Monday, September 16, 2013

Injured woman in truck accident closes roadways for hours

On behalf of Rubin, Glickman, Steinberg & Gifford, P.C. posted in Truck Accidents on Thursday, September 12, 2013.

"Investigators are still trying to determine what caused a truck accident in King of Prussia, Pennsylvania, that blocked the road for more than four hours. Police said the incident occurred around 6:40 a.m. It was then that an open-topped tractor-trailer carrying scrap metal was headed westbound on the I-76 ramp to U.S. Route 202 and tipped onto the barrier, spilling its load. According to reports, the scrap metal landed on southbound Route 202 and the Gulph Road ramp to the same roadway." Source

"Some of the metal landed on a woman's 2004 Toyota Corolla, trapping her inside the vehicle. The 46-year-old woman from Lansdale, Pennsylvania, suffered serious injuries, and emergency crews had to extricate her from the Toyota. She was taken to Paoli Hospital so that her injuries could be addressed. The 44-year-old driver of the semi suffered minor injuries and did not require hospital attention. All of the aforementioned areas - the westbound I-76 ramp, the Gulph Road ramp to Route 202 and southbound Route 202 - were closed due to the crash. A news outlet had a helicopter on the scene. This allowed them to note that debris was still on the roadway at 8 a.m. Some progress was made by 9 a.m., but the truck was not cleared from the ramp until 10 a.m. This was when traffic began flowing again on the I-76 ramp. The entire scene was cleared and the roads were reopened around 11 a.m." Source



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Injured woman in truck accident closes roadways for hours cont.

A repair truck used in a tram accident
A repair truck used in a tram accident (Photo credit: Wikipedia)
On behalf of Rubin, Glickman, Steinberg & Gifford, P.C. posted in Truck Accidents on Thursday, September 12, 2013.

"Investigators are still trying to determine what caused a truck accident in King of Prussia, Pennsylvania, that blocked the road for more than four hours. Police said the incident occurred around 6:40 a.m. It was then that an open-topped tractor-trailer carrying scrap metal was headed westbound on the I-76 ramp to U.S. Route 202 and tipped onto the barrier, spilling its load. According to reports, the scrap metal landed on southbound Route 202 and the Gulph Road ramp to the same roadway." Source

"Some of the metal landed on a woman's 2004 Toyota Corolla, trapping her inside the vehicle. The 46-year-old woman from Lansdale, Pennsylvania, suffered serious injuries, and emergency crews had to extricate her from the Toyota. She was taken to Paoli Hospital so that her injuries could be addressed. The 44-year-old driver of the semi suffered minor injuries and did not require hospital attention. All of the aforementioned areas - the westbound I-76 ramp, the Gulph Road ramp to Route 202 and southbound Route 202 - were closed due to the crash. A news outlet had a helicopter on the scene. This allowed them to note that debris was still on the roadway at 8 a.m. Some progress was made by 9 a.m., but the truck was not cleared from the ramp until 10 a.m. This was when traffic began flowing again on the I-76 ramp. The entire scene was cleared and the roads were reopened around 11 a.m." Source

"Since authorities have yet to determine the cause of the crash, it is unclear who might be held responsible for the woman's injuries. If the driver is responsible, it is possible that he and his employer will be held accountable. Doing so may require a lawsuit to be filed on behalf of the injured 46-year-old. If her injuries were life-threatening and she passes away, a wrongful death suit may be a viable option." Source

Source: NBC 10 Philadelphia, "Woman Trapped When Truck Spills Metal Onto Her Car" Dan Stamm, Sep. 04, 2013
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Tuesday, September 10, 2013

Neuropsychological Injuries

Nintendo Wii Injury
Nintendo Wii Injury (Photo credit: evansonline)

By 

Obviously, in a personal injury setting, traumatic brain injuries can be some of the biggest damages cases. Proving a traumatic brain injury is many times a complicated matter. Often, the plaintiff may sustain a closed injury that leaves no objective abnormality that can be detected on a diagnostic study such as an MRI or CT scan. In other words, there may not a fractured skull or a bleed on the brain or other similar abnormality, yet the plaintiff and his or her loved one will complain that the plaintiff is just not the same cognitively as before the traumatic event.
SOURCE
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Woah, really? Post-Traumatic Amputations in Diabetic Patients

Ulcus bei Diabetes mellitus
Ulcus bei Diabetes mellitus (Photo credit: rosmary)
Originally posted by Brandon Swartz
An often-encountered scenario in a workers' compensation or personal injury setting involves a diabetic claimant or plaintiff who sustains a blunt-force trauma or laceration injury to his or her foot or a toe. The blunt-force trauma or laceration injury many times begins as a minor trauma and then progresses to pressure necrosis (and ultimately gangrenous changes), osteomyelitis, acute infection and then amputation of the toe or foot.
SOURCE

While this might seem like an obviously causally related condition, the defendant in a personal injury action will almost always dispute causal relationship. In so doing, the defendant will hire a medical expert who will testify that the diabetes is the sole cause of the amputation and that the so-called traumatic event was incidental to any amputation undergone by the claimant or plaintiff. In order to effectively cross-examine the defense medical witness presenting this testimony, there are several important points critical to the plaintiff's arguments.
SOURCE

At the outset, the plaintiff's attorney needs to be aware of certain truths, misconceptions and terminology as they relate to the diabetic plaintiff or claimant. It is true that an individual with diabetes is otherwise susceptible to a difficult recovery from any trauma, especially a trauma to a peripheral body part such as a hand or foot. Any defense medical witness will concede that the medical literature supports this proposition.
SOURCE
This is a picture of my leg taken today showin...
This is a picture of my leg taken today showing a cellulitis infection as well as the oedema in the ankle. Toe amputation was caused by osteomylitis to the bone. (Photo credit: Wikipedia)

With respect to our scenario presented above, despite the diabetic plaintiff's propensity to a difficult recovery, the defense medical examiner will attempt to assert that irrespective of any trauma, the claimant or plaintiff is inevitably susceptible to osteomyelitis (bone infection) resulting in amputation. This assertion is a misconception. There is no medical literature to support the proposition that, absent some triggering event, a diabetic patient holds such susceptibility.
SOURCE

In 1999, a group of doctors published an article titled "Lower Extremity Amputation in Diabetes: The Independent Effects of Peripheral Vascular Disease, Sensory Neuropathy and Foot Ulcers." The article, which appeared in the peer review journal Diabetes Care and is endorsed by the American Diabetes Association, examined the risk factors for lower-extremity amputation in diabetic patients.
SOURCE

While the article did not study trauma and trauma's relation to lower-extremity amputation, it established that diabetic patients are not an amputation waiting to happen as the defense medical examiners would have the fact-finder believe. To the contrary, it is a truth that millions of diabetics live a full life and never experience amputation.
SOURCE

It is true that blood flow is not as great in diabetic patients and that patients with uncontrolled diabetes (high sugar levels) are more susceptible to infection. It is also true that diabetic patients are prone to suffer from peripheral neuropathy (lack of normal sensation in the extremities). While these truths can be framed to benefit either side, generally speaking, if there is credible testimony of the initial trauma, these truths will benefits the claimant or plaintiff's forensic causation analysis.
SOURCE

With respect to terminology, often-used terms in this setting include fibrosis, pedal pulses, diminished sensation, pressure necrosis and osteomyelitis. Fibrosis is the reaction of cells to the healing process. In the trauma setting, it is commonly interchanged with scarring. Pedal pulses is essentially taking the pulse at the area of the foot and ankle rather than at the area of the hand and wrist, as typically seen in television shows. Diminished sensation is lack of normal sensation in the extremities, commonly characterized as the peripheral neuropathy referenced earlier.
SOURCE

The most important term to understand is osteomyelitis or, in this circumstance, acute osteomyelitis. Acute osteomyelitis is the clinical term for a new infection in bone. Many times the defendant will focus on medical literature that suggests that diabetic patients can come about this infection hematogenously through a problem with the blood. While this is true, particularly in children, in adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue. The plaintiff's attorney needs to learn the three common ways osteomyelitis occurs and be able to argue the predominance of osteomyelitis in the post-traumatic setting. The plaintiff's attorney also needs to be able to counter the argument that a blunt trauma, which does not break the skin, is not sufficient to cause osteomyelitis. This is simply not true. A bruise is by nature bleeding — it is just bleeding under the skin, so a laceration is not necessary to make the causal connection. For a more complete understanding of the terminology, I recommend an article that appeared in one of the Oxford medical journals titled "Controversies in Diagnosing and Managing Osteomyelitis of the Foot in Diabetes."
SOURCE

Another aspect to our common scenario that I mentioned earlier is that the plaintiff's pain is many times not severe in the early stages and the plaintiff will even try to walk it off. Under this scenario, the plaintiff experiences a gradual increase in his or her symptoms, developing sometimes days or weeks after the initial trauma. When encountering that scenario, it is critical to stress that in the setting of sensory neuropathy, there is diminished perception of pain and temperature; thus, many patients are slow to recognize the presence of an injury to their feet. 
SOURCE

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Unemployment Benefits For Novices

English: Los Angeles California ice cream deli...
English: Los Angeles California ice cream delivery trucks equipped with new Hand Truck Sentry System for route deliveries. The New invention saves fuel, labor costs and cold temperature. The new HTS Ultra-Rack also reduces highway accidents, workers compensation injuries and freight claims damage. (Photo credit: Wikipedia)
A slate saw - geograph.org.uk - 286201
A slate saw - geograph.org.uk - 286201 (Photo credit: Wikipedia)
An employee’s first response to termination is generally panic, which is understandable. It helps to know that although it does not fully compensate an employee for his or her losses from termination, the Division of Labor and Workforce Development’s Unemployment Insurance benefits program does provide some relief to unemployed workers—generally sixty percent (60%) of the employee’s former salary.
SOURCE

The unemployment insurance benefit system was put into place as a “safety net” for employees. Unemployment was not instituted to provide benefits only to those terminated despite the fact that they were doing a “good job” at work, but also those who had job performance problems. Therefore, since poor performance is not a reason to deprive an employee of unemployment benefits, there are few reasons for which an employee will be denied unemployment insurance benefits.
SOURCE

Initially, however, an employee must be terminated and not resign from employment in order to receive unemployment insurance. The only situation in which an employee can resign and still receive benefits is when he or she can claim that the resignation is due to “good cause attributable to the work.” Under N.J.S.A. 43:21-5(a) and N.J.A.C. 12:17-9.1(a), an individual is not eligible for unemployment benefits if he or she voluntarily leaves work "without good cause attributable to such work." N.J.A.C. 12:17-9.1(b) defines "good cause attributable to such work" as "a reason related directly to the individual's employment, which was so compelling as to give the individual no choice but to leave the employment." “Good cause” can also include harassment or discrimination at the workplace which makes the workplace intolerable.
SOURCE

In addition to having resigned, an employee is disqualified from receiving unemployment benefits if he or she has committed simple misconduct or gross misconduct. Generally, simple misconduct is an action at the job which violates a policy or procedure of the employer and disqualifies the employee for unemployment for seven (7) weeks. Simple misconduct can include such infractions as reporting late to work, not following a work rule or other minor violations of the employer’s policies. Gross misconduct is much more severe and may even rise to the level of a crime. This can include employee wrongdoing such as stealing, embezzling, falsifying time sheets or other more major infractions of the employer’s work rules. If an employee is found by an unemployment examiner to have committed gross misconduct, the employee will not receive unemployment benefits at all until the employee has worked a certain amount of time in another job.
SOURCE

The unemployment system has various levels, providing several chances for appeal. At the first level an unemployment examiner will initially determine if an employee receives unemployment through a telephone interview with both parties. The employee should be prepared to provide basic information about his or her job to the examiner, including salary information, last day of work, an explanation of the employee’s job duties and the reason that the employer told the employee he or she was terminated. If the employee believes that the employer falsified its reason for terminating him or her, the employee should also be able to provide an explanation as to what the employee believes is the real or alternative reason for his or her firing. The employer is also allowed an opportunity to explain the reasons for termination.
SOURCE

After the hearing examiner decides whether the employee receives unemployment, the employee will be notified of the determination within a very short period of time, usually within a week after the initial hearing. The employee then has seven days from receipt of the unemployment decision letter or ten days from the date of that letter to appeal to the next level, the Appeals Tribunal, which hearing is also generally held via telephone. The Appeals Tribunal is misnamed because it only consists of one examiner, although in the past it consisted of three. In order to receive an appeal, the employee must be able to show that the initial unemployment examiner overlooked some piece of evidence that was important or did not credit some testimony that was important in the original hearing and/or that there is new information not available during the initial hearing that is relevant to the claim.
SOURCE

The final level of review, which has the same appeal time requirements, is the Board of Review. The Board of Review may hear the case telephonically or in some instances, in person. The same prerequisites for granting an appeal also apply at this level. At each level it is more unlikely for the unemployment determination to be reversed, so it is important to initially present your claim in the best way possible.
SOURCE

After the Board of Review level, the unemployment benefits claim can be appealed to the Appellate Division of the Superior Court. The Appellate Division reviews the unemployment decision and determines whether it was decided on an arbitrary and capricious basis. This is an extremely high standard for either party to meet; it’s equivalent to being able to show that the prior examiners decided the unemployment benefits determination based on the flip of a coin. Thus, there are few unemployment decisions which are overturned by the Appellate Division. There are also not very many which go to the Appellate Division because of the difficulty in obtaining a finding of “arbitrary and capricious.”
SOURCE

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