What is a Peer Review and why isn’t my Auto Insurance paying my Medical Bills?

Peer Review of Medical Bills under Act 6What is a Peer Review?

In Pennsylvania, your automobile insurance provides medical coverage to pay your medical bills for medical treatment for injuries sustained in car accidents. Generally, your car insurance company is obligated to pay all bills for treatment which is reasonable and necessary. It is not necessary that you get pre-authorization for treatment. It is your carrier’s responsibility to object to bills it considers unreasonable or unnecessary. Medical bills which are not paid within 30 days are subject to penalties under the Motor Vehicle Financial Responsibility Law (MVFRL). When an auto insurance company wishes to contest the bills submitted by treatment providers, it will send them out for a Peer Review.

An insurance carrier can challenge bills by Peer Review for up to 90 days prior to the challenge. The regulations require that the carrier send the challenged bills with supportive records to an authorized PRO (Peer Review Organization). This is an entity which has been approved by the Insurance Commissioner for this purpose. Bills which deal with particular treatment can only be peer reviewed by an entity in the same specialty. For instance, chiropractic bills can only be reviewed by a chiropractor. The peer reviewer does not see the patient for an examination. His job is to simply review the records and bills, and in accordance with accepted norms and guidelines, render an opinion as to whether treatment is reasonable and necessary. The reviewer does not even have to contact your doctor.

What should I do after a Peer Review?

Over 80% of Peer Reviews are unfavorable, in whole or in part to the patient. If your bills are peer reviewed, and the review is unfavorable, the report will advise you as to your appeal rights. Probably the worst strategy is to appeal an unfavorable Peer Review. Reconsiderations of peer reviews are also over 80% unfavorable to insureds and the loser of the appeal has to pay the fees (usually $450.00-$500.00). Insureds also have the right to file suit against their own insurance company immediately. There are numerous regulations which have been promulgated to protect insureds. Many of these are ignored or abused by carriers.

Do I need a lawyer if my bills have been the subject of a Peer Review?

To protect your rights in an automobile accident claim, it is always prudent to hire a lawyer as soon as possible after you have been involved in an accident. It is even more important to seek and retain counsel whenever an insured receives notice that his/her bills are being peer reviewed. Failing to challenge your carrier for refusal to pay appropriate bills can affect your treatment and affect your claim against the at-fault driver. Call our office today for a free consultation.

No Recovery, No Fee Lawyers in Erie, PA: What does “Contingent Fee” Mean?

No Recovery No Fee Lawyer in Erie PAHow do I find a lawyer in Erie that charges no fee unless they settle my case?

When watching TV, you’ll see that many lawyers advertise No recovery, No Fee payment structures, wherein the lawyer won’t charge a fee for your personal injury case unless he or she gets you money by way of a lump-sum settlement or a verdict. During our free consultations, this is often the first question we get when meeting with a new client. Like all personal injury law firms in Erie, PA, we do not charge a fee unless we obtain a recovery for our client.

What is a contingent fee?

This sort of “no recovery no fee” arrangement is referred to as a “contingent fee,” and it is the standard practice for nearly all attorneys in Erie, PA that handle car accidents and other personal injury claims. When you see some of the heavy-advertisers focus on this structure in their commercials, don’t be fooled into thinking they’re the only ones that don’t charge hourly fees and don’t charge big retainers; they’re simply the only ones that shout about it on television. Knowing that this is standard practice for nearly all lawyers, you’re free to do your research and pick the best attorney for you without having to worry about draining your savings account.

Are contingent fees fair? Should I pay hourly instead?

Contingent no-recovery-no-fee arrangements give great power to personal injury victims who are looking for a lawyer: instead of being stuck with the cheapest option out there and operating on a shoestring budget, he or she can hire the best attorney in Erie to fight the insurance company on his or her behalf. Insurance companies hate paying out a fair value for claims and hire good lawyers to help minimize their exposure: our contingent-fee arrangements allow you to even the playing field and fight for fair compensation.

Who pays for the expenses in a lawsuit?

In addition to charging no fee unless we obtain a recovery, our firm also fronts all litigation expenses: what this means is that you don’t have to worry about coming up with thousands of dollars for expert reports, medical depositions, records, expert witnesses, et cetera. Because insurance companies spare no expense when it comes to building their case, we front the money for whatever it takes to prove the significance and extent of your injuries. Our firm doesn’t let insurance companies win by simply outspending us. We ensure things are fair.

What should I do?

If you have been injured in a car accident or have a workers’ compensation claim, don’t think that you can’t afford a good lawyer. Give our Erie, PA Lawyers a call and we’ll arrange a free consultation. If, after meeting us, you want to move forward—feel safe knowing that we don’t charge a fee unless there’s a recovery.

Who pays your medical bills after a car accident in Pennsylvania?

Who pays for my medical bills after a car accident in Pennsylvania?

car accidentOne of the things that most people find surprising if they have never been in an auto accident is that the guy who ran the red light may not be responsible for their medical bills. at least not initially  Nonetheless, the above statement is true because Pennsylvania, like many of the states, has adopted a no-fault automobile insurance system.

The system mandates that auto insurance policies provide certain mandatory coverage offerings.  Those required coverages include:

  1. Medical coverage;
  2. Income loss benefits;
  3. Funeral expenses; and
  4. Death benefits.

These coverages are required offerings, but it is not required that the insured actually purchase that coverage on his or her policy.  Many people have health insurance and disability coverage through their employment, so they minimize or reject any required coverages in an effort to be economical and save costs.  In Pennsylvania, it is only required that there be at least $5,000.00 in medical coverage issued under the policy.  You can select the amount of coverage you are willing to purchase.  Additional policy amounts are typically $10,000.00, $15,000.00, $25,000.00, $50,000.00 or $100,000.00.  There is even a separate catastrophic loss coverage that adds $1,000,000.00 in medical benefits.  If you have good health insurance, should you purchase more coverage than the required minimum?

How much insurance should I buy?

First of all, the cost of increasing the coverage amount is usually very affordable.  I never recommend that a client spend all of their extra money on insurance, however, it is wise to carry more than the minimum coverage.  Health insurance plans typically have “subrogation” rights (this is the right to participate in any third-party recovery and it could have very serious ramifications for you).  I usually recommend a higher amount if it is within your budget.

Income loss benefits are also extremely important, however, it is not mandatory that an insured pay for same and include them on his or her policy.  Many people do not include these benefits because they are unaware of the coverage or because they have disability benefits through their employer.

Frequently, an accident will disable a person and he or she becomes unable to work for an extended period of time.  If you don’t have income loss benefits, you will be dependent upon your savings, disability insurance payments or a spouse’s earnings.  Thus, it is wise to carry this coverage.  The minimum amount is $5,000.00, but it usually can also be obtained for $15,000.00, $25,000.00 or $50,000.00.  Additionally, this coverage is some of the most economical coverage available for purchase.  You should purchase enough so that you can rely on the coverage to support your household if you are unable to work for an extended period of time.

These coverages are payable by your insurance company regardless of whether an accident is entirely your fault or the fault of another party up.  If the accident is the fault of another, you can recover losses in excess of your coverage amounts in a 3rd party action.

Frequently, insureds get into fights with their own insurance company regarding payment of ongoing medical expense or income loss benefits.

If you are told your insurance company is not going to pay for your medical bills and/or your income loss, you should contact an attorney as soon as possible.

What should I do if I injure my neck and back in a car accident

What should I do if I injured my neck and back in a car accident?

Neck and Back Pain after a Car AccidentInjuring your neck and back in a car accident can be devastating. Although neck and back injuries are the most common injuries after a crash, they can be the hardest to prove and the hardest for which to get fair settlements from the insurance company. Your claim will be denied because it’s preexisting, because you can’t prove it’s related, or because you have “limited tort.” If you’ve injured your neck and back in a car accident, here’s how to maximize your settlement:

Make sure the paramedics and emergency room doctors know if you’re experiencing neck and back pain.

The human neck and back are fragile, so it’s no surprise that neck and back injuries are often pre-existing (to some extent) and have causes other than car accidents. That’s why, after a car wreck, if your neck and back are in pain, it’s important that you tell your doctor! If an ambulance responds to your accident, be sure to let the paramedics know your neck and back are hurting if they’re in pain—don’t assume it’s temporary! It’s common for insurance adjusters to deny claims for neck and back injuries because the pain wasn’t immediately reported to paramedics or emergency room staff!

If your neck and back don’t start hurting until a few days after the car accident, make an appointment with a doctor or a chiropractor

It’s common for neck and back pain to start several days after a collision. Unfortunately, what ends up happening is that, once the pain starts, many people don’t start treating until months later when the pain doesn’t get better on its own. If your injury ends up being more serious than the sprain/strain you thought it was, the insurance company will say that this “treatment gap” indicates you must have hurt your neck and back somewhere else—not in the car accident! Without any doctor having seen you for months, it’s almost impossible to prove you actually hurt your neck and back in the accident. If your neck and back start hurting a few days later, make an appointment with your family doctor or chiropractor to get things looked at. In Pennsylvania, your car insurance is required to pay for medical treatment related to the accident; most people have at least $5,000.00 in medical coverage for accident related treatment (which includes chiropractors!).

How do I make the insurance company pay fair settlement value for my neck and back injury?

How to get the insurance company to pay you a fair settlement for your neck and back injury is a simple answer: get a lawyer. Because you do not have the ability to file a lawsuit and work your case up properly, the insurance adjuster will not pay you fair value for your neck and back injury. They know that, whatever they offer, you have no choice but to take it. Call our Erie, PA car accident lawyers for a free consultation; if we don’t think we can get you a better offer and more than pay for ourselves, we’ll let you know.

What happens when both drivers in a car accident are insured with the same insurance company?

What do I do after a car accident if the other driver uses the same insurance company as me?

Car Insurance PaperworkBoth drivers in a car accident being insured with the same company is not as uncommon a situation as one might expect.  In Erie, Pennsylvania, there are several large companies which have significant shares of the insurance market.  Hence, it is not that unusual for the same car insurance company to provide insurance coverage to both vehicles in a two-car accident.  How does that change the normal policy processing of the claims?

Auto Insurance carriers are sensitive to the pitfalls in this scenario.  An insurance company contractually owes a fiduciary obligation to protect its insured.  A fiduciary obligation is an extremely high duty of good faith and loyalty and it is one of the highest duties under the law.  This creates difficult conflicts where an insurer insures both parties in an accident.  After all, if the situation is contested, and it takes the position of one insured, it usually damages the interests of the other insured.

In these situations, it is extremely important to document everything.  The insurer will assign separate adjusters to handle the claims of each insured and those files are supposed to be maintained separately from access by the opposing adjuster.  In a disputed accident, the carrier will frequently refer the matter to an independent arbitrator to determine fault.  That is not a perfect system, though, because the arbitrator’s decision will be based upon the evidence submitted.  Keep in mind that while the arbitration can prove helpful, it does not absolutely bind the insured.  Hence, even if an insured is determined to be at fault, he or she could still have rights to sue.  Eventual success may depend upon carefully documenting the situation.

The scenario can be extremely confusing for the typical client.  I had a case a few years back where a client was rear-ended by another vehicle and both vehicles were insured by “A” Insurance.  An adjuster was assigned and contacted the client after her release from a hospital.  He arrived at her house, took a recorded statement and offered her “gas money” to help her with the expenses of treatment.  She signed a “receipt” on a clipboard and when she contacted the adjuster a month later after a week in a hospital to seek additional funds, she was advised she had settled the claim.  After contacting us, we discovered the adjuster had never disclosed he was the “enemy” adjuster for the other driver.  He had tricked her into settling her claim for a pittance.  She had assumed he was her adjuster.  We demanded the release be set aside and that request was refused.  The events precipitated several years of litigation that resulted in a significant recovery for our client, but the situation could have been averted by contacting counsel at a much earlier stage of the controversy.  If you are involved in such a situation, be sure to get a lawyer as soon as possible.

My Insurance Claim was Denied for a Pre-Existing Condition

You are entitled to compensation for aggravations to your pre-existing conditions

Pre-existing conditions are the most common excuses given for insurance claim denials. Whenever you make a claim for injuries after an auto accident, a slip-and-fall, or a workers’ compensation injury, the first thing an adjuster will do is request an authorization to get your medical records. What the adjuster doesn’t tell you is that he or she will use this authorization to obtain years of family doctor records to go on a “fishing expedition” for pre-existing conditions. This is just one reason that you should never sign anything without talking to a lawyer first—the insurance company isn’t entitled to all of your records! Even though the new injury made your pre-existing condition worse, the insurance company will then deny your claim as pre-existing.

Pre-Existing Conditions are Not a Valid Reason to Deny Your Insurance Claim

In Pennsylvania, in both personal injury cases and workers’ compensation cases, the insurance company is liable for aggravations to your pre-existing conditions! Don’t let them tell you otherwise. Regardless of any old injuries, if your injury was made worse—you’re entitled to compensation for the worsening.

Can I win my case if I have a pre-existing bad back?

Pre-existing back painDon’t be fooled: most people injured in car accidents or hurt at work have pre-existing conditions. The fact of the matter is that some people are more susceptible to certain types of injuries—particularly back injuries. It might be because of genetics or it might be because you work a heavy duty job that takes a toll on your back. Fortunately, Pennsylvania Courts have long recognized the “eggshell skull” doctrine, which allows compensation for injuries regardless of how predisposed a person might have been. After all, if not for this injury, your problem wouldn’t be so bad or wouldn’t have occurred at all.

What should I do if I have a pre-existing condition and was hurt in an accident?

Although Pennsylvania law allows compensation for aggravations of pre-existing conditions, the insurance company will still use it as a defense. That’s why it’s so important to hire a lawyer as early as possible—before the insurance company gets all the ammunition they need to defend against your case. Our firm has successfully represented a number of individuals whose claims were denied because of their pre-existing conditions. Call our Erie, PA lawyers today for a free consultation and case review and we’ll let you know if we can help.

Do I need a lawyer if the insurance company offered me a settlement?

Do I need a lawyer if the insurance company is offering me a settlement?

Why do I need a lawyer?Let me answer that question with a question: Would you perform surgery on yourself? Settlement of a legal claim is a serious matter. It usually pays to have help from an expert; a review of your case by our firm is free.

Insurance companies usually want to settle quickly. The reason for this is they know that, in some cases, injuries become more serious over time. There are many examples of this. One known medical phenomenon is the masking of pain in one area of your body due to an injury in another. For example, you may have hurt both your neck and a knee in an automobile collision. The knee pain might be so severe that you don’t realize that you also hurt your neck until the knee pain subsides weeks, or even months, following the injury. We have had several cases of minor head trauma which, quite some time following the injury, turned out to have aggravated an aneurysm.

If you settle your case before the full extent of your injury is known, there is likely nothing that can be done for you if additional injuries are later discovered. In one notable case, we represented a client whose head trauma did indeed result in a ruptured aneurysm. However, when we contacted the insurance company, we found out that our client neglected to tell us that he signed a general release shortly after the accident for one hundred dollars. He gave up what was likely a six figure settlement for less than the cost of a week’s groceries.

Is it too late to get a lawyer if I already signed a release?

Please note that Pennsylvania law does impose some restrictions as to when and where a general release may be signed. In very rare instances, it may be possible to set aside a release that a client has signed, but this is unusual indeed. If you have signed a release while in the hospital, within 15 days of your injury, or while incapacitated in some fashion, please contact us to review the circumstances of your case.

Can a lawyer get me a bigger settlement?

The most important reason, however, for having legal representation is to make certain that you receive an adequate settlement. We often meet with clients who have received an offer from an insurance company. Occasionally a fair offer is made and we will tell you if we don’t think we can improve upon it. However, it has been our experience that even after payment of legal fees, the net amount that the client receives is usually greater than what the insurance company had offered. Often the net result to the client is substantially better, even after payment of legal fees. So in effect the client has the benefit of having a lawyer and it effectively costs nothing in circumstances where the net result is better than the insurance company’s offer.

Why is this true? You don’t need to accept our experience alone. Let me quote from a book that is little known outside the insurance industry. It is called An Introduction to Liability Claims Adjusting by Corydont Jons. This is a book that has been used in training courses for insurance adjusters. Let me quote from the text:

If you have offered everything the case is worth, there is no more to offer. The case has no increase in value simply because an attorney has been engaged. Therefore, the widely recognized principal: “Never spend your top dollar until you think you can buy something with it.” This dictates caution and restraint in one’s final offer to a claimant.

The author is correct that merely because you have a lawyer your case is not made more valuable. However, insurance companies recognize that when they make an offer, the person receiving the offer may hire a lawyer. Once an attorney is retained, the client will usually not settle unless they net at least what they were originally offered. Therefore, if the insurance company wants to settle the claim, they will have to pay more.

While we usually are able to improve upon what the client has been offered, of course there is no guarantee. There may be facts that come to light that affect the value of the case one way or the other. Even if the client does not realize any improvement over what the insurance company had offered, they have received the benefit of professional representation. The client may have other issues or concerns beyond the settlement of the claim. The client may have concerns about future medical bills or providing for their family in the future. These are types of things which the other party’s insurance company couldn’t care less about, but our lawyers will be glad to help you with these concerns.

When should I hire a lawyer?

Remember that the best time to retain a lawyer is as soon as possible after an injury. At Bernard Stuczynski & Barnett we are always happy to provide a free evaluation of your claim. If you have received an offer from an insurance company, it makes sense to contact us to review if your offer was fair. Once we review everything that is known about your case, we will likely advise one of three steps to take:

  1. The offer is reasonable and you should accept it;
  2. We think there is a good possibility we can do better; or
  3. Further investigation is necessary to determine whether it is a fair offer.

If you’re curious as to whether or not you are being offered a fair settlement, call our firm today for a free consultation. We’ll let you know.

What is the difference between State Courts and Federal Courts?

State Courts, Federal Courts, and your Pennsylvania Insurance Claim

Federal CourtEveryone knows that we have a federal court system and state court system, but when asked to explain the differences, few people are able to do so. The purpose of this blog is to provide a short, basic summary of the difference between the two court systems and how it can affect your personal injury claim.

The federal courts are established by Article III of our Constitution. Federal judges are appointed by the President of the United States and are confirmed by the Senate for life. The federal courts decide cases that arise under specific federal laws which establish jurisdiction (the power to hear the case), in the federal courts. Examples of federal question jurisdiction are securities fraud, income taxation, bank robbery, and laws regarding the environment and telecommunications. In general, matters which affect “interstate commerce” can be regulated by Congress through law and the question of what is “interstate commerce” has been very generously decided in favor of the federal government.

Finally, federal courts are empowered to hear cases under what’s called “diversity jurisdiction.” This requires that the parties be citizens of different states and the case or controversy have a good-faith value of more than $75,000.00. While federal courts are usually regarded as more important by ordinary citizens, this is not the case. It is simply that the federal courts have distinct areas over which they have jurisdiction.

State courts hear cases which arise under the state or local laws of the state. The laws which impact us in most of the aspects of daily life usually arise under state law. For instance, laws regulating controlled substances, the operation of your vehicle (while intoxicated or not), real estate, decedent’s estates and our complete crimes code all arise under the state law. This also includes auto accidents, workers’ compensation, and various defective products cases. Under Pennsylvania law, these cases are all brought in the particular county in which the case or controversy arose.

Appeals are heard by either the Superior Court or the Commonwealth Court and further appeals can be heard by the Supreme Court of Pennsylvania. Pennsylvania judges are elected positions with a ten-year term, at the expiration of which the judge must stand for a “retention vote” to serve another term.

Federal and State Courts oftentimes have concurrent jurisdiction. In other words, a case can be heard by either of them. This frequently happens with insurance disputes.

While the regulation of insurance is a matter of state law, insurance carriers can and frequently will remove the case to federal court under diversity jurisdiction. There are many strategic reasons why this strategy is employed. For instance, in state court, Pennsylvania courts have decided there is no right to a jury trial in an insurance bad faith case, However, the federal courts in Pennsylvania have held that there is a right to jury trial in such cases.

This blog is intended to provide a basic summary on this topic. For more information and the application to a particular situation, you should obviously consult an attorney.

Pokémon Go and the Dangers of Distracted Driving

The Dangers of Pokémon Go and Distracted Driving

Pokemon Go Distracted DrivingPokémon Go is an “augmented reality” app that allows iPhone and Android users to walk around the real world, looking through the screens of their phones, in search of Pokémon—tiny monsters that can be caught and trained to fight other Pokémon for their trainer’s own amusement…and glory. Once you get past the dogfighting undertones and realize it’s all a game, there are a number of real-world dangers this app presents. “Pokémon Go” Fever is sweeping the nation, much like the California Gold Rush of the 1800s, and it’s only a matter of time before a budding Pokémaster steps into traffic while trying to catch Pikachu.

In their journey to be the very best—like no one ever was—there are reports of Pokémon Go players trying to catch Pokémon on their phones while driving their cars. This form of distracted driving is perhaps more dangerous than texting while driving, as it requires a user to actively use precision movements in an attempt to capture the rascally, anthropomorphized creatures. To complicate things further, it is unclear whether or not Pennsylvania’s no-texting-while-driving law would prohibit a user from catching Pokémon while driving, although common sense certainly would.

Pokemon Go Distracted DrivingDoes Pokémon Go encourage users to drive while playing?

Even more dangerous is, perhaps, the manner in which Pokémon Go incentivizes its users to play while driving their cars. To become aware of a Pokémon’s presence in a given area, the app needs to be open and running on the user’s device while passing through that region. The game then rewards players for traveling across the land—searching far and wide—while running the app, as it presents the user with more opportunities to catch the elusive creatures. It stands to reason that playing while driving would present an aspiring Pokémaster with the ability to surpass his or her pedestrian friends’ attempts to catch ‘em all, as those friends are limited by their inferior speed and inability to search a large geographic region in a short period of time. It seems that much of this danger could be prevented by Pokémon Go’s creators implementing a limitation that prevents its users from interacting with Pokémon or PokeStops while traveling above the speed of a swift jog. While such a feature would prevent kids from playing in the back seats of their parents’ cars, it could also save lives.

Be safe.

In all seriousness, we truly hope that, in light of this craze, that Pokémon Go players exercise extreme caution and good judgment in their hunt. While it’s great to get outside and explore new places, particularly in the beautiful Erie, PA region during the summer, watch where you’re going and don’t attempt to catch Pokémon while driving. All it takes is a split second of distraction to ruin somebody’s life forever. The last place you want to be is in court, on the stand, telling a jury that you mistakenly killed an innocent person because you had to catch ‘em all.

And to all the Pokémon players we’ve seen congregating in front of the church across the street from our office: we hear there’s a whole bunch a few blocks over in Perry Square. In addition to Pokémon-oriented litigation, our law firm handles Pennsylvania auto accident cases throughout the state. If you or a loved one has been injured in a car accident, call our office today for a free consultation.

Update: Pennsylvania State Police Post Bulletin Warning Players of Pokemon-related armed robbery

On July 13, 2016, the Pennsylvania State Police posted a Community Awareness Bulletin warning Pokémon players of armed robbers using the “lure” feature, meant to attract Pokémon, to attract unwitting players of Pokemon Go to secluded areas such that they could be robbed at gunpoint. Eleven players were allegedly robbed at gunpoint in St. Louis, Missouri, and local police are worried about similar attacks.

Hard Facts Make Hard Cases

Some personal injury cases are an uphill battle. Our law firm takes the hard cases.

There is a saying among lawyers that “when the facts are against you, argue the law; when the law is against you, argue the facts; when both the law and the facts are against you, just argue.” There is a lot of wisdom in this saying. First, it illustrates the importance of having accurate facts. When a lawyer renders an opinion, it is based on the facts as they are presently understood. If a critical assumed fact turns out to be wrong, that can change an opinion previously given. The saying also shows the importance of having a thorough understanding of the law as applied to the facts of the case. Finally, the saying is reflective of the lawyers’ duty to his or her client. The rules of professional conduct require a lawyer to advocate their client’s position “zealously.” The adage “just argue” may apply more in the criminal law field than to personal injury. In representing a criminal defendant, a lawyer often finds that both the facts and the law are very unfavorable.

Despite the fact that many clients think their lawyer can work a miracle, in the civil law field, which is anything other than criminal, the lawyer always has two big obstacles to overcome: the judge and opposing counsel. If there is a problem with the facts or the law in your case, you can count on opposing counsel to point out those deficiencies. A judge will know your case is weak if there is a problem with either the facts or the law.

What makes a personal injury case more difficult?

I have always said that it is much more difficult to be a plaintiff’s lawyer than a defense lawyer. Representing the plaintiff, you have to be right about everything. A defense lawyer only needs to be right about the one hole in your case, whether it happens to be a critical factual dispute or a legal ambiguity.

That said, there is rarely a perfect case from the plaintiff’s point of view. Witness stories will vary leading to a dispute over a critical fact. Conflicting decisions from different courts may result in an ambiguity in the law. There is nearly always a dispute over the extent of injuries, or the impact of those injuries on the plaintiff’s life. The critical element is having the experience to know which deficiencies in a case can be overcome, and which will result in a dismissal. Of course, no lawyer can ever be 100% accurate in their opinions. There is another adage that every litigator will attest to, which is that “I have won cases that I expected to lose and I have lost cases that I expected to win.”

Many lawyers shy away from what appears to be a difficult case. Some law firms only want you as a client if you were rear-ended while stopped at a red light. At Bernard Stuczynski & Barnett, we pride ourselves on being able to analyze cases that have very difficult facts. We have a track record of succeeding many times with cases that have been rejected by other law firms.I will discuss a few specific examples.

Example One: Obtaining Workers’ Compensation for an injured Horse Jockey

Injured Horse JockeyAlthough all of these cases are a matter of the public record, the specific facts have been changed in order to protect the identity of the client. One case that comes to mind is that of a female exercise rider at the local horse racetrack. Exercise riders typically are freelancers, meaning that they may ride for several different trainers. We represented an exercise rider who was seriously injured when thrown by a horse. Ordinarily, an independent contractor is not entitled to workers’ compensation benefits. However, under the law, if facts can be developed showing that the relationship is more of an employer-employee one, then it may be possible to collect workers’ compensation benefits. In this case, we were able to develop that the exercise rider worked on a regular basis for the same trainer, the trainer provided specific instructions as to how to exercise the horse and generally exerted control over the rider. Through thorough legal research we also located an obscure workers’ compensation decision that awarded benefits to an exercise rider. On top of all the difficulties of the case, the trainer was uninsured. As a result of properly developing the facts and the law, we were successful in obtaining benefits from the Uninsured Employer Guaranty Fund.

Example Two: Workers’ Compensation and Personal Injury Settlements for Trucker that hit a Farm Animal

In another memorable case, we represented a truck driver who struck a bridge abutment. He was very seriously injured and there was no question that he was entitled to workers’ compensation. The collision was caused by our client striking a cow that was loose on the road. With this seemingly impossible set of facts, not the least of which was whether or not our client should have been able to see and avoid the cow, we were able to obtain a substantial recovery for him. We did this through an exhaustive investigation which, among other things, developed that the owner of the animal had neglected to close the pasture gate on the evening of the collision. Ordinarily, when a worker obtains a settlement from a third party, the workers’ compensation insurer is entitled to their money back. However, in this case, we were able to negotiate a substantial settlement from both the farmer’s liability insurance and the workers’ compensation carrier.

Example Three: Settlement for Slip-and-Fall in a Grocery Store

In another case with difficult facts, we represented a woman who slipped and fell on a broken jar of pickles at a grocery store. A grocery store is not liable for such an occurrence unless the plaintiff can establish that the store had notice of the hazard and had ample time to clean it up. While many law firms would summarily reject such a case, we were able to develop evidence that another customer had actually reported the hazard several hours before the injury. We were able then to negotiate a very good settlement for our client.

Our law firm takes the hard cases that other firms reject.

When a lawyer chooses to accept or reject a case, it is simply a matter of opinion. If we reject a case, we feel we are actually benefiting the client by saving them the agony of pursuing an unsuccessful claim. However, we do take seriously our ethical obligation to not lightly reject a client’s case. At Bernard Stuczynski & Barnett, we are always happy to provide a free case review—no matter how difficult the case may first appear. Even if you have been turned down by another lawyer, we may be able to help. We treat clients the way that we would like to be treated if we were the client.