Mild Traumatic Brain Injury after an Accident

Posted on April 16, 2009 by admin

Car accidents and brain injuriesMost brain injuries that doctors and lawyers see are classified as “mild.” Mild traumatic brain injury (MTBI) accounts for more than 80 percent of closed head injuries. Moderate and severe brain injuries are among the most disabling conditions resulting from physical trauma, since the operations of the brain underlie all of our behaviors, emotions and experiences, and thus – any issues in the brain function can adversely affect or completely impair just about any of our physical, mental, or cognitive abilities and skills.

The prevalence of mild traumatic brain injuries with the risk of permanent brain injury is one of the most hotly contested conditions in personal injury claims and injury litigation. The dispute is usually around whether a person who has significant symptoms of cognitive and/or emotional dysfunction  after the brain injury is suffering from permanent brain damage or is likely to recover.  This fact will naturally have a significant effect on the outcome of any settlement negotiations or trial of an injury claim.

For both medical and legal purposes it is essential to evaluate a patient for the long-term consequences of brain injury by several different and slightly overlapping specialties as soon as possible after the accident or an incident giving rise to the injury.  A good starting point is seeing a neurologist – a medical doctor who can evaluate the general health of the injured nervous system and its functioning. Neurologists can order an interpret brain scans looking for abnormalities in the brain structure (CT Scan, MRI) and metabolic function (PET, SPECT). The neurologist can also evaluate and treat the complications of brain injury, such as post-traumatic seizures and provide medical treatment for headaches and dizziness.

A neuropsychologist can evaluate changes in a person’s cognitive or mental abilities  and in behavior caused by the brain injury.  This specialist can administer objective tests of memory, attention, problem-solving, sensory perception, planning, organization, and a long list of other types of cognitive ability.  In some cases, the complex behavioral difficulties that can arise from brain trauma are treatable  by psychiatrists, specializing in organic brain impairments – the doctors known as neuropsychiatrists.

Like with most other serious injuries, getting evaluation and treatment promptly can significantly affect the recovery of the person diagnosed with a traumatic brain injury.

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Falling Asleep while Driving and Injury Accidents

Posted on April 11, 2009 by admin

Today, I met a happily married couple for over 25 years who was a painful reminder of the dangers of both falling asleep while driving and also sleeping while being a passenger.  The wife was pushing the husband’s wheelchair as they arrived to see me regarding an employment law related matter.  When I asked how the man ended up being disabled and in a wheelchair, they told me that they were involved in an auto accident over ten years ago when they both took a long-distance trip in their car.

I was surprised to see that while the husband sustained such a serious, crippling injury, the woman seemed like she did not sustain a serious injury.  As I found out, the woman was behind the wheel, driving on a highway, while her husband was sleeping as a passenger next to her in the car. As the woman started falling asleep, she veered off the road and collided into a pole.  Since she was not fully asleep, her body was somewhat “ready” for the impact. Her husband, on the other hand, was in deep sleep.  Thus, at the time of the impact, his body was not able to provide any amortization for the impact and was freely and violently thrown forward, even though the vehicle was not traveling at a high rate of speed, when hitting the tree. As a result he suffered permanent spine injury,  and both of his knees were broken, rendering him unable to walk for the rest of his life.

Ironically, the very reason people switch who sits in the driver seat when going on a long distance trip is in order for the driver to not get too tired and not fall asleep, allowing the person who is not driving to take rest breaks and sleep while being a passenger in the car. As the above example illustrates, this is a very dangerous situation, as even a minor accident or collision will likely hurt a body of a sleeping person much more seriously than that of a  driver who is awake or who is not fully asleep.

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Bulging Disc Injury in the Back after the Accident

Posted on April 8, 2009 by admin

One of the common injuries in serious auto accidents, especially high-speed rear-end accidents is bulging disks in a spine. A bulging disk is a condition related to the spine, usually the lumbar, or lower back, that occurs when a disk bulges through a crevice in the spine. Disks are the soft, gelatinous material that cushions the vertebrae of the spine. A bulging disk injury occurs when the disk shifts out of its normal radius and most often occurs simply as a result of age. A bulging disk is different from a herniated disk in that a bulging disk typically occurs gradually over time rather than suddenly.

In many cases, a bulging disk may be diagnosed as a condition secondary to another problem. Because a bulging disk does not always cause pain, it may only be found during a routine or diagnostic imaging test such as magnetic resonance imaging (MRI).  the medical treatment for a bulging disk is relatively conservative in most cases. Rest and lifting restrictions are common, and a doctor may recommend a combination of heat and ice therapy and anti-inflammatory medications or cortisone injections to aleviate the symptoms.

Back surgery, though not as common, can relieve severe pain caused by compression on the nerves from a bulging disk that becomes herniated.

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Witnesses and settling an injury accident claim

Posted on April 7, 2009 by admin

car accident san francisco police witnessThe importance of witnesses and their statements at the scene of the injury accident heavily depends on the strength of the otherwise available evidence of liability of one of the drivers. If the evidence is compelling (such as when one vehicle is rear-ended by the other) and it is supported by a police report, in which the officer finds the rear-ending party at fault, then the statement of a witness doesn’t play a significant rule as liability will likely be established.

However, when in a contested liability situation, a statement of a witness can be crucial to proving a case. Recently, I have been contacted by a driver who was “t-boned” at a busy intersection in San Francisco, when another driver ran the red light. The other driver adamantly argued that my client was the one running the red light and the insurance company for that driver would not accept liability and would not engage in settlement discussions. However, one statement and one written declaration from a witness, who testified that the other driver ran the red light, tipped the scales of of liability in my clients favor, which was enough for insurance company to accept liability and make a settlement offer.

If you have been involved in an injury accident and have a contact information of one or more witnesses, call them as soon as possible and ask them to write down exactly what they say, as memory tends to fail when it comes to little details tham make a big difference, such as location, time of the date, the color of the vehicles involved in the accident and other facts of the incident.

Ideally, your witnesses should be unbiased and disinterested. These should not be your friends or relatives, and the value of the wintess who was a passenger in your car at the time of the accident is not very high.

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How overtreating may hurt your injury claim…

Posted on March 27, 2009 by admin

overtreating injuries after the accidentOne of the most critical elements in any legal claim, whether civil or criminal, is the credibility of the testifying witness or claimant.  Injury claims are not an exception. An honest, reasonable victim will likely recover more and sooner for his injuries. This is exactly why it is so important to make sure that you do not receive more treatment than you should. Many doctors are tempted to provide more treatment than necessary to the injured patients, especially if these doctors work on the lien basis, so that they can receive a larger chunk of the settlement at the end. The problem is that once the claims adjuster receives an unreasonably high bill from a doctor or a chiropractor, he will necessarily suspect fraud or as they call it in the insurance industry “orchestrating” more treatment than reasonable and necessary, and he will submit the records received to their own medical expert for evaluation. This will result in significant delay of the settlement process of an injury claim and will likely cast doubt on your entire claim – something that an injured person should avoid when dealing with insurance companies.

Being reasonable and honest about your injuries and your pain, without exaggerating or understating your symptoms is the best strategy to recover a fair compensation for the incident which you were involved in.

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Hiring the Right Injury Lawyer

Posted on March 13, 2009 by admin

tips for hiring the right accident injury lawyer in san franciscoThere are thousands of lawyers in California and well over a hundred injury lawyers in San Francisco who seem to have a similar education, licensing and specialization in personal injury law and yet the quality of representation and attention that different injured persons receive from different injury lawyers is so different.

So, how do you choose the right attorney for your injury case? Here are six important factors that you should consider when hiring an attorney to represent you in your claims:

1. Your attorney is not overconfident in the outcome of your case. No matter how experienced and seasoned the lawyer is, he cannot and should never be sure of the outcome of your case. Every competent attorney knows that he should never predict the exact outcome of the case, because for obvious reasons legal claims have many elements to them that are inherently unpredictable and affect recovery of damages. There are so many facts and circumstances that might come into play,as the case develops, and the nature of our legal system is such that there is simply no way to know for sure whether you will win or lose and if you win – how much money exactly you will recover from the other side.

A responsible legal professional will assure you that he will do the best he can to represent you as aggressively as possible but he will not make any promises as to how much you will recover and how long exactly the process will take.

2. A good attorney should not act like a pushy salesman. Your attorney shouldn’t shove papers underneath your hand for your signature telling you that “it’s ok and you have nothing to worry about.” Instead, he should explain to you in plain and understandable terms what you are signing, why it is necessary to execute the document, and what the consequences are. The attorney should be educating you about the next steps in your relationship and how the process works.  For instance, a good attorney will go over your services contract paragraph by paragraph, making sure that you understand what the scope and the limitations of his representation is.

A good attorney will also advise you that you are free to terminate your agreement at any time and seek alternate counsel and hire a different attorney of your choice at any time.

A good attorney is patient with his clients and makes sure that you have a general understanding of the process, and he doesn’t make you feel unwelcome or like you are wasting his time.

3. A good lawyer is capable of keeping in touch with you in a way that makes you feel that your case gets the attention it requires. An attorney has an ethical duty to communicate with his client effectively and respond to the client’s communication with reasonable promptness.  One of the most common complaints reported to the California State Bar by clients is that attorney fail to communicate and return phone calls / e-mails and letters from their clients. Being ignored is a frustrating experience in any setting – professionally, socially and especially when it comes to dealing with a lawyer. Litigation process is stressful enough and raises many questions or concerns in a client as the case develops that need to be addressed promptly. A good attorney is not “too busy” to return your calls and he keeps you informed of the developments of your case.

4. A good attorney will advise you not only how to prosecute your case but whether or not it is worth your time, money, energy and emotions to actually go after it. Not every fight is worth fighting, and sometimes it is a better idea to walk away for your own benefit even if the other side gets away and isn’t held liable. An honest attorney will not make you fight a case just to charge you an hourly fee. He truly works in the best interests of his clients by not only pursuing their legal rights but also advising them whether or not it’s prudent to pursue a case altogether. He understand that pursuing a claim is a business decision first and foremost for all parties involved.

5. A good lawyer is not too busy to handle your case. A competent lawyer will not take on more work than he can handle in a quality manner. A good attorney will not sacrifice the quality of his services for the sheer volume of the business because he realizes that his reputation and concern for his existing clients’ cases is his priority.

6. Lastly, your attorney doesn’t come across as a “typical” lawyer. A great attorney defies the stereotypes that are commonly associated with the legal profession – arrogance, greed and flamboyance, and substance abuse. He is friendly, personable and charismatic and you actually enjoy working with him/her. Attorney-client relationship is one kind of intimate relationship between people where many confidential facts and concerns are often disclosed. Effecitve attorney-client communication requires that the attorney be open and honest with his client and will encourage the client to be the same.

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Three common mistakes that affect the value of your injury case

Posted on March 7, 2009 by admin

Here are three of the most common mistakes that injured persons make after the accident that can substantially reduce or even jeopardize the value of their personal injury case:

1. Waiting for too long to treat after your injury incident. Few things cast more doubt on the severity of your injuries in the eyes of the insurance companies / opposing counsel than large gaps in treatment. This makes sense. After all, the other side is only entitled to doubt how much pain you are suffering from if you were not eager to get help soon after sustaining the injury or if you didn’t treat consistently. Thus, it’s not a good idea to be “tough” after serious accident and decline ambulance services and emergency room treatment if you experience pain.

2. Telling the insurance company adjuster that you weren’t seriously injured. It is almost always the case that the person who is injured in an accident does not experience pain immediately after the impact due to adrenaline rush and other factors. Much of the pain and discomfort in neck, back and other parts of the body appears 24 hour after the accident or even later. Some of the serious symptoms are not noticed until several days after the incident or even longer.

Thus, you should not rush to inform your insurance company about what your exact injuries were shortly after the accident because you might just not know it. You are much better of generally describing the pain that you are experiencing and reminding the adjuster that you are not sure what your injuries are as you didn’t undergo a full medical evaluation yet. The claim adjuster might be pressuring you into describing your injuries and pinning you down to your words, so that later it will be harder for you to add new facts or new symptoms. However, you should not give in to that often unethical pressure. There is nothing wrong with answering the “what hurts?” questions with “I don’t know yet” or “I am not sure.”

3. Lying to your attorney. I met clients who would hide the fact that they had prior injuries and accidents until the other side found out about their medical past. I have been sent video tapes that captured my client working at a physically demanding job while claiming that he was severally injured, unable to perform any work and was unemployed. To say the least, it is an uncomfortable situation for a lawyer to find out a certain fact about his client from the opposing counsel, and in most cases it’s actually and embarrassing discovery that significantly reduces the values of the injury case, casting serious doubt on the injured person’s credibility and honesty. Thus, lying on a deposition under oath can be fatal to your case.

One of the golden testimony rules is this: if you don’t remember something you are asked about, simply say so: “I don’t remember.”  Testimony is not a test of your memory of dates, times and quantities.  If you remember a certain detail, it’s great. If not, don’t make it up. And be as truthful with your injury lawyer as you possibly can. By Arkady Itkin, Esq.

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Treatment of Accident Injuries: Physical Therapy

Posted on March 3, 2009 by admin

There are as many physical therapy regimens as there are doctors prescribing this form of treatment. Basically, the regimens include passive treatment such as heat application, cold application, ultrasound, and massage, as well as active treatments, such as exercises. The passive treatments are commonly used during the initial recovery phase after the patient has undergone a bed rest. Again, the objective is to reduce the pain and increase mobility.

Active or exercise treatments may be beneficial in several ways. First, after a period of inactivity, it is important to increase mobility slowly and carefully so as to avoid straining the affected area.  Secondly, exercises can strengthen the stomach and back muscles, improving the patient’s posture and helping to resolve the condition and avoid recurrence. Third, participation in an active program with a therapist can go a long way toward convincing a patient of his or her ability to resume normal activities without being re-injured.  Many people who suffer a neck or back injury in an accident are extremely apprehensive about resuming their normal activities.  A controlled and monitored exercise program can be truly therapeutic in this regard.

Many chiropractors and osteopaths also recommend the use of a cervical pillow to ensure that the cervical spine is maintained in alignment if a patient rests or sleeps. Chiropractors generally recommend against sleeping in the prone position, as it may resultt in excessive rotation stress in the upper cervical spine.

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Post Traumatic Stress Disorder after an Injury Accident

Posted on March 2, 2009 by admin

post traumatic stress disorder after a car accidentPost Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after epxosure to a terrifying event, such as a serious auto accident, especially an accident in which the victim believe that he/she was about to die. In some individuals, PTSD may result in a type of brain damage. Such damage may be assocated with the effects of constant chemical processes associated with increased fear and anxeity.

According to the Diagnostic and Statistical Manual of Mental Disorder IV, PTSD may be summarized as exposure to traumatic event, associated with persistent re-experience of events, lasting more than one month, and which significantly impairs social, occupational, or other important areas of the person’s life and functioning.

It is not uncommon for a person who has been involved in a serious accident to suffer from PTSD, experiencing constant fear of driving in general and feeling that they are just about to find themselves in the similar accident again, and that there is not much they can do to preven it.

Typically, successful treatment of PTSD will include both medication to aleviate the anxiety symptoms as well as psychological counseling to rebuild the person’s confidence and rational outlook on the surrounding environment.

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Brain Injury and Concussion after a Car Accident

Posted on March 2, 2009 by admin

brain injury and concussion after a car accidentA concussion is the most common type of traumatic brain injury. Some people refer to such injures as a mild closed head injury, and these injuries may result in development of post concussion syndrome. Many sources treat mild brain injury as concussion. It is widely accepted that after a concussion, mental function of an injured person is at least temporarily impaired. There is usually damages from the biochemical changes in the brain as well as the possibility of structural damage following a concussion.

Contrary to what many people believe, brain injury does not always involve loss of consciousness. Some medical professionals in the older schools of thought still maintain that one may noe have a brain injury without a total loss o consciousness. Published information from the government, however, indicates otherwise. The US Center for Disease Control and Prevention and the American Academy of Neurology do not require a loss of consciousness for theconcussion diagnosis.

The improtance of the above fact cannot be understated. Defense attorneys and insurance companies will aruge that the injured did not sustain a traumatic brain injury because he/she did not lose consciousness. This is simply not true, and you or an experienced injury lawyer can cite to a host of medical research and date to back this up.

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