem is that many symptoms associated with MTBI are subtle and therefore, many people who have suffered this type of brain injury go undiagnosed.  Typically, people who have suffered from a MTBI or concussion will have very short periods of a loss of consciousness or no loss of consciousness at all.  In addition, traditional diagnostic testing such as CAT scans and MRI's will generally not show the subtle changes of the brain that occur with MTBI's. Because there is frequently no "objective" medical evidence of a MTBI, brain injury litigation most often centers around cases where a victim suffers a MTBI rather than a more severe and obviously debilitating brain injury.  

Many people with mild brain injury may suffer from a multitude of symptoms including short-term memory loss, loss of focus and attention, depression, irritability, anxiety, headaches, problems with hearing, problems with language, confusion, balance difficulties and other physical, cognitive and behavioral changes.  These symptoms can cause people to lose the ability to function normally, both from a professional and a social perspective.  Because of the possible devastating effects of such an injury, and the difficulty in "proving" during the course of brain injury litigation that a very real injury exists, it is important to obtain thorough evaluations, treatment plans and rehabilitation from a variety of health care providers with different areas of specialty.  Typically, plaintiffs who have suffered mild traumatic brain injuries will be evaluated by a neuropsychologist who will do a battery of tests to determine the areas of cognitive and psychological deficits.  Plaintiffs will also be evaluated by medical doctors such as physiatrists, neurologists or neuropsychiatrists who can diagnose the injury, determine the effects of the brain injury and develop an appropriate treatment plan.  Plaintiffs also may need the assistance of physical therapists, occupational therapists, speech therapists, audiologists, vocational counselors and others depending on the extent of the deficits and the symptomatology.  Many of these experts will be needed to provide opinions and testimony at trial in order to establish the existence of the injury, the effects of the injury and the cause of the brain injury.  It is also very important to show how the plaintiff has changed as a result of the brain injury.  This can be established through the testimony of friends, family members and co-workers who have noted changes in the plaintiff's behavior since the injury.  

During the course of brain injury litigation, defense counsel will thoroughly investigate the plaintiff's injury claims by delving into the plaintiff's prior medical and psychological history, academic background, employment background, etc.  Defense counsel will also hire their own experts to examine and evaluate the plaintiff and to provide opinions as to the nature and extent of the plaintiff's injuries.  The plaintiff may have to submit to one or more lengthy evaluations by a neuropsychologist, neurologist, psychiatrist, or other medical doctor or doctors.  The plaintiff may also need to be interviewed by vocational counselors regarding his or her capacity to work.  

Brain injury litigation is complex and can sometimes be very time consuming, stressful and expensive.  However, given the severity of the potential consequences of such an injury, it is important to have an experienced brain injury attorney who is familiar with the medical and legal issues involved in brain injury litigation to assist an injured victim in getting the appropriate treatment he or she needs and in thoroughly preparing the case to ensure that the victim obtains the recovery that he or she deserves.