Choice of Jurisdiction in a Workers’ Compensation Claim

Apr 25, 2019 | David Snyder

In Maryland, we are fortunate to have multiple, major metropolitan areas within a short distance of each other. Because of the unique nature and location of the District of Columbia, there are many Maryland residents who work in either Washington, DC or Virginia and there are many employees of Maryland companies who reside in either of these other two jurisdictions. This often leads to situations in the workers’ compensation context where the laws of two or more jurisdictions may apply and an injured worker may be able to choose where to file a workers’ compensation claim. Despite the close geographic proximity of Maryland, DC and Virginia, the three workers’ compensation systems have significant differences which must be understood when attorneys are advising their clients of the most beneficial jurisdiction for filing a claim. This article focuses on determining the possible jurisdictions for filing a claim and determining which is the best for a client, based upon some of the differences in the laws of Maryland, DC and Virginia.

I. Jurisdiction and Barring of a Claim

As attorneys, we have an obligation to advise our clients and potential clients on the best course of action in their case. In a workers’ compensation claim, this should start with assessing the different jurisdictions where to a claim could be filed and then proceed to an evaluation of the possible benefits or drawbacks of each. This analysis must start with an understanding of the bases for jurisdiction under Maryland, DC or Virginia law. Because each jurisdiction has its own workers’ compensation laws and each was drafted independently from the other at different points in time during the last century, the jurisdictional rules vary. In addition, it is important to note that the filing of a claim in one jurisdiction may forever bar the filing of that claim in another jurisdiction in the future.

A. Bases for Jurisdiction

Maryland provides that an injured worker is covered under the Maryland Workers’ Compensation Act if he is either injured within the state of Maryland; injured while working outside of the state on an incidental, casual or occasional basis as long as he is regularly employed within the state; or is injured while working outside of the United States as long as the contract for hire was made in Maryland for work to be performed wholly outside of the United States.1 Although the Maryland Act provides that an injured worker is covered while working within the state of Maryland, this general rule does not apply if the employment in Maryland was temporary or intermittent, the injured worker and employer are not Maryland residents, the contract for hire was not entered into in Maryland, the employer has provided workers’ compensation coverage in another jurisdiction and the other jurisdiction both recognizes the extraterritorial provisions of the Maryland Act and has its own similar exemptions.2 In one of the few cases to actually parse out this last provision of the Act, the Court of Appeals of Maryland determined that a Virginia resident working for a Virginia employer in Maryland on a temporary basis was covered by Maryland’s Act because Virginia had no reciprocal provision (i.e. Virginia would have covered a Maryland resident working for a Maryland employer and injured under similar circumstances).3

Although the District of Columbia states the bases for jurisdiction in its Act, these bases have been, in large part, elaborated upon and expanded by the case law. Nonetheless, the starting point of any workers’ compensation analysis should always be with the text of the Act itself. The District of Columbia Workers’ Compensation Act provides jurisdiction when the injured worker was injured in the District of Columbia as long as they performed work for the employer in the District of Columbia4, or if the injury occurs outside of the District of Columbia but the injured worker’s employment was “principally localized” in the District of Columbia.5 It is this second provision, specifically the definition of the terms “principally localized,” that has led to the most significant litigation.

For injuries occurring outside of the District of Columbia, the DC Court of Appeals applies a three-pronged test that considers: 1) The place(s) of the employer’s business office(s) or facility(ies) at which or from which the employee performs the principal service(s) for which he was hired; 2) If there is no such office or facility at which the employee works, the employee’s residence, the place where the contract is made and the place of performance; or

3) If neither (1) nor (2) is applicable, the employee’s base of operations.6 The Court, in Hughes, did not announce a bright-line percentage rule for determining where principal service(s) were preformed and certain caveats apply. However, the Court ultimately determined that Mr. Hughes, who was a mechanic for the Washington Metropolitan Area Transit Authority who spent 60-70% of his time in Virginia, was not entitled to claim compensation in Washington, DC under these criteria. In a subsequent case involving a player for the Washington Capitals, the Court found that a  professional hockey player’s employment was principally localized in the District of Columbia based upon the fact that “the Capitals’ business is locally oriented and its relationship to the District no mere matter of convenience: its principal purpose, as the ALJ found, is to play hockey games, more of which it plays in the District than in any other jurisdiction.”7 The case law is still in flux and at least one case is pending before the District of Columbia Court of Appeals for additional clarification as to when injuries occurring outside of the District can fall under its jurisdiction.

Virginia has jurisdiction over an “injury by accident” or an occupational disease occurring within the Commonwealth.8 In addition, injuries occurring outside of the Commonwealth are covered under the Virginia Workers’ Compensation Act if the contract for employment was made in Virginia and the employer’s place of business is in Virginia, as long as the contract for employment was not expressly for work performed entirely outside of Virginia.9 The Virginia Workers’ Compensation Commission and courts have attempted to administratively and judicially restrict what constitutes an “injury by accident” in recent years and have held that the “actual risk” test is applicable in determining whether an injury arose out of and in the course of employment; the “actual risk” test holds that an injury is compensable if the employment subjected the injured worker to the particular danger that brought about the injury.10

B. Exclusivity of Making a Claim

Of the three local jurisdictions, only the District of Columbia law holds that a claim cannot be filed in DC if an injured worker has made a claim and received compensation for the same injury elsewhere. Specifically, the DC Workers’ Compensation Act states that, “No employee shall receive compensation under this chapter and at any time receive compensation under the workers’ compensation law of any other state for the same injury or death.”11 This means that an injured worker cannot have lawfully received benefits under the laws of another jurisdiction, whether it be Maryland, Virginia or elsewhere and later file and maintain a claim in the District of Columbia.12 In no scenario, however, is the employer permitted to select a forum for a claim which is binding on the injured employee.13

Although the Court of Appeals in Springer held that an injured worker did not have to file a claim and receive benefits under the laws of another jurisdiction, Maryland presents an interesting scenario. In Maryland, a self-insured employer or an insurance company cannot pay an injured worker’s benefits until a claim has been filed by the injured worker.14 Therefore, unless an injured worker has both filed a claim in Maryland and been paid benefits, Maryland has not exercised jurisdiction and a claim can still be filed and maintained in the District of Columbia. By contrast, Virginia is a voluntary payment jurisdiction, meaning that a self-insured employer or insurance company can pay benefits without an order; if the injured worker receives a check for and cashes the check for those benefits, then they are forever barred from maintaining a claim in the District of Columbia.

II. Differences in Average Weekly Wage and Compensation Rates

When determining the best jurisdiction in which to file a claim, especially for an injured worker who holds multiple jobs or is a high wage-earner, it is of the utmost importance to ensure your client receives adequate compensation while recovering from his or her injuries. Unfortunately, a work injury that results in an extended period of disability is invariably going to set an injured worker and her family back financially, so it is our duty to mitigate that setback as much as possible.

A. Maximum Compensation Rates

Because each jurisdiction employs its own manner of calculating an injured worker’s average weekly wage and determines its own maximum compensation rate applicable for any injured worker within the jurisdiction, it is important to be aware of the general method of calculating average weekly wage/compensation rate as well as the maximum rates, particularly when representing a high wage-earner. This article will not address the intricacies of the various methods of average weekly wage calculation in each jurisdiction (although I would be happy to discuss them ad nauseum), but will provide the basics. Maryland, the District of Columbia and Virginia each employ their own calculation methods for determining an injured worker’s average weekly wage and resulting compensation rate (i.e. the rate at which disability benefits are paid under the law). Being aware of these numbers is important when advising clients as to the potential benefits available to them under the law as well as the value of their case, thereby allowing the client to make an educated choice as to the proper jurisdiction for a claim.

Maryland generally considers the wages earned during the 14 weeks immediately preceding the work injury.15 Maryland determines the maximum compensation rate on an annual basis, based upon the State Average Weekly Wage and publishes these figures.16 In 2019, the maximum compensation rate for temporary total disability benefits is $1,116.00 per week.17 This rate is scaled down for permanent partial disability benefits based upon the different “tiers” employed by Maryland for calculation of permanent partial disability benefits.18

DC considers the wages earned during the 26 weeks immediately preceding the work injury.19 The District of Columbia also determines the maximum compensation rate on an annual basis, also based upon the Average Weekly Wage of all non-governmental (either DC or federal) employees in the District and publishes these figures.20 In 2019, the maximum compensation for any type of compensation benefits is $1,521.74 per week.21

Virginia considers the wages earned during the 52 weeks immediately preceding the work injury.22 Virginia also determines the maximum compensation rate on an annual basis, in July, also based upon the wages of all employees except for those employed by the United States government and publishes these figures.23 From July 1, 2018 until June 30, 2019, the maximum compensation rate for any type of compensation benefits is $1,082.00.24

B. Wage Stacking

In the District of Columbia, injured workers are entitled to “stack” their wages for purposes of the calculation of workers’ compensation benefits.25 This means that injured workers who are working at two or more jobs at the time of their injury are entitled to be paid based upon lost wages from both jobs. The law makes no distinction in terms of how much injured workers are entitled to be paid depending on which of their two jobs they were performing when injured. In other words, even if someone is injured while working at a job that pays $100.00 per week and the injury prevents him from also working at his job that pays $1,000.00 per week, he can still “stack” his wages.

One of the published decisions on this point involved a client who was working two jobs at the time that she was injured.26 She was working in the District of Columbia for the employer where she injured her shoulder and she also had a part-time job working for a different employer.27 When she was originally injured, her employer was still able to provide her with modified work so that she could continue earning an income.28 Her part-time employer, however, could not provide work within the physical restrictions that her doctor imposed on her.29 Actually, her doctor restricted her from working at her part-time job because he was concerned that she would over-exert her injured shoulder.30 As such, her employer correctly began to pay her wage loss benefits based upon the partial loss in her total, stacked wages that she sustained.31 However, at a certain point in time, the client then injured her other shoulder and the originally-injured shoulder got worse while she was in physical therapy.32 At that point in time, her employer was no longer able to provide modified work for her.33 When that happened, her employer should have begun paying her full temporary total disability benefits based upon the wages she was now losing from both of her jobs. The employer and their insurance company disagreed, and we had to go to a hearing before the Office of Hearings and Adjudication.

The District of Columbia Court of Appeals heard this matter of first impression following an appeal to the Compensation Review Board.34 In response to the employer’s argument that the Court would somehow create confusion and a conflict of legal principles if it found the client was entitled to total disability benefits for both jobs, the Court of Appeals stated, “A legal paradox is not created by this decision. It is permissible to have two separate awards attributable to one injury because there are two separate jobs—and earnings—being affected by one injury. One injury can impact a person’s concurrent earnings differently because of differing job responsibilities—the examples are infinite.”35 Basically, the court implicitly recognized not only that people work different jobs that can be impacted by a work injury, but also that people who are working two different jobs may have vastly differing job responsibilities at each job.

Unfortunately, this is a key area of the law where Maryland and Virginia are lacking. In Maryland, injured workers cannot stack their wages. So, if someone is injured while working at her part-time job and misses time from a much more lucrative full-time job, the state of Maryland has determined that they are out of luck and just has to deal with the very limited income replacement benefits to which she would be entitled at her part-time job. Virginia has essentially a “middle ground” law between DC and Maryland. In Virginia, injured workers can only stack their wages if their second job is similar to the job at which they are injured.36 Virginia and Maryland simply are not grounded in the realities of modern employment and are doing their citizens who sustain work injuries a massive disservice by failing to require that they be compensated for lost wages at both jobs.

III. Permanent Partial Disability Benefits

All of the jurisdictions permit injured workers to receive temporary total disability benefits during the period of their recovery (with certain limitations in Virginia) when they have a total loss of earning capacity or wages, temporary partial disability benefits during the period of their recovery when they have a partial loss of earning capacity or wages and permanent total disability benefits (with certain limitations) if they are unable to ever work in any gainful employment. These benefits are largely the same in all three jurisdictions. The most significant differences in computation and availability of benefits appear in the area of permanent partial disability (“PPD”) benefits. Because attorneys and clients are often focused on the end-game of a case and because the vast majority of injured workers do return to work in some capacity, the type and amount of permanent partial disability benefits are also an appropriate consideration.

DC permits two types of PPD benefits: those involving wage loss and those to a “scheduled member” (defined as an arm, hand, finger, leg, foot, toe, eye, ear or vision or hearing).37 An injured worker is entitled to compensation for total or partial loss of a “scheduled member” after reaching maximum medical improvement if there is some impairment to that part of the body.38 PPD benefits can be paid for permanent disability to a scheduled member even if the injury itself is nonscheduled (i.e. to the head, neck or back) because the situs of the disability that controls, not the situs of the injury.39 Permanent partial disability is determined, in large part, based upon the opinion of a medical expert in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment as well as the “Maryland five factors” of pain, atrophy, weakness, loss of function and loss of endurance.40 In other cases, wherein the injured worker has injured a non-scheduled part of the body, the injured worker is entitled to compensation based upon permanent loss of earning capacity.41 This is calculated either: at the time the injured worker returns to work or achieves maximum medical improvement and is the greater of the difference between the pre-injury average weekly wage and the wages of the new job at the time of the injury; or, the difference between the wages of the new job at the time the injured worker returns to work and the wages the injured worker would have been earning at that time had they continued to work in the pre-injury employment.42 One final important note is that, unlike in Maryland and Virginia, an injured worker can not receive PPD schedule loss benefits and thereafter receive temporary total disability benefits, absent extraordinary circumstances (e.g. an amputation).43

In Maryland, an injured worker is similarly entitled to PPD as of the time of reaching maximum medical improvement if they have some permanent impairment.44 Similar to DC, Maryland also differentiates in some regard between scheduled and non-scheduled disabilities, with the scheduled members being the same as those in DC and also including the nasal septum.45 Maryland, unlike DC, also allows for a physician to rate the non-scheduled body parts and permits an award of permanent partial disability benefits regardless of wage loss (though loss of industrial use is considered under this portion of the Act).46 As in DC, Maryland considers the medical impairment as rated by a physician using the American Medical Association Guides and the “Maryland five factors” as outlined supra.47

In Virginia, an injured worker is also entitled to PPD, but only for a scheduled member injury.48 Unlike DC and Maryland, neither a physician nor the Commission is required to use the American Medical Association Guides to evaluate the permanent impairment, because an impairment does not need to be determined by any set of guidelines, tables or other measuring tools.49 In addition, Virginia does not recognize the use of the “Maryland five factors,” though it seems possible they could be implicitly or explicitly considered in line with the above standard.50

IV. Conclusion

Clients and potential clients often have jurisdictional choices to make following a work injury. By being knowledgeable about the differences in employees’ right to compensation in Virginia, Maryland and DC, you can better advise them about what you believe is the most beneficial jurisdiction. My colleagues and I are always happy to lend an ear or some advice as well.

Biography: David M. Snyder practices personal injury law at CHASENBOSCOLO Injury Lawyers. He is licensed to practice law in Maryland and the District of Columbia and intends to be licensed to practice law in Virginia in 2019. He focuses his practice on representing only injured workers in workers’ compensation cases in Maryland, the District of Columbia and before the U.S. Department of Labor in Longshore and Harbor Workers’ Compensation Act/Defense Base Act/Non-Appropriated Funds Instrumentalities Act cases. He also represents his clients in third-party negligence cases arising out of work injuries in these jurisdictions. CHASENBOSCOLO represents injured victims in Maryland, the District of Columbia and Virginia and has offices in Greenbelt, Maryland; Waldorf, Maryland; Falls Church, Virginia; and a new office in Baltimore, Maryland.

Endnotes
1 Md. Code, Lab. & Empl. § 9-203(a).
2 Md. Code, Lab. & Empl. § 9-203(b)(1).
3 Janet’s Cleaning Service v. Roynon, 311 Md. 686, 696 (Md. App. 1988).
4 D.C. Code § 32-1503(a).
5 Id.
6 Hughes v. D.C. Dep’t of Employment Servs., 498 A.2d 567, 569 (D.C.
1985).
7 Lincoln Hockey v. D.C. Dep’t of Employment Servs., 997 A.2d 713, 718
(D.C. 2010).
8 Va. Code Ann. § 65.2-101.
9 Va. Code Ann. § 65.2-508.
10 The Southland Corp. v. Parson, 338 S.E.2d 162, 163 (D.C. 1985).
11 D.C. Code Ann. § 32-1503(a-1).
12 See, e.g., Springer v. D.C. Dep’t of Employment Servs., 743 A.2d 1213
(D.C. 1999).
13 Washington Metro. Area Transit Auth. v. D.C. Dep’t of Employment
Servs., 825 A.2d 292, 296 (D.C. 2003).
14 Code of Md. Regs. 14.09.06.01.
15 Code of Md. Regs. 14.09.06.03.B(1).
16 Maryland Workers’ Compensation Commission, Maryland Workers’ Compensation Rates, https://www.wcc.state.md.us/Adjud_Claims/
Comp_Rates.html (last visited March 14, 2019).
17 Maryland Workers’ Compensation Commission, Maximum Rate of Benefits for Calendar Year 2019, https://www.wcc.state.md.us/PDF/ Rates/2019.pdf (last visited March 14, 2019).
18 Id.
19 D.C. Code Ann. § 32-1511(a)(4).
20 District of Columbia Department of Employment Services, MaximumMinimum Compensation Rate/Supplemental Allowance, https://does.dc.gov/publication/maximum-minimum-compensation-ratesupplemental-allowance. (last visited March 14, 2019).
21 Id.
22 Va. Code Ann. § 65.2-101.1.a.
23 Virginia Workers’ Compensation Commission, Virginia Workers’ Compensation Commission Chronological Compensation Benefits Chart, http://www.vwc.state.va.us/sites/default/files/documents/Rates-MinMax-COLA-Mileage.pdf (last visited March 14, 2019).
24 Id.
25 MCM Parking Co. v. D.C. Dep’t of Employment Servs.¸ 510 A.2d 1041, 1044 (D.C. 1986)
26 See, generally, Providence Hospital v. D.C. Dep’t of Employment Servs., 163 A.3d 115 (D.C. 2017).
27 Id. at 118.
28 Id.
29 Id.
30 Id.
31 Id.
32 Id.
33 Id.
34 Id. at 120.
35 Id.
36 County of Frederick Fire & Rescue v. Dodson, 457 S.E.2d 783 (Va. 1995).
37 See, generally D.C. Code Ann. § 32-1508(3).
38 D.C. Code Ann. § 32-1508(3)(A)-(U).
39 Wash. Metro. Area Transit Auth. v. D.C. Dep’t of Employment Servs., 683
A.2d 470, 474-5 (D.C. 1996).
40 D.C. Code Ann. § 32-1508(3)(U-i).
41 D.C. Code Ann. § 32-1508(3)(V).
42 Id.
43 Cherrydale Heating & Air Conditioning v. D.C. Dep’t of Employment
Servs., 722 A.2d 31, 32 (D.C. 1998).
44 Md. Code Ann., Lab. & Empl. § 9-625.
45 Md. Code Ann., Lab. & Empl. § 9-627(b)-(j).
46 Md. Code Ann., Lab. & Empl. § 9-627(k).
47 Md. Code Ann., Lab. & Empl. § 9-721.
48 Va. Code Ann. § 65.2-503.
49 Choudhary v. Fairfax Co. Pub. Sch., JCN VA00000199617 (July 6, 2016).
50 See, id.


Safety Never Takes a Snow Day: How to protect yourself and your loved ones during winter storms

Mar 19, 2019 | Tom Teodori

Some view a blanketing of snow as a welcome occurrence while others as an annoying disturbance.  Regardless of your viewpoint, snow and ice frequently result in workplace injuries or negligence claims. In 2014, more than 42,000 people were hurt on the job in snow and ice related accidents. These injuries often result in lost time from work and the need for medical treatment. The most common injuries are traumatically caused from slipping and falling, or are exertional injuries from snow removal. These injury categories may be very broad, but often involve strains and sprains to the neck and back, broken bones, concussions, joint injuries to the knees, hips or shoulders, spinal injuries and/or heart attacks. Although snow and ice related injuries affect all age categories, the elderly are particularly susceptible.

If you were injured while working due to weather related conditions, you may be entitled to workers’ compensation benefits. The District of Columbia, Maryland, and Virginia have distinct laws when it comes to workers’ compensation so knowing and being advised of your legal rights is important. For more information on those rights, check out David Kapson’s recent blog post.

How can I stay safe while walking in wintry weather?

The National Center for Injury Prevention and Control, a division of the Centers for Disease Control and Prevention (CDC), reports that falling is the leading cause of non-fatal injuries for those 24 years and older. So in order to protect yourself while walking on snow covered or icy sidewalks and parking lots, you should be mindful of the following:

  • If you do not have to go out, the best way to stay safe is to stay at home to allow snow and ice removal teams to do their job.
  • If you have to go out, please be patient with the working men and women who are cleaning up our communities. Here are a few suggestions:
    • Don’t rush. It’s normal to want to get inside and warm up, so people often are hurrying to get out of the unpleasant weather conditions. However, its safer to take it slow and use flat footed and small steps – almost like a penguin. Stay on cleared or treated walkways and avoid untreated shortcuts.
    • Wear proper footwear for the conditions – avoid heels and smooth soled shoes.
    • Stay off your phone, watch where you are walking, and try to avoid carrying heavy loads.
    • Be very careful stepping on or off of curbs, as well as getting in and out of cars.
    • Be mindful of areas that have been subject to refreezing and particularly black ice.

Following these suggestions should help keep you safe. But, if you are being as careful as you can be and you still fall and are injured, the laws in the District of Columbia, Maryland, and Virginia protect you. If this happens, it is important that you speak with a trial lawyer who is experienced in handling slip and fall cases.

How long do property owners have to clear sidewalks after a snowstorm?

The simple fact that you fell and are injured does not mean that person who owns the property is responsible for taking care of your medical expenses, lost wages and potentially life changing injuries.

In D.C., property owners are required to clear the sidewalks within 8 daylight hours of a snowstorm. Both businesses and homeowners face fines for not clearing sidewalks.

Maryland does not have a statewide snow removal law. The safety rules for snow removal are set by the individual counties. Montgomery County requires property owners to perform snow removal within 24 hours. Property owners in Prince George’s and Howard Counties have 48 hours to complete snow and ice removal. Charles County has no safety rules requiring property owners to shovel snow and clear ice from sidewalks.

Virginia also leaves the snow and ice removal safety rules to the local governments. The City of Alexandria requires snow clearing within 24 to 72 hours depending upon the severity of the storm. Arlington’s snow and ice removal rules allow 24 to 36 hours depending upon the severity. Neither Fairfax County or Prince William County have safety rules for snow and ice removal.

Who is responsible?

While the law is designed to protect our communities and its members, actually holding the person who caused the injury can be very tricky for multiple reasons:

Both businesses and homeowners have insurance to protect them if someone is hurt by their negligence or irresponsibility with snow and ice removal. But insurance companies employ armies of lawyers whose job it is to protect the insurance company’s money. They know all of the tricks that can be used to avoid having to pay for an injured person’s medical expenses, lost wages and life changing injuries. When an injury in a fall changes your life, you need to talk with a trial lawyer who has actually gone to court in these kinds of cases to have a fighting chance against the insurance company’s lawyers.

Here are a few of the legal tricks that insurance company lawyers use:

  • First, the insurance company will say there’s nothing the business or homeowner could have done to prevented the fall or the resulting injuries. This is simply not true. An experienced trial lawyer will know how to show all of the steps that a responsible property owner should’ve taken in order to prevent ice and snow from creating the risk of a fall; much less the fall that actually happened.
  • Second, the insurance company’s lawyer will argue that the business or homeowner did not know that there was a dangerous condition on their property. This argument stops many innocent people from being protected since proving that the property owner had notice requires very specific evidence. Again, an experienced trial lawyer will know how to fight the insurance companies tactics and find the evidence needed.
  • Finally, and most dangerously, is contributory negligence. The District of Columbia, Maryland and Virginia are three of the five states in the United States that still follow the rule of contributory negligence. What this means is that if the insurance company’s lawyer shows that the injured person was 1% at fault for the fall, the property owner is not responsible to pay for the injuries.

Beware of Recorded Statements

When someone in our community is injured by a property owner’s choice not to follow the snow and ice removal safety rules, one if the first things that happens is the injured person gets a phone call from a representative of the property owner’s insurance company. The insurance company will tell the injured person that they need to take a statement to set up the claim. Do not give a statement. That statement will give the insurance company lawyer all the ammunition they need to shoot down your claim.

How do I stay safe while driving during winter storms?

People who are not able to stay at home during winter storms frequently have to drive. But driving in winter conditions is more dangerous than trying to cross slippery sidewalks and parking lots on foot. According to the National Highway Traffic Safety Administration (NHTSA), 17% of all vehicle crashes are caused by winter weather conditions. Each year more than 1,300 people lose their life in snow and ice related vehicle crashes. In addition, more than 116,000 people annually are injured in snow related crashes.

If you can stay off the roads, you should do so.

But, if you have to leave your home, here are a few suggestions to keep you safe while you are driving to protect both yourself and those on the road around you:

  • Make sure your vehicle is winterized, and that you have appropriate clothing and supplies in the event something goes wrong.
  • Since everything takes longer on snow covered roads, remember to accelerate, brake and turn slowly. Give yourself and your vehicle time to safely respond.
  • Double your following distances.
  • Try to avoid stopping on hills. Maintain some momentum in order to prevent getting stuck.
  • Try to avoid coming to a complete stop. If you can slow down enough to keep rolling, you will lesson the chances of getting stuck.
  • If all else fails, be mindful that if its not necessary, don’t go out until government crews have safely treated the roads.

If you are injured by an irresponsible driver during winter weather conditions, the laws of District of Columbia, Maryland and Virginia will protect you. The irresponsible or negligent driver is required to pay for your medical expenses, lost wages, and interruption in your life that they cause.

We all know that the drivers on the roads in our community are covered by insurance. If you are injured in a car wreck during winter weather conditions, you should talk to a trial lawyer who has a track record in court with these kinds of cases. Many people believe that making a claim for injuries in a car wreck will cause their insurance bills to go up. This is not true. Only the person who causes the wreck will pay higher insurance bills.

How Insurance Companies Protect Irresponsible Drivers in Winter Weather Crashes

Just like in fall cases, drivers who do not follow the traffic safety rules are protected by insurance companies and their armies of lawyers. Everything the insurance company says to you and asks you to do after a wreck is carefully planned. The plan is designed to make sure the insurance company lawyer can make the injured person look like a liar, a faker or a fraud at trial. Do not talk to the insurance company without getting legal advice first.

Just like in slip and fall cases, there are legal defenses that relate to winter weather conditions that can be used to protect drivers who do not follow the traffic safety rules – and their insurance companies’ wallets. Two of these defenses are the “sudden emergency doctrine” and contributory negligence.

An insurance company will argue that winter weather conditions create “sudden emergencies.” They will say that these emergencies make car wrecks unpreventable. But this is simply not true. If the injured person gives the insurance company a recorded statement, one of their goals will be to gather facts from that person that can be used in court to prove that the injury was the result of an unpreventable sudden emergency. At CHASENBOSCOLO, our trial lawyers that fight insurance companies in court and know how to stop the insurance lawyer from using this trick to avoid accountability.

Contributory negligence in a car wreck cases is the same as in a slip and fall case. What this means is that if the insurance company’s lawyer shows that the injured person was 1% at fault for the wreck, the irresponsible driver gets a pass for the injuries they caused. Again, this is why its important to talk to an attorney before you talk to the insurance company, even if its just to know your rights.

Winter weather can be very dangerous, especially when people behave irresponsibly. Thinking about the dangers is the first step of protecting ourselves and our loved ones from life changes injuries. No matter how careful we are, the choices other people make can cause life changing injuries. If that happens, its important to know your rights and your legal options. This doesn’t just help you get justice, but it helps make our communities safer by making it clear that property owners and drivers who take a snow day on the safety rules won’t get a pass. If you’ve been hurt as a result of someone else’s irresponsible actions in the snow, contact CHASENBOSCOLO for the experienced legal representation you deserve. Call (301) 220-0050 to set up your free consultation today.


What you don’t know CAN hurt you

Image

Jan 04, 2019 | Shaketta A. Denson

The United States is one of a hand full of countries that trusts its citizens to self-correct by allowing a jury of their peers to sit and come to an agreement when there is a dispute between parties. It is a system that goes back to Ancient Athens 900-146 BC, when a process called “Diskastai” was used to ensure that people could not select jurors for their own trials. The bigger the issue, the larger the group of Diskatai were used. This has trickled down to the justice system that we all know and love. Now, we get that magic notice in the mail summoning us to sit in a room for 8 hours praying that we won’t get picked.

Our justice system, while not perfect and sometimes an inconvenience is something of a marvel. Having a collective of folks from our neighborhoods and communities coming together to set the standards for safety and behavior that we want is special. However, despite the fact that most folks by age 30 have been selected or summoned for jury service, they do not know a lot about how it works. Jury trials have a mystery to them that is confounding not only the lucky souls picked for duty, but also to those on either side of the issue. As a practicing trial attorney, I am often confused, confounded and alarmed at the things that we can and cannot say and do during a civil trial. It’s not something that they teach you in law school. There they build our jury system up on the foundation of justice and truth and that every person: man, woman and child is equal before the law. The most important thing we are taught is the search for the truth the search for that which is hidden. That all things in the dark will come to light. The reality however, is that there are several things you, as juror, are not allowed to know. Things that the mighty decision makers from on high, the judiciary, have decided are not worthy of your consideration. The system has begun to take for granted the intelligence of the modern juror and their ability to decipher the good, the bad and the ugly. My mother taught me that ALL information is good information and, in that vein, I share this information with you.

Insurance is the name of the game

When a person is injured in a car crash, slip and fall, or any kind of incident that results from someone else’s actions, they have the opportunity to file a civil action. That civil action, or lawsuit, is based in what we call negligence or tort. A tort is a wrongful act or infringement on the rights of another. The injured person files a claim against the person who injured and becomes a Plaintiff. By filing that suit, the legal system ensures and that this is the last time that the “wrongdoer” or Defendant is really involved. The insurance company for the Defendant tags in on the behalf and from then on they control the process. The insurance company is the one who decides if this is a case that is worth settling or not, or whether it should go to trial or not. They are the ones who assign an attorney and a random adjuster who was not involved in the actual happening of the event/tort and has never met either person involved, but still makes major decisions. The adjuster is the person who holds the purse strings, controls the money. They say what a case is worth to the insurance company and what should be paid, if anything, for the affect the injuries had on their life. They are also the people who fight the most to keep the truth away from the jury.

Often times the person who was actually sued has no say in how things proceed. It is all about protecting the insurance company’s and their bottom line. Insurance companies are in the business of making and keeping money. Insurance companies are not in the business of paying claims, as that is not how they make money and stay solvent. When the case gets to trial and a jury picked, despite the fact that the Insurance Company are the ones who provide the defense and ultimately the ones who will pay any verdict obtained, we are not permitted to tell you this. It’s a big secret, a Wizard of Oz “Pay no attention the man behind the curtain!” farce. This would not be so bad if that same man behind the curtain were not allowed to argue the point that a just verdict would financially harm or even bankrupt their client. The Defendants can talk all day about what a verdict would mean for poor old Ms. Simpson who is retired and living off of Social Security, when the reality is that she will not spend a dime on that verdict. Her insurance company will. Our justice system is set up to make you believe that the person being sued is who is paying the bill. They aren’t, and we cannot pull back that veil. There is no Toto to expose the wizard. In some local states, even when the person being sued IS an insurance company the jury is still not permitted to know who they are. In effect, they get to hide completely from Lady Justice.

Is drunk driving really a bad thing?

Let’s say that you are involved in a car collision with someone who is intoxicated. Pretty devastating huh? Pretty scary? We all know that drunk driving is not safe, and that using alcohol and/or drugs then getting behind the wheel kills thousands of people every year. Judges in MD and DC have decided that the fact that someone is drunk or high behind the wheel is NOT RELEVANT to your case. Even if you wind up injured, permanently hurt and they have been convicted of driving under the influence that fact will never see the light of day in front of a jury. As long as the Defendant says they were drunk and/or high and caused a crash, they get to hide the fact that they were drunk at trial. Despite the fact that the law says that the person suing has to show all the dangers that could happen and that the Defendant appreciated that danger, the fact that they were aware of the dangers of driving drunk is not important. In essence, we are saying that people do not have to take responsibility for their actions and can continue to put those on the road with them at risk day after day. The rationale handed down by the courts is that that fact of the Defendant driving drunk unfairly prejudices the jury against the Defendant, but should they not have to bear that prejudice? They knew the law when they chose to drink and get behind the wheel, they should have to bear all of the consequences.

They have been in how many crashes?

How many car crashes or collisions has the person who hit you been in before hitting you? Do you think this is important? Would you want a jury to know this when thinking about whether or not that person has a reason to lie, or if they should be held to a higher standard? While they can mount a pretty effective defense that you as the Plaintiff are just out looking for money because of the unfortunate events that have happened in your past, the Defendant can hide behind the curtain yet again. Did they fall asleep behind the wheel and hit a pole just 40 minutes before hitting you? Have they been convicted 10 times in the year before for reckless driving too bad so sad, the powers that be have said that prior car crashes are not relevant, even if they happened the SAME DAY as the one that you were in. This person could be Evil Kanevil on the streets and the jury will never know because the courts have deemed it “not relevant” and “not important”.

Where’s the beef?

So let us say you are injured and call the police. They talk to everyone involved and they create a report. In some situations they make a decision about who was at fault or what the circumstances are surrounding what happened. We get a copy, the Defendant gets a copy but guess who doesn’t get to see it? The Jury! This is probably the number one thing that jurors ask for. “What about the police report. Is there one? What does it say? Can we see it?” Well, yes and no. We are not allowed to talk about its very existence unless we have the cop there in trial to testify. However, here in lies the rub. The Defendant can simply say “Oh I did it, but they were not really hurt” and BOOM! You talk about the police report “not relevant”. On the other hand, let’s say that the Defendant is contesting what happened in the crash, Police officers are really really busy and notoriously hard to track down. They move around, they transfer and sometimes it’s not always in their best interest to take a day off from work to testify in a civil trial. You can admit the police report to prove observable conditions for example the weather, the condition of the road, time or place and position of the vehicle, but in a drunk driving situation is that the meat?

If you are starting notice a common theme of relevance, you are correct. The irony is, that the very people, that the justice system works so hard to keep in the dark, the jury, are the very people who are charged with deciding the facts and if something and someone should be believed or not.

So, how does this information hurt or help you? Well, it is important to know the truth. Our current justice system, while a beautiful dance of brain vs. brawn, has become a game. A cat and mouse game where The Plaintiff spend time trying to expose the truth, while The Defendant goes through great lengths to keep it from you. The Jury should know how it all works so that you know and understand your rights, should you ever unfortunately be involved in a situation where you are hurt as a result of someone else’s actions.

You should know that, no matter what they tell you, it all comes down to the insurance company. They are the ones in control, they foot the bill, and they make the hamster wheel turn. There is rarely a situation where they are not the person actually paying the bill and you should not be ok with them lying to you about it. You should not be ok with them being able to hide anything from you, whether it be a prior accident history, drunk driving or a police report. You should go in with your eyes open, whether you are a Plaintiff, Defendant or Juror.

This is not Fahrenheit 451. Our jury system works because our jurors are SMART, way smarter than they system gives them credit for. Why else would we have trusted them to make decisions, for thousands of years. Jurors are discerning and compassionate and attentive. My idea of justice, true justice, would be to lay it all out on the table things that are a benefit and harm to both sides and let jurors do what we charge them to do, figure out the truth and decide what amount if any should be allowed as compensation.

Will this always benefit the Plaintiff? No. It will however not always benefit the Defendant either. It is truly a balancing the scales of justice. And that is why most lawyers, at least the ones that I know, got into this business. The very definition of Justice is just behavior or treatment. “A concern for justice, peace, and genuine respect for people.” Webster’s Dictionary 2018. Let’s start treating our jurors with the respect of the TRUTH.


Don’t Be the Strong Silent Type: How to Talk to Your Doctor to Ensure Your Rights are Protected Following a Work-Injury

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Nov 20, 2018 | David Kapson

If you read my first blog, you will recall that two things I am very fond of are pop culture and stories. One of my favorite all-time pop culture phenomena is the acclaimed HBO original series, The Sopranos. I think I have watched the series in its entirety at least three or four times. Anyone who is familiar with the series knows, Tony Soprano, the anti-hero lead character and mob boss extraordinaire spends a lot of time in therapy session with his psychiatrist following panic attacks and bouts of anxiety. No doubt, those symptoms are related, at least in part, to his Tony’s work as a career criminal, but that’s not why I bring up the reference.

I often find myself thinking about a bit of dialogue between Tony and his psychiatrist, Dr. Melfi in the very first episode when I advise my clients about how to communicate with their doctor following a life changing work injury. Struggling with the fact that he has to open up to his doctor in order to get to the root of his problems in therapy Tony says the following:

Tony Soprano: Let me tell ya something. Nowadays, everybody’s gotta go to shrinks, and counselors, and go on “Sally Jessy Raphael” and talk about their problems. What happened to Gary Cooper? The strong, silent type. That was an American. He wasn’t in touch with his feelings. He just did what he had to do. See, what they didn’t know was once they got Gary Cooper in touch with his feelings that they wouldn’t be able to shut him up! And then it’s dysfunction this, and dysfunction that, and dysfunction vaffancul! The Sopranos Pilot (season 1, episode 1).

You may find yourself asking how does this reference apply at all to communicating with your medical provider in a workers’ compensation setting? The answer is quite simple, do not be Gary Cooper, John Wayne, or Tony Soprano when visiting with your doctor after a work injury. Put another way, to be the strong and silent type could be the kiss of death when it comes to making sure all of your rights are protected, including your entitlement to causally related medical care and treatment and money benefits.

In my first blog post I stressed the importance of telling the truth after a work injury and how that honesty has two components, one obvious, and one less so. I want to focus on this honesty and truthfulness in the context of communicating with the doctor. The obvious component is to not lie or make anything up. I’m less concerned about the obvious element. It’s easy, it speaks for itself, and frankly, I do not want to represent anyone in a legal matter that is not an honest and credible person.

I’m more interested in the less obvious component, the “do not hold anything back” side of telling the truth. I always tell clients at our very first meeting that the doctor is not a mind reader and is only going to address the complaints that the patient makes when taking a history. Not holding anything back means paying attention to your body and documenting all symptoms and complaints, in all affected body parts following a work injury. In this scenario, all means all, including all symptoms and complaints whether they are a direct result or a consequence of the work injury.

Telling the doctor all of your symptoms and complaints, means telling every doctor you see, whether your treating doctor, or the doctor the insurance company sends you to for an evaluation, all of the symptoms and complaints and when you experience them. I tell clients all the time, you need to make sure the doctor understands what you feel and go through on your worst day, not your best day. Sometimes symptoms can wax and wane, but the bottom-line is that an injured worker is not seeking treatment for how they feel on their best day, its about how they feel at their worst. This allows the doctor to get an accurate picture of the condition or conditions the injured person is experiencing and develop a treatment plan to get the person feeling better. That’s the ultimate goal after all!

Consequential Injuries

A consequential injury is an injury or medical condition sustained as a result of an employment related injury or illness. Often times, when a person has an injury on one side of their body, like knee or ankle injury, or a shoulder or elbow injury, they overcompensate for the loss of use the injured side of their body and put more stress, wear and tear on the opposite, non-injured side. Consequential injuries can develop due to this overcompensation. It’s very important to not go all Gary Cooper or Tony Soprano when this situation occurs. I urge clients to make these complaints to the doctor immediately when they begin to have these problems. I also ask clients to make certain their doctor is actually documenting the complaints in the medical reports and making treatment recommendations based on the complaints. This is especially important in the workers’ compensation setting because the insurance company may choose to deny authorization to treatment for consequential injuries, so the sooner the complaints are documented by the treating physician, the easier it tends to be for consequential injuries it is to be accepted. Whether that’s on a voluntary basis by the insurance carrier, or through the worker’s compensation court system.

Head Injuries

Sometimes folks who experience severe injuries to their bodies also strike or injure their head as a result of the work accident. Unfortunately, these conditions can go unnoticed or undiagnosed at first, especially if there is the need for emergency triage or treatment for a bodily injury immediately after the incident. Injured workers find themselves experiencing post-concussion symptoms, or neurological problems as they seek treatment with their primary care physician or an orthopedic specialist following the injury. The rule against being the strong silent type applies in this situation as well. If you find yourself if this predicament it is very important to make all of these symptoms and complaints related to a head injury to your doctor so that he or she documents them in the reports and provides a referral to a neurologist or other specialist with the skills to treat the specific problem. The same rationale as outlined above in consequential injuries about getting approval for the requested consult and treatment from the insurance company or through the court system.

Psychological Injuries

A life changing work injury can impact a person’s life many ways, including leading to feelings of anxiety, mental anguish, and depression. These conditions are compensable and if you experiencing psychological complications following a workplace injury you have the ability to seek treatment at the expense of the workers’ compensation insurance carrier. If you find yourself in this situation, do not hold anything back, make the complaints to your treating physician, get a referral for a psychological consultation, get it submitted to the insurance carrier for approval and get yourself into treatment and on the road to feeling better.

In response to Tony Soprano’s question, about whatever happened to Gary Cooper? The strong silent type. My hope is that by properly educating injured workers about their rights and how to communicate with their doctors as a means to protect those rights we can eradicate the strong silent type mentality from the culture of workers’ compensation. In doing so, it should help the injured worker get faster access to reasonable, necessary, and causally related medical treatment for any and all condition related to their work injury and make it harder for the insurance companies to deny honest hard working people access such treatment.


A Worker’s Guide to Navigating Longshore and Maritime Workers’ Compensation Law

Nov 07, 2018 | Krista DeSmyter

Thousands of men and women are injured at work every day. Different state and federal laws can apply to the rights of these injured workers depending on several factors. Factors that determine which set of laws applies to a work injury include the place of injury, the location of the employer, the nature of the work, where the contract for employment was made and what government entity has an interest in protecting the health and sustainability of a particular work force. The overarching purpose of each state or government having workers’ compensation laws should be the same (See this post). However, there can be major differences in each state’s laws. This is because each state is sovereign, meaning it has its own laws that apply within its borders, and there can be significant differences in the laws as they apply to each work injury depending on how the legislature writes the laws. There are some groups of workers who fall under the jurisdiction of federal laws, the Longshore and Harbor Workers’ Compensation Act, where the United States has a specific, Constitution-based interest in protecting the class of workers. No matter what state or country the worker is from, workers covered under the Longshore and Harbor Workers’ Compensation Act are entitled to uniformly applied federal law under the oversight of the United States Department of Labor.

Explosions, fires, equipment failures, falls and other mental and physical traumas are just a few common accidents that cause serious injuries on the job. Even the most minor injury suffered on the water or on a military base can quickly lead to a devastating and lasting condition. Many times, these conditions are not covered by state workers’ compensation laws. Sometimes, such injuries can be covered under state law as well as under federal law. If you are injured in a work accident, how do you know where to file your claim and what jurisdiction’s laws best support your family and protect your family’s future? This blog will teach you basic procedures of some federal workers’ compensation claims and will advise individuals navigating their rights to seek an attorney who will help best protect an injured workers’ rights no matter what law applies to their case.

What laws protect longshore and maritime workers?

Federally mandated laws established to protect workers injured while working on waterways, overseas or on military bases include:

  • The Jones Act ­– Protects workers injured on ships or vessels due to the negligence of a ship owner, captain or fellow employee. Under the law, injured workers can recover medical care and cost of living expenses.
  • The Longshore and Harbor Workers’ Compensation Act – Protects land-based maritime workers, such as vessel repairmen or cargo loaders, who suffer injuries or illnesses related to their work. The Longshore and Harbor Workers’ Compensation Act will cover workers injured while loading, unloading, repairing or making maritime vessels. The United States government has a basis in the Constitution to oversee admiralty injuries and to uniformly protect the work force that is so important to the national economy through commerce and defense. See United States Constitution, Article III, Section2 and Article 1, Section 8. The Longshore and Harbor Workers’ Compensation Act provides compensation for medical care and wage loss/disability benefits.
  • The Defense Base Act – Provides protection to employees working outside the United States on United States military bases or under a contract with the United States government for public works or for national defense. Examples of such workers are linguists, security/police forces, cultural advisors, translators, construction workers, truck drivers, engineers, and project managers. The United States government has an interest in protecting this unique work force who are protecting the interests of the United States overseas. The Defense Base Act is an extension of the Longshore and Harbor Workers’ Compensation Act and applies the same provisions to the workers it protects. The Defense Base Act provides compensation for medical care and wage loss/disability benefits.
  • The Non-Appropriated Funds and Instrumentalities Act – Protects civilian employees providing services to the U.S. Armed Forces, including those who work for Army and Air Force Exchange Services, Army and Air Force Motion Picture Services, on-shore Navy Ship Stores, Navy Exchanges, Marine Corps Exchanges, Coast Guard Exchanges and other agencies of the United States under the jurisdiction of the Armed Forces conducted for the comfort, pleasure, contentment and mental and physical improvement of personnel of the Armed Forces. See https://www.dol.gov/owcp/dlhwc/nfia.htm. The Non-Appropriated Funds and Instrumentalities Act is an extension of the Longshore and Harbor Workers’ Compensation Act and applies the same provisions to the workers it protects. The Non-Appropriated Funds and Instrumentalities Act provides compensation for medical care and wage/loss disability benefits. 

Is there a time restriction for making a claim?

Yes. In general, the time you have to file a legal claim after a work injury is limited. You must notify your employer of the work injury as soon as possible, preferably in writing, after a work injury. The time for filing an actual claim within the jurisdiction under which an injury is covered is limited. Also known as the statute of limitations, the time limitation to file a claim can be as short as one to three years from the date of injury. Specifically, under the Longshore and Harbor Workers’ Compensation Act and the extensions of the Act described above, the time for filing a claim is within one year after sustaining a work injury or from the last day of payment of benefits, whichever is later. This statute can vary depending on the nature of your case. If you wait to file a legal claim until the statute of limitations has expired, you may lose your rights to compensation. That’s why it’s important to seek legal help as soon as you can after a work injury. An attorney at ChasenBoscolo is ready to help you protect your rights and meet any time requirements for making a claim under the laws of whatever jurisdiction best protects your rights.

Why do you need an attorney?

 Without the help of an experienced attorney, you may not receive the full amount of compensation you are entitled to under the law. Insurance companies may think they can take advantage of you and offer you less money than you deserve for your injuries and lost wages. Insurance companies try to save money by steering an injured worked toward a jurisdiction with less injured worker protections. This is wrong. An experienced attorney knows how to preserve your claim for workers’ compensation benefits in a timely manner in the jurisdictions that cover your claim, and they can pursue your claim under the laws most favorable to sustaining and protecting your and your family’s present and future. Like much of life, the answers to these questions usually are not crystal clear. An attorney at ChasenBoscolo is ready to help. We will take the time to talk with you about your goals, find out how we may be able to fight for you and put your best interests first in determining how to advance your case. Whether you were injured on an unseaworthy vessel or while loading cargo onshore, if you are a seaman, longshoreman, harbor worker or military contractor and were injured on the job or due to someone else’s negligence, you will benefit from experienced legal help.


What is My Case Worth and How is it Determined?

Sep 20, 2018 | Tom Teodori

If you’ve made it to this page, its probably because you, a family member or friend sustained injuries resulting from the negligence of a company or individual. According to the National Safety Council, motor vehicle crashes in the United States during 2017 resulted in 40,100 deaths and 4,500,000 seriously injured people. Those numbers are mindboggling—110 people die each day in a motor vehicle collision and more than 12,328 are injured daily. For teenagers, car crashes are the number one cause of death. Tragically, you have a 1 in 102 odds of dying in a car crash during your lifetime. Being struck as a pedestrian is 1 in 561 and for those riding motorcycles, the odds are 1 in 846. Slip and fall statistics are also alarming. You have a 1 in 119 odds of dying as a result of a fall. The above numbers are ridiculously high, and you can see the real life and close-to-home tragic consequences of such events.

Negligence is frequently the result of somebody’s violation of the safety rules which are designed to protect us and keep us safe. Some sort of distraction, lack of proper attention, inadequate training, not following protocols, taking short cuts and otherwise not doing what a reasonable person would do creates the negligent conduct. When that safety violation occurs, the negligent party has an obligation to make things right. The question is—what is right?

How much money is right? What factors are considered in valuing an injury claim?

Although some might think it unseemly to value injury claims in dollars, that is the only method our system of justice allows. The United States’ system of justice derived from the common law system developed in England. Although many changes and modifications were made following our Declaration of Independence in 1776, we still hold to the judicial system that requires a negligent wrongdoer to fully compensate an injured party for his or her losses. Failure to do so is a failure to do justice. We are very fortunate to have the system we do because a justice system used in other parts of the world dates back to around 1754 B.C. Known for Babylonia King Hammurabi, its called the Code of Hammurabi. You are likely familiar with this justice system based upon retribution, an eye for an eye and tooth for a tooth.

So, returning to your inquiry, what is a case worth? Numerous factors dramatically affect the value of an injury claim. Many will be discussed below, but some common factors include the defendant’s conduct, the injuries sustained, medical care, lost wages, permanent injury and where the injury occurred. Although you may have heard from a friend or family member about a formula for determining case value, that system or process really has not existed for decades. Insurance companies today use computers to determine case value. Experienced injury attorneys are aware of this and have the tools and resources to fight for fair compensation.

Are there any liability issues?

The first step in assessing proper case value is resolving any and all liability issues. Liability simply means who is at fault. Is the at fault party completely at fault, or only partially at fault? Is fault disputed? Depending on the state where the negligence occurred, fault is crucial. The District of Columbia, Maryland and Virginia are three of the five jurisdictions in the United States that follow the concept of contributory negligence. In most states, comparative negligence is the standard. Why is that important to case value? In contributory negligence states, if the injured person is even 1% at fault then he or she is not entitled to any money—nothing! A harsh result, but that’s the legal standard in contributory negligence jurisdictions. In most of the US, the standard is one of comparative negligence. In such states, a comparison is made between the negligence of the parties and the injured person’s money award is reduced by his/her comparative negligence. So in a contributory negligence jurisdiction, if the injured party is found 1% at fault for a car crash, there would be no recovery. However, if with same set of facts the car crash occurred in a comparative jurisdiction (Pennsylvania) and the jury awarded $100,000.00 to the injured person, the award would be reduced by the injured person’s negligence (1% = $1,000.00), so the award would total $99,000.00.

Click here to learn more about how contributory negligence effects slip and fall cases.

How does an insurance company evaluate the value of your case?

In the past, an insurance company adjuster would use his/her common sense, education, training and experience to determine case value. However, in the mid 1990s, the claims departments of most large insurance companies underwent a radical transformation based upon suggestions by McKinsey Consulting. The suggestions were designed to reduce the amounts insurance companies were paying to injury victims, thereby dramatically increasing profits. So currently, most insurance companies use computer software based upon potentially hundreds to thousands of different data points to determine case value. One such program is called Colossus, which was originally created by Computer Science Corporation and leased to hundreds of insurance companies. The human element in reviewing claims has been significantly reduced, and at times, all but eliminated. The insurance industry cost savings have been huge while payments to injury victims have been dramatically decreased.

So, if an insurance company is going to use computer software to reduce the value of a case, what can be done about it? First, it’s important to retain a law firm experienced in handling claims with insurance companies using the computer software. Accurate documentation of injuries, type of medical care, body parts, loss of enjoyment, medical procedure codes, supporting records, medical billing codes, permanent injuries, etc. are important when preparing settlement demands that will be assessed by the computer.

Second, it’s critical to retain a lawyer and a law firm with a well-earned reputation for going to court. Insurance companies track and record which law firms fight for their clients by filing suit and which lawyers are more likely to just take the money and run. If your lawyer has a reputation for settling, you will get less of an offer than another lawyer with a reputation for fighting for his/her client. Normally, settlement value increases after suit is filed and may continue to increase as you get closer to the actual trial date.

Third, be prepared for a fight and you must remain patient. If the insurance company makes you an unfairly low offer and suit is filed on your behalf, the insurance company may hold on to its money until very close to trial. Insurance companies understand that they have the money and it doesn’t make much difference whether they pay today or one year from now. It’s not going to have much, if any, impact on the large insurance company. Insurance companies make money over time on their money through investments, so the delay is normally nothing but beneficial for insurance companies. You, on the other hand, have lost time from work, received less than you thought for the value of your vehicle, incurred medical bills that threaten to turn you over to credit agencies, spent through your savings and now feel the need to settle your claim. The insurance company now has you at a disadvantage. Again, an experienced injury lawyer will assist you through this difficult process and help you see the light at the end of the tunnel.

Some of the factors to consider in assessing case value include:

  1. The defendant’s behavior – The more outrageous the negligent behavior, the better the case value.
  2. The defendant – Will the defendant make a good or bad witness?
  3. The amount of insurance coverage
  4. The type of negligence claim – Minor rear-end crash versus tractor trailer setting off chain reaction collision.
  5. What county suit could be filed in – Certain jurisdictions are more favorable and insurance companies are aware.
  6. The injuries sustained and their extent and duration – Muscle strains versus herniated discs, brain injuries, fractures
  7. How the injuries effect your overall physical and mental well being
  8. The physical pain and mental suffering in the past and expected in the future
  9. Scarring – Scar to the face worth more than scar on back
  10. Medical expenses in the past and expected in the future
  11. Loss of earning in the past and expected in the future
  12. Past and future pain, permanent impairment, loss of mobility, companionship, enjoyment of the things you enjoy

No two cases are the same, and even similar facts and injuries frequently lead to widely different outcomes. What may be relatively minor for one person may be devastating for another—how can a computer make that determination? The problem is, insurance companies rely upon them to perform that function thousands of times per day. There is no humanity in using a computer to determine the seriousness of an injury and how it impacts and changes a person’s life. For that, you need an experienced lawyer on your side, one the insurance company knows will file suit if a fair offer is not made. Even so, because of the use of Colossus or similar programs, the insurance adjuster doesn’t have the flexibility to go above the computer value, so the decision must be made—settle or sue?

Ultimately, your case is worth this— what you’re willing to accept in settlement and if not, then what you are awarded at trial. A skilled trial attorney should be able to give you a pretty good idea of the value range of your claim based upon their experience.

A lawyer should also explain the settle or sue options so that a decision in the client’s best interests can be made. If the case ultimately proceeds to trial, then the value will be determined by a jury using many of the twelve criteria listed above.


Anatomy of a Work Injury Through the Eyes of a Lawyer That Cares

Aug 29, 2018 | Matt Peffer

One of the first things that I learned as a trial lawyer is that I should be educating, advising and litigating for my client. For that to happen, I need to know the same things that we were all taught as young children. What happened? When did it happen? Where did it happen? Who knows what happened? Why did it happen? And most importantly, what do you expect me to do for you? So with that, let’s explore all the areas of law that a work injury can spread to.

The Worst Day of Your Life

As part of your work day, you are asked by your branch manager to drive from your Dupont Circle worksite to the Vienna, Virginia, office to cover for a sick colleague. As you discuss this with your boss, you let her know that you have a conference call with the Atlanta office at 1 p.m. She tells you no worries; you should attend by telephone on your way to Vienna. That sounds like a plan, and before you leave, you check in with your significant other who is on their way to a job interview since they have been out of work for the last six months. Oh, and you send a text to your son that you will watch his game on Game Changer, since there will be no way you will make it back home to Maryland in time for his game. Just another day in your life, and it can’t end soon enough, you think to yourself. However, somewhere west of Falls Church, Virginia, while relaying the data to the Atlanta office, something happens. The next thing you see is your significant other holding your hand in the hospital. You are told that you are lucky to be alive because your car looks like an accordion. The tractor trailer that crashed into your car also hit another car, and that driver was not so lucky. As you try to piece this together, you notice the pins and rods sticking out of your ankle, and your back and head are throbbing with pain. You ask your significant other, what are we going to do? Unfortunately, this kind of day plays out all too frequently. As a trial lawyer, my sole goal is to try to help you put your life together again through the use of the laws that exist to protect you and everyone when this happens. So, let’s begin.

Let’s examine what happened to you. We know from the discussions at the hospital that you were involved in a vehicle crash and that your injuries were caused by that crash. There are many ways to investigate how this crash happened. We can examine the police report, the first responders’ notes and the hospital records for x-rays taken of body parts that you might not know are injured. These are just some of the initial steps I take to make sure I have a basic understanding as to how your life was changed that day.

Let’s examine when it happened to you. We know from the arrival of the first responders that your life was changed at 1:32 p.m. We know from the examination of your phone records that you were on a work call to Atlanta at the time of the crash. We know from your car data, as well as the surrounding road cameras, that you were not speeding and did not leave your lane. We also know from the letters we sent out to the company of the truck driver that they cannot dispose of the phone records or other communications that may have been taking place at the time of the crash or it will be held against them later.

Let’s examined where it happened. We know from the road cameras, towing reports, police reports and reconstruction reports (as you recall, the other car driver was not so lucky) and hospital reports that the crash happened in Falls Church, Virginia.

Let’s examine who knows what happened. We know from the investigation so far that your colleagues in Atlanta heard the crash. We know from the various reports by police that other drivers witnessed the crash. We know from the hospital that your significant other was called to the hospital and given a description of what happened, as was your boss. You also found out that statements were given to all the insurance companies involved.

Let’s examine why it happened. We know from our investigation so far that you were not the cause of this crash. However, that is not the full picture. We also have to know why your injuries happened as a result of the crash. I need to examine not only all the medical reports and tests from the hospital, but also all the treatment reports from the doctors you will need to see and pay to recover from your injuries.

How a Lawyer That Cares Protects You

As a trial lawyer, I have a pretty good idea of why injuries happen, and it usually never starts with “I meant to do that.” The fact of the matter is that all injuries can be prevented—it’s just a question of when it could have been prevented and did the person or entity want to invest the time or money it would take to prevent the injury. Now join me on a journey to put your life together again through the laws that may be available to you.

I know of only two ways that I, as a personal injury lawyer, can put your life together again under the laws: medical treatment and money. I put them in that order because if I take care of your needs, the money will take care of itself. Your first cause of action to rectify the harms brought to you and your family is to pursue a negligence action against the responsible parties. We look at many things when considering who to hold responsible for your harms, including where should we hold those parties responsible. The responsible parties to take care of you medically and financially can be the driver of the truck, the company who employs the driver of the truck, the parties responsible for the design of the roadway you were on, your employer or your own car insurance, among others. In your case, we will decide together which state or federal court we should hold the parties responsible in so that we can put your life together again. In a negligence action, the laws are designed to address both your economic and non-economic harms (pain and suffering), and depending on the state, we will want to pursue it in a court that provides the fullest recovery. However, this will take a considerable period of time, and you have bills to pay and a life to continue while you receive medical care.

We should also look at what other laws there are to protect you. Your injury arose out of and in the course of your employment, and therefore the workers’ compensation laws are available to help you medically and financially. While you are recovering and not able to work, the workers’ compensation laws of at least the District of Columbia, and maybe the surrounding DMV, will provide you with lifetime medical care at the expense of your employer’s workers’ compensation insurance, as well as tax-free weekly income replacement benefits to help financially during your recovery. This is an important law that is sometimes overlooked, but for injuries at work it is invaluable to you, since your employer is required to purchase them as part of your employee benefits.

If we believe that this life changing injury has permanently restricted you from engaging in certain job duties of your employment, you may have rights under the American with Disabilities Act. It is not okay that your career and your family’s right to happiness has been put in jeopardy as a result of this injury. Although a personal injury attorney may not specifically handle this part of your case, he or she should be able to educate as to who may be able to help.

If we believe that this life changing injury has completely eliminated your ability to ever return to gainful employment, you may have access to medical care and financial assistance under the social security laws of your state. This may include a claim for social security disability benefits which you have been paying into because of your employment. Once again, a personal injury attorney should be able to educate you as to what steps to take to protect this right. You may also have been prudent enough to have purchased a disability policy in case of your inability to work, or even your employer, as part of your employment, has a disability policy on your behalf that you could turn to for medical and financial assistance.

What You Should Expect

Now that you have been educated about your rights, you need to be advised as to what your best course is to put your life back together. We will discuss not only the time and effort it will take, but a personal injury will be open and honest about what it will cost you. In most cases, it will cost you nothing as personal injury cases are handled on a contingency basis. This basically means that your personal injury lawyer will not get paid unless you get paid. As all of us are aware, if it’s not worth fighting for, then it is not worth pursuing. I never have represented a person with a life changing injury and heard them say, “My life and my family’s life is not worth fighting for.”

At each step of the process, timely advice is the key to putting your life back together. Therefore, communication with your personal injury lawyer is a sure sign that they care about you. This is all about you. Without you, there is no personal injury case. This relationship is the foundation on which your recovery will begin.

As the saying, “put up or shut up” implies, we are going to have to fight for your rights. Your life changing injury happened, and somebody has to say, “I was the responsible party.” As simple as it is to say, I’m sorry for what I have done, it’s not that simple when money and reputation are involved. In order to put your life back together again, a personal injury lawyer may need to go to trial to have a jury of your peers hold the company of the truck driver responsible, or to force your underinsured insurance policy to pay if they refuse to pay you the benefits you purchased from them. However you choose your fight and against whom you fight, make no doubt about it, you will need a personal injury lawyer to lead the way.

As I said earlier, one of the first things I learned many years ago about what a personal injury lawyer should do: Educate, Advise, and Litigate for your clients, I have spent over 20 years of my life discovering that those are the tools of a personal injury lawyer. I have also discovered that in order to be a personal injury lawyer, I must always strive to be:

A lawyer that will always have time to listen to you. A lawyer that will always have time to put your interest first. A lawyer that will always fight for you.


Results: An Experienced Trial Lawyer’s Understanding of Brain Injuries in Personal Injury and Sports Injury Cases Takes Care of the Client

Aug 20, 2018 | Ben Boscolo

How does a trial lawyer who understands concussions, head injuries and traumatic brain injuries take care of people who are hurt in car wrecks, falls or sports?

If you have hurt your head in a car accident or crash, a trip or slip and fall or a sports injury, you may be having many problems that you do not connect to your head injury. If you are have injured in any of these ways, a concussion or brain injury can cause any of the following symptoms:

  • Headaches or feeling of pressure in the head
  • Confusion or feeling as if in a fog
  • Memory problems or amnesia about your accident
  • Dizziness or if you see stars when you were hurt
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Sensitivity to light or noise
  • Appearing dazed
  • Problems responding to questions
  • Problems with word finding
  • Irritability
  • Fatigue
  • Depression

Questions about how brain injuries cause these kind of symptoms are answered in this blog.

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If you remember one thing, choosing to have your case handled from the beginning by an experienced trial lawyer who understands representing injury victims with head injuries increases your chance of getting justice.

Here are two examples of the results we secured for clients who asked for our help after they suffered a concussion:

Concussion or Traumatic Brain Injury While Playing Soccer

A soccer player reached out to CHASENBOSCOLO to help him deal with the complications of a concussion that occurred as a result of playing soccer. As a result of the player’s choice to hire an experienced trial lawyer who understands traumatic brain injuries, he received almost three quarters of a million dollars in benefits. More importantly, the player will receive all of the medical care he needs for his traumatic brain injury for the rest of his life.

Some people think a brain injury to a professional soccer player does not have much to do with the problems they experience from a concussion in a motor vehicle collision or a fall. Hearing the player’s story will help anyone who has a head injury understand: (1) the symptoms they can have; and (2) how the insurance company will behave.

Our client suffered a concussion when he was elbowed in the head. After the hit, our client experienced immediate symptoms included a loss of consciousness, dizziness and confusion. Over the course of the next two days he was dazed, confused and struggling to participate in the daily activities of life. However, like many folks who suffer traumatic brain injuries, he was in denial. Having grown up in a sports culture that encouraged him to “shake off” minor injuries like hitting his head, he did not think these symptoms prevented him from playing. More importantly, as a person who did not let anything stop him from accomplishing his goals, he was committed to not missing any games.

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The player was cleared by the team’s orthopedic surgeon, not a doctor who generally takes care of head injuries, to return to play. Based on his desire to play soccer and the opinion of the doctor, the player chose to play in another game two days later. He will regret this decision for the rest of his life. He started the game despite having ongoing symptoms of the concussion two days earlier. During the game, he was hit in the head for a second time. This hit caused a dramatic worsening of his post-concussion symptoms.

Since suffering that concussion, our client never regained full brain function. For about a year, his employer gave him a front office job that simply required him to sit at a desk, use the computer and telephone and talk to people. Even these simple job duties proved to be too great for him. This former elite athlete was not able to answer the phone or use a computer due to the symptoms of his brain injury.

Even worse, his life’s plans were derailed. While playing soccer, he had formed a business running soccer camps and coaching youth soccer players as a way to both supplement his income and to begin planning for his post-career life. Before the injury, he was involved in all of the activities that go into running a business. He marketed the business, entered into contracts, coached players, made personal appearances and participated in the day-to-day operation of the business. Before his concussion, he had no problems balancing the e-mails, phone calls and meetings that were required to build and run his business with the demands of his work as a professional athlete. Multitasking was part of his daily life. After the traumatic brain injury, he tried to keep his business running. Although he could no longer participate in camps or coach kids, he tried to help by making personal appearance and performing administrative work for the business. The player did what he could to market, negotiate contracts and respond to daily e-mails. As time passed, he learned that he could not even do these simple activities that required virtually no physical activity. Looking at the computer screen for an extended period of time worsened his symptoms. Attempting to multitask worsened his symptoms. He had no choice but to give the business to his partner

As a result of these back-to-back concussions, the player is now unable to work in any meaningful way. While he can function as a husband and father for a few hours each day, these back-to-back concussions prevent this former professional athlete from engaging in the simple activities of daily living for more than a few hours at a time. He is now forced to spend most of his time in his home without much noise or light in an effort to prevent the worsening of his post-concussive symptoms.

The player’s health was gone and his ability to care for his family was in danger. He asked us to protect his family. We decided that the best way to do this was to file a workers’ compensation claim.

When we did, his former team denied that he had any ongoing symptoms as a result of the concussions he suffered. The claim was contested from beginning to end. The club contended that the player did not have a traumatic brain injury. The club accused him of exaggeration. The club said he was doing this just to get money. Since there is no test that can prove a person has a traumatic brain injury, the club used that fact to support its argument.

We presented his case to an Administrative Law Judge. To overcome the fact that there were no tests prove there is a brain injury, we presented the testimony of two neurologists and a neuropsychologist who had cared for the player.

While the Judge was considering the case, the club agreed to a settlement that will allow the player to protect himself and his family. The player’s medical expenses, which to date exceed $100,000.00, have all be paid by the workers compensation insurance company. The club will continue to pay for the medical care he needs for the rest of his life. Finally, as a result of our efforts, our client received in excess of $600,000 to make up the wages he lost as a result of the end of his career.

If insurance companies doubt that a highly motivated professional athlete actually suffers from traumatic brain injury, you can be sure that they will doubt all hard-working men and women who suffer with post-concussion symptoms. If you have suffered a head injury while working, talk to a trial lawyer who is knowledgeable about traumatic brain injuries. If you do so, he or she will fight for an outcome that protects you and your family

Concussion or Traumatic Brain in a Car Accident or Motor Vehicle Collision

If you suffer a concussion in a motor vehicle collision, you should talk with a trial lawyer who understands traumatic brain injuries. A lawyer with experience in representing people with head injuries will help you get the results that you deserve.

In 2013, a woman who was a community fixture in a Maryland suburb of the District of Columbia suffered a head injury in a wreck. She was a long-time employee of the community’s school system. At the time she was injured, she co-owned a toy store in the center of town. Prior to the motor vehicle collision, she was in perfect health and had an excellent memory. She was responsible for maintaining her toy store’s inventory. Her former business partner told us that she had a computer-like recall of toys the store had in stock and what each toy cost.

On the day of the injury, the woman was leaving the store’s parking lot. A traffic light controls the exit. The woman stopped at the traffic light and waited until it turned green. She looked to her left, her right and back to her left to be sure that traffic was stopped. When she was sure it was safe, she entered the intersection. A driver coming from her left in the left hand lane of traffic ran the red light and crashed into the driver’s side of the woman’s car. The airbags deployed. The woman was tossed from side to side hitting her head during the collision. She immediately developed a lump on her forehead and had cut on her head. She was dazed but did not lose consciousness.

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In addition to injuring her head, she suffered injuries to her left shoulder, upper and lower back, and the left leg from the knee down.

At the emergency room, she denied she had lost consciousness. But, she could not remember anything between hearing a boom and realizing that someone was at her door asking her if she was all right. She has absolutely no recollection of the period of time right after the crash.

In the days, weeks and months that followed the collision, she had headaches, dizziness, balance issues and memory loss. Simple things like finding her keys or remembering what toys were out of stock escaped her mind.

Our client is a very tough person. She does not like or trust doctors.

Other than some treatment that was designed to try to improve her balance problems, our client chose not to get much medical care and treatment. When she was still experiencing memory loss, headaches, balance problems and dizziness, we sent her to see a top-notch neurologist. That neurologist determined that our client had a brain injury. He recommended neurological care. Our client chose not to get this care because it would only provide temporary relief and she does not like going to doctors. The neurologist concluded that our client lost 15% of the function of her brain.docotrhart

Our client also was afraid to drive because she thought another irresponsible driver would ignore the traffic safety rules and hit her again. Our client was sure that she was going to be in another crash. Her driving anxiety is so bad that she never drives past the intersection where the collision happened. In order to help her overcome her fear we sent her to see a highly regarded psychiatrist. That doctor determined that our client suffered from depression and anxiety as a result the motor vehicle collision. He recommended psychological care. Our client chose not to get medical care because it would only provide temporary relief and she does not like going to doctors.

The insurance company, as they always do, based its evaluation of the case on the medical care and its costs. Since our client did not like doctors and did not get much medical care, her medical expenses were not very high. In the weeks and months leading up to trial, the insurance company offered only $57,000 for the life-changing traumatic brain injuries that our client suffered.

We decided that the case had to be presented to a jury. The case was tried for two days. The neurologist explained how the traumatic brain injury occurred and a friend, family member and former business partner all testified as to their observations of how the motor vehicle collision changed our client’s life.

After learning about traumatic brain injuries in general and how our client’s life was changed, the jury returned a $500,000 verdict.

This is why it is important to have a trial lawyer who is knowledgeable about traumatic brain injuries handle your personal injury or workers’ compensation case

The Most Important Thing to Remember

The simple truth is that concussions and traumatic brain injury are serious, life-changing injuries. Traumatic brain injuries are common in car wrecks, fall or sports injuries. Traumatic brain injuries are hard to understand and treat. It is very hard to prove that a person has a traumatic brain injury. Insurance companies and their lawyers know how to get their clients off the hook if you suffer a traumatic brain injury in a car wreck, fall or sports injury. If you want the results you deserve, you should talk with a trial lawyer who has actually tried cases involving traumatic brain injury.

CHASENBOSCOLO has more than twenty experienced trial lawyers waiting to help you, and we’re ready to help day or night.


Authorization Denied: When Health Insurance Becomes a Barrier to Treatment

Jul 23, 2018 | Ashley Strandjord

Nestled between the Bronx and Manhattan, the most serene location I’ve ever found in New York City is the Harlem River at 6:00 a.m. Mondays through Saturdays.

The murky water reflected the impending sunrise off its oily sheen. After attaching the riggings to the shell and climbing in, both the stillness and the serenity of the river rippled away.

I rowed for three years in college. The dreaded two-a-days workouts and indoor erg pulls were the only downside to trolling between Yankee Stadium and the Broadway Bridge. At some point during my third year, I began to notice a dull ache in my hip after practice. Nothing some rest (and ice cream) couldn’t fix. As race season ramped up, the pain intensified and was less willing to subside with my self-prescribed therapy à la mode.

I sought treatment with the athletic department’s trainer. “Just ice it and it will go away,” they said. It didn’t. Back to the trainer’s office. “Have you tried heat? It will help.” The pain persisted. I then went to my family practitioner. “Have you tried a course of anti-inflammatories?” Yes, but just like everything else so far, no relief.

In the meantime, race season had ended, finals were approaching and I found I was having trouble walking back from the subway after work. I was given a referral to see an orthopedic surgeon. After performing a few quick tests, my orthopedic surgeon told me we needed an MRI and it was possible I had torn “something” in my hip.

Jumping Through Hoops for Insurance Authorization

The MRI order was promptly denied by my health insurance company. However, they approved an x-ray of my hip. My doctor and I agreed that although the MRI was what he had ordered, I should go ahead and get the x-ray taken.

Results: “Unremarkable.” Back to the doctor so he could inform my insurance company I needed an MRI. Again, it was denied with a note indicating it was “unlikely a 22-year-old female is having difficulty walking.” However, they approved a CT scan with contrast. Not a procedure I’d ever like to repeat, but I got it done (at, of course, the facility my insurance company identified).

Back to my surgeon who said, “We still really need an MRI to see what is going on.” Turns out, the CT scan had been inconclusive. On the plus side, they had injected some lidocaine and I was feeling great! (For a mere two days.)

The MRI was finally approved and done (again at a facility identified and approved of by my insurance company). The results were in. I had “an acetabular labrum tear and possible degenerative changes.” In English, please? I tore a small piece of cartilage near the femoral head and the pelvis, and there were indications of arthritis.

I was then informed the surgery did not come with a guaranteed success story. In fact, it was unclear whether the effects of the surgery would last a few months or the rest of my life. “What about if I want to have kids?” We don’t have the research. “Will I be able to go back to rowing?” Absolutely not. “What about hiking? Walking a strong dog on a leash?” You should be okay. “Dancing? Running? Bicycling?” All of those are fine—but no yoga or Pilates. After this surgery, you will be forever restricted from those activities and anything that isolates the hip muscles and joint. I was 22 and contemplating what my life would look like with a perpetual cloud of uncertain future surgery and/or restrictions.

I went for a second opinion (as you might imagine, not covered by my insurance company) and a review of all the studies performed on my hip. I went to a prestigious hospital in New York City to consult with a doctor that spends the large majority of his time on torn acetabular labrums. It turned out to be an incredible waste of time. I was seen by the doctor’s physician’s assistant, who listened to my description of the pain and its duration. The doctor himself came in for less than four minutes. During that time, he spoke rapid-fire and there was no time for any of my follow-up questions. He told me my MRI images were “far too fuzzy to even interpret,” and, “I’d have to measure your legs if I’m going to do this surgery—it might have to be a total hip replacement, I’m not sure yet,” and, “You’ll have to get new MRIs done at the place I like down on 58th. Go there and have them sent back over to me and we’ll go from there.” And then he was gone. And so was I.

It was time to schedule surgery with my orthopedic surgeon, which my insurance company again denied. My doctor appealed the denial on my behalf, explaining I was an otherwise perfectly healthy 22-year-old who could not walk without pain.

Denied again. My surgeon called to explain the denial. He indicated that often the denials are decided by employees of the insurance company who have little to no medical training or background, but rather follow a set of parameters provided. He again appealed on my behalf, using the multiple studies as support for the surgery. At this point I was tired of the run-around and constantly having to rely on someone else to advocate on my behalf. A short time later, the surgery was finally approved.

Becoming My Own Advocate

I was elated to find out that not only was the surgery approved, but so were 24 visits to a physical therapist after surgery. The physical therapy was to be performed at a location entirely inconvenient to both my home and office locations. I did some research of physical therapy centers closer to my home and office and sought the advice of friends and officemates. I was fortunate enough to work as an administrative assistant in a law firm specializing in medical malpractice at the time—so the advice was well taken. I took that information and called my insurance company myself.

I explained that the location they had identified to attend physical therapy sessions was inconvenient and was not the location where I wanted to seek treatment. I gave them the name of the facility not two miles down the road from my office, which was accessible during my lunch hour and okay with my employer. I expressed my willingness to attend physical therapy (I really wanted to get better and get back to what I was doing) and that I took my healthcare very seriously. I was told a decision would be made but that there were no guarantees and I shouldn’t get my hopes up.

To their credit, the insurance company approved my physical therapy at the location I designated. I got the approval letter in the mail and it seemed like it was all coming together. The surgery was a few days away, and I had the physical therapy all lined up—now all I needed to do was rest, recover, and get back to my daily life. Until I scrutinized the letter—which indicated they had only approved 18 sessions of therapy at that location. I rooted through all my paperwork (and there was a mountain of it) to find the other approval letter that allocated 24 physical therapy sessions. I looked at them. And read them again. Read each one over—placed them side by side and upside-down. One said 24 sessions. The other 18. Apparently, asking to have the same treatment at a different facility resulted in the loss of 6 sessions.

I gave the papers to family members to read to ensure I wasn’t missing anything. I asked the attorneys in the firm to glance over them. Nobody could explain the loss of 6 sessions of physical therapy on the eve of surgery simply by switching locations, and I still had unanswered questions that no one seemed to be able to answer. But I knew someone who could.

A telephone call to my insurance company confirmed they had unilaterally decreased the number of sessions I needed post-surgery. I placed a call to my doctor’s office to let him know what had happened. He agreed the facility I was now going to attend was superior to the one identified by the insurance company, but there appeared to be no rationale as to why they slashed 6 sessions from my treatment. He told me not to worry—we would start with the 18 treatments, and he would prescribe more if I needed them.

The surgery was a success. I awkwardly clunked around on crutches for two weeks until my post-operative visit with the surgeon. He had the biggest smile and asked (with far too much enthusiasm) if I wanted to see the photos from the surgery. No, I did not. Turns out, it wasn’t a question; we were going to review them together. We looked at the tear—which was much worse than previously seen on the MRI. We looked at the femoral head, which had a lot of arthritic bone that was removed during the surgery. We reviewed every detail of the surgery—and I was finally given clearance to attend physical therapy and take a proper shower.

Hitting the Wall

After 18 sessions of lunch-hour physical therapy, the physical therapist and my doctor agreed I needed at least 18 more sessions to ensure proper healing and that the surgical repair would last. They both prescribed 18 more sessions. However, the insurance company had not made its decision regarding the continued treatment before my next scheduled session.

I asked the physical therapy facility if they would be able to provide treatment in the interim. They were willing to help, provide treatment and lend support wherever they could. A few days later, I received an approval letter for continued physical therapy sessions from the insurance company. Six more sessions. One-third of what had been prescribed by treating professionals.

I grumbled and fought with the insurance company, roping in my doctor and the physical therapist. The insurance company wouldn’t budge and refused additional treatments. 24 sessions in total were the most they would cover, and if I wanted to continue I certainly could—paying out of pocket, of course.

I attended my last 6 sessions, keeping in close communication with my surgeon and the physical therapist. I asked if I could have them draft and approve a home exercise program that I could do at home in lieu of paying out-of-pocket for continued visits. They both agreed this was an excellent idea—but if there was any pain I was to return to their care immediately.

Creating the Spark

While all of this was going on, I had been working in a law firm while trying to figure out whether I really wanted to go to law school. I had been working in the same firm for over seven years at that point, and I wanted to make sure that law school was really and truly my dream. Going through this experience only solidified my desire so that I could advocate for others. Along the way I learned how to effectively advocate for myself both in and out of a legal forum, and I am always enthusiastic about using my skill set to the benefit of others.

It’s been over eight years since the surgery. I can live without yoga and Pilates. My husband and I (attempt to) ride a tandem bicycle on occasion. I’ve hiked a portion of the Appalachian Trail while pregnant. I chase after my son on uneven terrain and skillfully dodge dump-trucks in my living room.

It’s no longer the dark waters of the Harlem, but I’ve found serene places all over the DMV—and I can’t wait to find more.

Useful Tips for Those Dealing With Injuries:

  • Be your own advocate.
  • Talk to your doctor and ask questions.
  • Bring a notepad with questions you have and space to write down what the doctor says.
  • Discuss your symptoms with your doctor and ensure you both have a clear understanding of the course of treatment.
  • Ask why your health insurance, or your employer’s workers’ compensation insurance (if you were hurt on the job), is denying treatment recommended by your doctors.
  • Work with your treating providers to find alternatives while you’re waiting on authorization (or if authorization is denied).
  • Be persistent. Sometimes, it will take several “nos” to finally get a “yes.”
  • If insurance is requiring you to go to a provider that doesn’t work for you, see if there are alternatives available. Do the research to find a better location that accepts your insurance.
  • Don’t be afraid to ask your doctor to advocate on your behalf for necessary treatment.

The Life-Changing Impacts of Injuries

Jul 16, 2018 | Kyle Shoemaker

Many people may know someone injured in a traumatic event, such as a motor vehicle collision or a fall. However, many people don’t, or the people they know who’ve been hurt have kept this information private. As personal injury lawyers, it is our job to help others, particularly juries, to understand the real and meaningful ways that an injury disrupts the lives of our clients, particularly when that injury is caused by another’s actions and decisions.

As anyone who commutes in the Baltimore-Washington metro area knows, rear end collisions occur every day. Sometimes, the drivers and passengers involved walk away with no problems. Other times, they are not so lucky. To illustrate the unseen effects of injury, consider this relatively simple example for a car crash involving Gary. (To be clear, Gary is not a real person, he exists only for this example). Gary is 32 years old and works as a welder for a utility company. He is driving work on an ordinary Monday morning when, while waiting at a red light, his car is rear ended. The police are called, the parties exchange information and both vehicles are able to drive away. Gary goes on to work. After all, he doesn’t feel too badly immediately following the crash, and he has bills to pay and a family to support. Since Gary works for a utility company, his work is physical. He has to move and lift heavy tools, move large metal objects, and engage in other physical activity. As the day wear on, what began as tightness in his neck and back became worse.

To an outside observer, neck and/or back pain may not seem like something that is terribly serious. Someone who doesn’t have first hand experience with this sort of traumatic injury may think that a bit of neck or back pain is no big deal. And Gary himself may not know how serious the injury is. The true severity of an injury like Gary’s may not always be apparent in the immediate aftermath of the collision.

So let’s take a look at some of the ways in which Gary’s injuries will impact his life. To begin with the broadest view: he will experience physical pain. Back and neck pain can cause even the most mundane of movements to be painful. What will that pain actually mean to Gary in concrete, real life terms? What will that mean for his relationships, his work, his hobbies, his goals? Let’s break that down in more detail.

How Physical Injuries Effect Family Relationships

Gary is relatively young at 32 years old. He has two young children: a 3-year-old boy and a 4-month-old girl. As any parent can attest, caring for young children requires a tremendous amount of work, even on the good days. Now imagine that Gary has arrived home after a long day of physical work. Even without his injury, he is tired and probably a bit sore. Layer on top of that the pain and stiffness from Gary’s injuries, and all of a sudden playing with or caring for his children is a much more difficult task. No parent wants this kind of interaction turn into a physically painful and difficult experience. A three year old may not understand why Daddy doesn’t want to pick him up when he gets home from work. Imagine how that makes Gary feel when he sees the hurt on his child’s face when he tells them no, Daddy can’t carry you.

But that’s not the only relationship that suffers when someone is injured. These days, many two-parent households are ones where both parents have to work to make ends meet. This means that both parents need to find time to take care of ordinary household chores (anything from major home repairs, to everyday tasks like carrying in groceries) in between work, sleep, and taking care of the children. When one of those parents is dealing with some kind of physical injury, that division of labor can be upset. So an injured person like Gary, who is already trying to get better, may be dealing with the feelings that come along with feeling like he is not doing his part to keep the family operating day to day. Effects such as those described above can stress on a relationship, which might already be strained thanks to the daily grind of working and taking care of young children. This isn’t to imply that Gary’s wife (or the partner of any injured person) wouldn’t be understanding in a situation like this. But even “minor” neck or back injuries can have effects which can persist. When you add the psychological stress brought on by some of the other factors discussed, even the healthiest relationships suffer.

When Injuries Prevent You from Working

How do Gary’s injuries affect his work? As I mentioned, Gary is a welder for a utility company. This means he may be working outdoors. Or maybe he works in confined locations inside power plants. He may find himself bending, crouching, or climbing. Welding is a skilled trade that is in demand in many areas. Welders have the potential to make a decent wage, but the work is physical. If Gary is temporarily placed on a limited or off work status, his family will likely face financial hardship. Only 39% of Americans have enough savings to cover a $1,000 emergency. In the D.C. Metro area, there’s no way $1,000 covers rent or a mortgage; never mind utilities, gas, food… the list goes on and on. If Gary’s off work (or “disability period”) lasts a long time, or if he loses his job entirely, that financial hardship goes up tenfold – putting even more pressure on him and his family.

But that’s not all. Gary, like many Americans, takes a certain sense of pride and identity from his work, and from his ability to provide for his family. When an injury threatens Gary’s ability to go to work and provide for his family, more than just his job is threatened. Part of Gary’s very identity is threatened, and that is something that is impossible to put a price on.

When You Can’t Do the Things that Keep You Sane

Depending on what Gary likes to do for fun, his hobbies or recreational activities could be impacted by his injuries. If Gary enjoys physical activities like cycling, or playing basketball, or bowling with friends, he may not be able to do these things at all, or might find himself dealing with even more pain if he tries. But sports aren’t the only hobbies hampered by injury. Imagine that Gary enjoys working on cars as a way to enjoy his free time. If he has a neck or back injury that causes him pain, the last thing he will want to do after a long day of work is to get under the hood of a car. Further, if Gary is unable to spend times taking part in activities with his friends, those friendships may suffer, all because Gary was in a car crash. Even relatively stationary activities like reading a book can be affected if Gary’s neck or back pain make it difficult to sit in one position for an extended period of time.

Now, one may say that it is pessimistic to assume that all of these things will happen to Gary because he got hurt. But ALL of these things don’t necessarily have to happen to one person for that person’s life to be impacted in unexpected ways due to an unexpected injury. Even if just SOME of these things occur, that is enough to change a person’s routine, or make the challenges of daily life more difficult than they were before the injury.

What About Driving Anxiety?

All of these factors can combine with each other to create a profound psychological impact on an injured person, particularly through feelings of anxiety, fear, isolation, anger, or helplessness. Gary, or any other victim of a motor vehicle collision, may experience fear or anxiety related to driving. This can be crippling to a person who has to drive to meet their daily needs, such as going to work, shuttling children around, or running other routine errands. Additionally, a person who curtails their own driving due to fear or anxiety loses the freedom of mobility that comes with driving. This can cause a person to limit their engagement with other people in their lives and potentially grow isolated. Let us assume that Gary had a rich social life before being involved in his collision. If he doesn’t like to drive to different places and if it hurts to take part in physical hobbies, that social life is going to suffer. Through his diminished ability to perform his job, his inability to participate in the lives of his children, and his loss of ability to travel or do the things that he used to do for fun, Gary is left with a much different daily life than the one he enjoyed before. For a relatively young adult in the prime of his life, the feelings of isolation, the lack of control over one’s situation, and the uncertainty about one’s recovery can be overwhelming and debilitating.

Getting Medical Help

It may go without saying, but injuries like Gary’s will probably require some kind of medical treatment in order to resolve. As alluded to above, neck or back injuries from a car crash can be relatively minor, in the case of “soft tissue” whiplash injuries such as sprains. Or the same kind of crash may result in more serious injuries such as a disc herniation or even a fractured vertebrae. More serious injuries like this could even require surgical treatment if more conservative treatment measures turn out not to be successful. Surgery of any kind is risky even under the best of circumstances. Neuro surgery or orthopedic surgery carries with it risk of side effects, potential for failure, or other complications. Some injured people have good health insurance that can help ease the burden of the cost of surgery and follow up care, but other injured people may face the uncertainty of not knowing how such a bill will be paid. Still others may undergo surgery in an emergency setting and then get stuck with a huge medical bill with no way to pay it. Even assuming that a is successful, a person with a serious injury may never fully recover and may be left dealing with the effects of that injury for a life time.

But Why Do Injured People Need Attorneys?

So why do injured people need attorneys? Well, let’s look back at Gary’s case: The insurance company for the vehicle that ran into him wants to close his claim as quickly and as cheaply as possible. Gary is not in a position to truly understand the real value of his claim and the insurance company knows this. That’s why Gary needs an experienced attorney that’s looking out for him. Obtaining representation when you find yourself in Gary’s position is not about taking advantage of anyone or anything. It is about making sure that the insurance company (which makes a profit by finding a way to not pay a fair claim value) does not take advantage of a person who is in a rough spot. That is why it is so important for someone who’s been injured in a car crash, slip and fall, or some other circumstance caused by another’s carelessness, to contact an experienced and knowledgeable personal injury attorney to determine their rights and see if they need an attorney. Make sure you talk to someone who is looking out for you, and willing to go to bat for you when the insurance company tries to play games.

If you are reading this post and you’re lucky enough to have never been injured as the result of someone else’s negligence, I hope this information can give a bit of insight into what it’s like for someone who has had their life disrupted by circumstances outside of their control. If you have been injured in a car crash, a slip and fall, or as the result of another’s carelessness, I hope this has helped you understand why its important to at least consult with an attorney to help understand your rights and what you’re entitled to.