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Most head injuries are minor. The skull provides the brain with considerable protection from injury. Most head injuries are mild, but a head injury may be a serious problem when it occurs. Accidents are the leading cause of death or disability of men under age 35, and over 70% of accidents involve head injuries and/or spinal cord injuries. Common causes of head injury include traffic accidents, industrial/occupational accidents, falls, physical assault, and accidents in the home.

Traumatic brain injury is a serious and debilitating injury. Persons with a severe brain injury often have problems with mental and physical functioning, and may require on-going supervision and assistance, as a result of post concussion syndrome. Even a person who has suffered a head or brain injury, with little or no documented loss of consciousness, may have permanent deficits which make it impossible for them to return to their previous lifestyle and sphere of activities.

I. INTRODUCTION

A. General Types of Head Injuries
B. Head Injury problems
C.  Treatment
D.  Choosing a Traumatic Brain Injury Lawyer

II. REHABILITATION TEAM

  1. The Case Manager
  2. The Physiatrist
  3. The Neuropsychologist
  4. The Rehabilitation Specialist
  5. The Economist

I.  INTRODUCTION

While traumatic brain injury is certainly nothing new, it has only been in the past few years that the professional rehabilitation community has been able to make significant strides in the rehabilitation of these victims. Based on studies, it is likely that the annual incidents of new head injuries treated in hospitals are 400 per 100,000 patients treated. It is now estimated (Center for Disease Control) that there are 5.3 million children and adults living with the consequences of sustaining a traumatic brain injury in the United States. This represents about 2% of the population.
An estimated 2 million people receive a traumatic brain injury each year. An estimated 1 million are treated and released from hospital emergency departments and each year 230,000 Americans are hospitalized as a result of traumatic brain injury. Every year 80,000 Americans experience the onset of long-term disability as a result of sustaining traumatic brain injury. More than 50,000 people die each year as a result of traumatic brain injury. Vehicle accidents are the leading cause of brain injury. Falls are the second leading cause, and are the leading cause of brain injury in the elderly.
A. General Types of Head Injuries
There are two major types of head injuries — (1) an open head injury which is the result of a penetrating wound; and (2) the closed head injury. A penetrating injury is best exemplified by a gun shot wound, in which the scalp is penetrated and brain damage created where the bullet actually moved through brain tissue. A closed head injury is one which usually results from blunt trauma to the head, typically in a motor vehicle accident. Acceleration and deceleration forces cause the brain to rotate in the skull. As a result of this, maximum pressure is exerted on the frontal and temporal regions resulting in sheering and extensive white matter damage. In a closed head injury, brain damage over a large area often results in a great variety of deficits including loss of consciousness, problems in attention and memory, and alterations in social behavior. Extensive research has confirmed that it can be very difficult for head injury victims to return to normal family or community life.
B. Head Injury Effects
To appreciate the effects of traumatic brain injury; one must understand the individual and the symptomatic disorders. Problems can include attention and arousal disorders, communication and language difficulties, loss of memory, diminished ability to learn, visual and auditory perception, hampered information processing, reasoning, judgment and problem solving. It is not unusual for a person who suffers a traumatic brain injury to recover the ability to communicate and interact with other individuals, thus disguising these deficits to the casual observer. Only when detailed studies are completed and careful observation has been made in the home or rehabilitation center are these disabling consequences apparent.
C. Treatment
Immediately post-accident, the plaintiff is normally treated in a hospital setting. The head injury usually involves treatment by a neurologist; when organic damage is present it will require treatment by a neurosurgeon. At the outset, the victim in addition to normal medical treatment will normally receive an evaluation, both physical and psychological, by a physiatrist (a physician specializing in physical medicine). Post-discharge treatment is usually resumed in a rehabilitation center where the physiatrist supervises treatment. Usually a number of therapies will be involved in the rehabilitation including a physical therapist, an occupational therapist, a visual therapist, a specialist in cognitive remediation. These stays are lengthy, painful and expensive.D. Choosing a Traumatic Brain Injury Lawyer
It is at this stage that the injured victim usually seeks the help of counsel. The sad truth is, however, that all lawyers are not created equal. It is a very sad fact of traumatic brain injury life that many survivors will not receive adequate recompense for their injury because their lawyer did not have enough experience to know how to analyze, prepare and present a legitimate claim for damages. Many times, the blame is directly traceable to the attorney who is not forthright in the first place regarding his/her lack of experience handling cases involving traumatic brain injury. Time after time the inadequate result rests with the attorney who did not understand the seriousness of the injury simply because of its “invisible” nature.
Unfortunately, even where an injured victim has overcome denial, and has further overcome the social stigmas associated with bringing a lawsuit, s/he may nonetheless experience further “hurt” due to an association with a lawyer having no idea how to properly present claims involving traumatic brain injury. BEWARE: EDUCATION, TRAINING AND EXPERIENCE VARY BETWEEN LAWYERS.
We at Riordan Law Group are committed to handling claims of individuals sustaining traumatic brain injury (TBI). We are committed to spending the time with you and your family members to gain a deep understanding for each and every way the injury has affected your life. We are committed to spend the necessary time in order you understand your rights in the progress of your case. Our staff is committed to trying to make your life easier, and we will endeavor to put you in contact with support groups and treating doctors as your case may require.
Given the importance of your choice of counsel, you should be prepared to meaningfully question prospective lawyers in order to ascertain his or her qualifications to handle your case. For example, you should determine how many TBI cases that lawyer have been involved in as principal attorney during the last three to five years. You should determine what percentage of the lawyer’s practice is devoted to cases involving TBI. You should not hesitate to inquire of the settlements/verdicts obtained by the lawyer on TBI cases. (This should be done with a recognition that every case is different.)
You want to make sure that the lawyer is current. In this regard, ask the lawyer how many seminars or conferences s/he has attended over the past several years involving TBI issues. Review that lawyer’s website, or ask the lawyer to provide you with any articles written over the past three years involving any aspect of TBI.
You are about to embark on one of the most important decisions of your life, to wit: The choice of the right lawyer to represent you. You are armed with a powerful tool, the Contingency Fee Agreement. This Agreement allows you to retain experienced counsel without having to pay hundreds of dollars per hour up front. Please, do not make your decision cavalierly. Ensure that you are comfortable with the counsel of your choice. Ensure that counsel has the confidence and experience to properly handle your case. The path is a difficult one, and the choice of counsel can make all the difference in the world.
In almost every case, relatives are overwhelmed when they envision the costs of caring for the injured victim, particularly when it appears to be a life-long disability. This excites an awareness of the immensity of financial problems facing the victim and/or his family over the rest of his life expectancy.
As lawyers, we must first address the fact that a major head injury case is going to call for a set of special experts in a narrow field of diagnosis and treatment for this devastating injury. The lawyer at this point will be aware of the involvement of a neurologist and/or a neurosurgeon, as well as a physiatrist and other specialists in therapeutic medicines. At this juncture, counsel is confronted with medical terms and professional disciplines which are completely unfamiliar. By now counsel has become acutely aware that the injured victim’s one chance of useful return to the community and family depends upon the type of treatment he gets. Most often treatment is totally dependent upon the amount of money which is made available. Obviously, the lawyer’s responsibility in these cases is most serious and demands preparation and organization of the case in a thoughtful and orderly manner, if the victim is to obtain sufficient compensation to allow him to maximum rehabilitation.

II. REHABILITATION TEAM

A. The Case Manager
A case manager is required in any serious brain injury case. The case manager helps to assure quality care and cost effectiveness. He is an absolute necessity for the proper organization and evaluation of the case. The case manager is simply a person who is a health professional and who can coordinate the activities of the victim’s rehabilitation. He or she will also advise the lawyer as to the treatments and the various options opened to the injured victim, act as a communicator between the lawyer, the client and the health professional, and act as an advocate for the injured victim with respect to the various health care providers.
A case manager should be a health care professional, primarily either a Rehabilitation Specialist, a Physiatrist, or a nurse trained in head trauma. Experience has taught us that a nurse who is well trained in the area probably is easiest to work with, as well as the least expensive burden.
The case manager carries out the day-by-day details seeing that the rehabilitation program goes smoothly, seeing that the funds from insurance companies and state catastrophe funds are properly allocated and on time. It is easier for someone in the medical profession than for lawyers to make contact with physicians or of the other health care providers in getting appointments, opinions, in advising as to progress, treatment and in what improvements could be made all along the way. The case manager is constantly at the lawyer’s side. Perhaps most importantly, the case manager is instrumental in helping the lawyer assemble the damages component of the victim’s case and the team of professionals that goes with it.
B. The Physiatrist
Obviously, the damage assessment team will consist in part of the medical doctors who first examined and treated the patient at the hospital immediately following the injury. Through these medical experts, the physical injury to the brain itself will be described and diagnosed. Since serious brain injury involves lengthy periods of treatment in order to bring about some form of rehabilitation, a physiatrist will already have become a part of the team; have been instrumental in treating the victim through the hospital and post-hospital recovery period.
Specializing in physical medicine, the physiatrist will continue to direct treatment to the patient as he undergoes various therapies. It is the testimony of this expert, the physiatrist, which will demonstrate the basis from which the other experts will testify. Necessarily, he or she will demonstrate, to a reasonable degree of medical certainty, what the plaintiff’s damages are and what the extent of his recovery is. It is noteworthy that that communication between counsel and the physiatrist as well as the therapists who carry out his or her orders should be and will be maintained by the case manager, who is constantly meeting with all parties, constantly reporting to the lawyer.
C. The Neurophysiologist
The treatment of the brain injured victim immediately brings into play the opinions and expertise of the neurosurgeon or the neurologist. In the case of a serious brain injury it is absolutely necessary that a neuropsychologist be retained, particularly where the victim exhibits gross mannerisms or other abnormalities which are not apparent at first blush.
1. Neuropsychology defined
There is a distinction between a neuropsychologist and a neurologist or neurosurgeon. Neurologists and neurosurgeons treat victims based on signs of brain dysfunction including changes in motor and reflex function, sensory deficits, alternation and basic arousal and frank aphasic disorders of speech and language. A neuropsychologist provides a comprehensive evaluation of the integrity of the higher brain functions including intellect, problem solving capacity, capacity for memory and new learning and other relevant capabilities.
Neuropsychologists are psychologists who have received their training, developed skills and accumulated experience in the study of these brain behavior relationships.
Neuropsychology uses a series of tests and techniques which have been developed over a period of time to validly and reliably differentiate persons without brain damage from persons who do have brain damage in one of its many forms. Tests are so refined that they determine where in the brain such injury has occurred, and monitor the severity of the brain damage while demonstrating what type of lesion process caused the brain injury. Information which is gleaned from this testing is utilized to determine the structure of the relative brain behavior strength and the deficits characterizing such brain injured individual.
2. Choosing a neuropsychologist
Often it falls to the lawyer to make a determination as to what neuropsychologist should be retained. The lawyer has to consider the estimation of relative skill level of various neuropsychologists, and then is best practically achieved by talking to other lawyers with experience in the area. Among the qualifications of a neuropsychologist is the quality of his or her prior reports and testimony. Certification or diplomat status with awarding organizations including the American Board of Professional Psychology, the American Board of Clinical Neuropsychology and the American Board of Professional Psychology are important. Experience is the most important barometer of the qualifications for the neuropsychologist you choose.
In selecting a neuropsychologist, a lawyer must evaluate the neuropsychologist as a witness, making a continuing assessment as to what effect that will have on the outcome of the case.
3. The neuropsychological report
Most important to the purpose of the trial attorney is the neuropsychological report. This is a communication of findings of examination and should be written in a clear manner and not with technical language. This information is vital in determining the damages of future care needs and costs. It is also the most important key to settlement.
A neuropsychologist who makes an assessment in cases such as this will utilize standard testing methods to identify specific and general cognitive and perceptual motor abilities and deficits with an eye toward defining problems. This extensive testing procedure can identify cognitive and behavioral deficits and localize the hemisphere or lobe that is involved. A neuropsychological assessment is to identify the function of the brain that requires rehabilitation as well as those that are not impaired.
A neuropsychological assessment is a critical part of the total evaluation of the injured victim. It is a lengthy and difficult process. The assessment usually covers a period lasting from 4-7 hours, often longer. Lawyers should be aware that this is a costly affair, not always depending on the number of hours involved.
D. The Rehabilitation Specialist
In recent years, significant breakthroughs have been made in rehabilitative techniques for persons with brain injury. Research in the area of brain injury is being conducted in many centers throughout the United States. Although the state of rehabilitative care for such persons is still in its infancy, effective treatment is available. Persons who specialize in individual rehabilitation and habilitation to maximize human potential are called rehabilitation specialists.
1. The life care plan
Based on reports, which are provided by experts including the physiatrist and the neuropsychologist, a rehabilitation specialist is able to furnish a background report utilizing the education and training of the injured victim which can plan a rehabilitation program covering the remainder of the disability of the individual. The plan, formulated by the rehabilitation specialist, recommends the correct diagnostic tools and the appropriate treatment modalities. This plan also enters a long term perspective for the individual and develops appropriate goals as to the patient’s functions and his or her quality of life and the economics involved. Essentially for the lawyer, the rehabilitation specialist provides a report which includes a number of features which can be used at trial in order to determine the economic needs of the injured victim as he proceeds through life.
2. Elements of the life care plan
In the report, the rehabilitation specialist will emphasize the following:
(a) vocational handicaps and potentials
(b) wage loss
(c) medical and therapeutic evaluations
(d) medical and therapeutic treatments
(e) home care v. facility care
(f) home modification
(g) equipment needed for rehabilitation
(h) future surgery
(i) future complications
(j) personal items
(k) recreation and leisure times needs
(l) medications
This will usually include a cost of item analysis, showing dramatically what the needs of the injured victim are during the recovery stages. To the lawyer this is an exciting development in that there exists a witness who will lay out the day by day needs of the injured victim throughout his or her future. In addition, the rehabilitation specialist provides guidance and expertise in fitting the injured victim into a program which will accelerate his recovery and return to home family and the community.
E. The Economist
The last expert who should be retained on behalf of the plaintiff in a major brain injury case is an economist who specializes in cases involving brain damage. Using a rehabilitation expert’s report as a basis, this expert can reduce the whole cost process to a set of figures easily translatable to a jury’s verdict. This is a must if the jury is to move through the maze of treatment and costs involved in arriving at a verdict. Only the economist can finally arrive at a lump sum value of what the case is worth.
We at Riordan Law Group are committed to handling claims of individuals sustaining traumatic brain injury (TBI). We are committed to spending the time with you and your family members to gain a deep understanding for each and every way the injury has affected your life. We are committed to spend the necessary time in order you understand your rights in the progress of your case. Our staff is committed to trying to make your life easier, and we will endeavor to put you in contact with support groups and treating doctors as your case may require. For a free claim evaluation and discussion of your concerns.

Riordan Law Group
charges clients of personal injury claims on a contingency basis. What that means is the attorney is only paid if he or she wins money damages for you – the client. This makes it possible for anyone to hire only the best lawyer. It gives everyone access to the justice system and representation that is equal to the best that insurance company’s, doctors and other defendants can hire.  Contact us today to discuss your legal options with our lawyers. 1-800-825-0157 or outside Massachusetts, 508-588-5562, email: Riordanlawgroup@verizon.net