Sunday, May 22, 2011

Are You Serious???!!!


If you want to recover noneconomic damages when you have chosen the limited tort option on your auto policy in PA, unless you meet one of the other named exceptions ( don’t-get-fooled-get-full-tort,) you have to sustain a serious injury within the meaning of the statute to do so. Otherwise, you are limited to recovery of certain unpaid medical expenses, wage loss and property damage. The limited tort option means what it says...damages which are recoverable as a result of a motor vehicle accident (MVA) are limited by the choice of this option under Section 1705 (d) of the Motor Vehicle Financial Responsibility Law( MVFRL) unless certain exceptions are met.

For the purpose of this discussion, the exception to be explored is the serious injury exception, which is most commonly attempted where the other clear cut exceptions do not apply.  Under Section 1705 (d) one must prove a “serious injury” in order to prevail in a claim for noneconomic damages such as pain and suffering.  In Section 1702 of the MVFRL, serious injury is defined as “a personal injury resulting in death, serious impairment of body function or permanent serious disfigurement.”   75 Pa. C.S.§ 1702 

It was not further defined in the statute, which naturally resulted in litigation of this most important issue.  Although there are few cases, the ones which do interpret it are stringent in their requirements:

In McGee v. Muldowney, 2000 PA Super 116; 750 A.2d 912 (2000), the Superior Court established the criteria for a threshold determination of whether or not a serious injury had been suffered by the Plaintiff. The Court first emphasized that unless reasonable minds could not differ on the conclusion, the conclusion as to whether a plaintiff suffered a serious injury within the meaning of the statute was not to be determined by a trial court upon the filing of a motion for a summary judgment by the defendant in a limited tort case, but left to a jury to determine.  Washington v. Baxter, 553 PA. 434, 719 A. 2d 733 (1998)

In the Washington case, the Court noted that neither the legislative history of the MVFRL nor the Michigan statute upon which it was based intended such a procedure, but rather left it to the jury to determine.  The Court then proceeded to look to Michigan precedent again to define “serious impairment of a body function and adopted the definition elucidated in a Michigan case, DiFranco v. Pickard, 427 Mich. 32, 398 N.W. 896 (1986) as follows:

The "serious impairment of body function" threshold contains two inquiries:

a) What body function, if any, was impaired because of injuries sustained in a motor vehicle accident?

b) Was the impairment of the body function serious? The focus of these inquiries is not on the injuries themselves, but on how the injuries affected a particular body function. Generally, medical testimony will be needed to establish the existence, extent, and permanency of the impairment…. In determining whether the impairment was serious, several factors should be considered: the extent of the impairment, the length of time the impairment lasted, the treatment required to correct the impairment, and any other relevant factors. An impairment need not be permanent to be serious.  DiFranco, 398 N.W.2d at 901. Washington v. Baxter, 553 Pa. at 446-48, 719 A.2d at 740 (footnotes omitted).

The McGee court noted as follows:  The Supreme Court emphasized that "the question to be answered is not whether appellant has adduced sufficient evidence to show that appellant suffered any injury; rather, the question is whether appellant has shown that he has suffered a serious injury such that a body function has been seriously impaired." Id. at 449, 719 A.2d at 741 (emphasis in original). See also: Kelly v. Ziolko, 1999 PA Super 157, 734 A.2d 893, 899 (Pa.Super. 1999).

The McGee court then examined the evidence and found that there was no serious injury based upon the following paragraph:

“Simply put, appellant was examined and treated on several occasions during the six months following the accident, but did not seek any medical attention (except for the visits to Dr. Mannhertz on December 20, 1993, and May 31, 1994) during the next five and one-half years which preceded the answers which he filed to the motion of appellee for summary judgment. Moreover, during that same period he was employed full time in a trade.

In summary, appellant has failed to present objective medical evidence as to the degree of any impairment and extent of any pain suffered during the five years preceding those answers to the motion for summary judgment. The subjective allegations presented by appellant, in the absence of objective medical evidence, do not permit a finding that appellant suffered the requisite "serious injury." While appellant has established that he suffered some injuries to his back and shoulder, he has, nonetheless, failed to establish that these injuries resulted in such substantial interference with any bodily function as to permit a conclusion that the injuries have resulted in a serious impact on his life for an extended period of time. The decision, therefore, was not to be left to a jury, because "reasonable minds could not [here] differ on the issue of whether a serious injury had been sustained."  citing Washington v. Baxter, supra at 446, 719 A.2d at 740.

A careful reading of the Court’s language makes it clear that the medical treatment pursued and other factors can make a critical difference in whether a limited tort claim will withstand the McGee analysis. If you purchase full tort coverage, none of this would be necessary and you could make a claim for pain and suffering. Call my office at 215-752-3732 if you need advice. I am here to extend a helping hand.

 

Tuesday, April 12, 2011

How Can I Help You?


I work together with experts to ensure you get the best result and the best representation possible. There is no attorney fee unless we recover money damages for you... How can I help you?

Over the years, my practice has centered on helping victims of negligence and work injuries. I am a lawyer who can help you with auto accidents and negligence cases which include slip and fall, dog bite, construction accidents, wrongful death, product liability and medical malpractice, work injuries and social security matters. I limit the number and type of cases I handle so that I can serve you personally and know your case thoroughly. You will not feel as if you are just a file among many- your case is important to me and you will be treated with respect and prompt personal service. Phone calls are returned quickly and your questions answered as thoroughly as possible. 
 
If your case is not in my area of practice, I can put you in the hands of an attorney who is best equipped to handle your specific case. I have been in practice since 1981 and I know the attorneys in the area who are best suited to your needs. I will work with only the best attorneys to assure you the best representation for your problem.  REFERRALS

Call me at 215-752-3732 for a free consultation and evaluation of your case.
or email me at jjsesq@comcast.net

Please note that your case can often overlap into other areas of the law. It is better to coordinate all of your problems through one office since there are so many issues that relate to one another and need to be coordinated among the attorneys who work together as a team to assure you the best result. For example, if you are injured in an auto accident while working on the job and then you cannot work at all, you may have cases in all three areas-auto accident, workers' compensation and social security disability. Sometimes one benefit source takes an offset or a credit because you are receiving another benefit. This can become complicated and people can lose money if it is not handled properly. Medicare Set Asides have become mandatory; workers’ compensation carriers are entitled to subrogation against third party recoveries for payments made by them and credit for unemployment compensation benefits received by a claimant; private health insurance carriers can assert liens against recoveries for payments made for medical expenses. This can become confusing and overwhelming for the injure plaintiff. These issues are negotiated for you so they are resolved when your case comes to a conclusion. 

HELPING INJURED PEOPLE RECOVER
"I Will Come To You If You Are Injured."

Wednesday, March 16, 2011

A Two Way Street: Attorney-Client Privilege


The attorney-client privilege is an old and sacred protection given to communications between an attorney and his or her client. The goal of the privilege is to allow clients to tell their attorney everything the attorney needs to know to properly represent and guide the client without fear of the opposing side being able to access this information by way of legal discovery in or out of the courtroom. One of the worst things a client can do is to lie to ot withhold information from the attorney on the case. People often think of the privilege only in terms of criminal matters. It does not matter whether it is a civil or a criminal case. The attorney needs to know all of the facts which might be relevant to the claim. If this communication is hindered in any way, the entire justice system suffers.

In the civil context, on February 23, 2011, the Supreme Court of Pennsylvania held in the case of Gilliard v. AIG Insurance Company that the attorney-client privilege is essentially a two way street, operating both to protect the flow of client communications to the attorney, as well as attorney communications and advice to clients. While this decision came about in the context of a case against insurance companies for bad faith and the plaintiff’s counsel was seeking all documents in the file of the attorneys representing the insurance companies, the breadth of the decision will also protect the plaintiff from the insurance company seeking any written communications between attorney and client.

The whole intent is not only to protect what the client says to the attorney but what interpretation and advice the attorney gives to the client in light of the facts of the case as they develop. Like any rule, exceptions will be carved out as time passes. Even in the context of the type of litigation which led to this decision, an insurer (and their attorney) will lose the privilege if they assert an "advice of counsel" defense to justify their actions in the handling of a claim.

Otherwise, the revered tradition of protection of these communications remains intact. This is an important decision recognizing not only the need for unfettered communication from the client to the attorney, but also the need for the attorney to communicate advice to the client freely and without reserve.  


 

Friday, January 28, 2011

Who Are You Protecting?

A look at PA Auto Insurance:
UM and UIM  Coverage

When people purchase auto insurance, they often buy very high limits for liability coverage and take the lowest possible limits for underinsured and uninsured coverage. Who are you protecting, anyway? Not just the other guy, but yourself and your family as well. That is what insurance is all about!!! To insure yourself in the event of harm. Let’s take a look...

Liability insurance covers your liability to the other driver if you cause an accident. This means that if you cause an accident and it is considered your fault, you are liable to the other party for damages and injuries you might cause.

Underinsured motorist (UIM) coverage is just that...insurance that you pay for to cover you if the other party is underinsured. Uninsured motorist (UM) coverage is insurance that you pay for just in case the other party is uninsured (it DOES happen). What does that mean? Let’s say you are in an accident and it is the other party’s fault. You are injured, badly. The other party did not do so well when he/she chose liability coverage and is only covered for liability to the other driver (you) for $15,000.00 in damages. Meanwhile, you were being frugal when you chose your own insurance and while you took $100,000.00 in liability coverage for any damages you might have caused to another person, you only took $15,000.00 in underinsured/uninsured (UIM/UM) motorist coverage. You wanted to save in auto insurance premiums but instead you lost in auto insurance coverage.

What does this mean? It means that while your damages may well exceed the total of $30,000.00 you can get in combination from the other driver’s liability policy ($15,000.00) and from your own underinsured (UIM) coverage ($15,000.00), you will not get a penny more than the $30,000.00 in combined coverage. While there are sometimes ways to sue the liable party directly for money in excess of their coverage, good luck! There is also the possibility of stacking vehicles, but that is another topic, to be covered elsewhere, and it is likely that if you took low UIM/UM coverage, you probably scrimped on and rejected stacking. Besides, it is only available if you have more than one vehicle insured by the policy. And, if the other party is uninsured, you would only collect your UM policy limits of $15,000.00.

What should you do? You should purchase underinsured(UIM) and uninsured (UM) motorist coverage in amounts equal to what you purchase in liability coverage. So it might cost a little more in premiums, but this is a perfect example of getting what you pay for. You cannot purchase more in UIM or UM than what you purchase in liability...the Pennsylvania State legislature prohibits this, but they allow you to protect yourself for less. Go figure :-) Don’t listen to them...listen to me!!!

Always buy UIM and UM in amounts equal to what you purchase in liability insurance. Do it now!!! Check your policy. Look in the section where it lists UIM/UM coverage. Go call your agent and have them make the change. Get UIM/UM limits equal to your liability limits, and make sure you get decent liability limits. It is well worth the few extra dollars in premiums. Who are you protecting? You are protecting yourself and your family.

Thursday, November 11, 2010

THE WAR DIARY-Coming Home

Regina & Frederick Sweinberg, Jr.
My mother and my father together after the war.

Taken from something I wrote a few years ago....

My father works in the post office, as a mail handler. He is a World War II vet. He receives a small disability for what is known as shell shock, the PTSD which results when your mission is to detonate and disarm land mines. Sometimes people are maimed or killed when they miss the mark and the bomb explodes them into oblivion. My father was one of the lucky ones, although slowly becoming deaf in one ear as a result of the damage .

Emotionally was another story. He refused to talk about the war. He just said he did not like to talk about the war and left it at that. He refused to talk about the war. After he passed, my brother Boyd discovered the manuscript of the diary he had kept while traveling through Europe, only 26 years old. It was pretty long too. I guess he thought he had said what he felt he needed to in the diary. He wanted to leave it at that. He never said a word to anyone about the diary.

I include excerpts from the personal diary of Captain Frederick Sweinberg, Jr., my father, kept during his tour of duty to his country, serving in WWII, September 14,1944-August 8, 1946. He had been part of the troops that disengaged the land mines. If you didn’t do it right, you were maimed or you died. He was 26 when the war had ended and my father was coming home. He refers to my mother as Jean. Her given name was Regina. This must have been his nickname for her then as I never heard him call her Jean. It was part of my name now, Joyce Jean.    

July 25-August 2, 1946: All aboard was the cry and you can bet your boots we were all more than ready to leap on...About 3pm we shoved off and took our last look at the never to be forgotten shores of Germany. It’s hard to describe the feeling that one felt but it was just a prayer thanking God that we finally were on our way home to our loved ones....

The trip as a whole was not too bad...The chow was terrible because all company grade officers sleep in the troop accommodations and ate in the troop galley. It’s a crime they allowed such food to be served. The first-class passengers ate rather wholesomely but then we were glad to be going home and that overwhelmed any discomfort we encountered...The big day finally came when we arrived in NY harbor at dawn on August 2, 1946...Boy that NY skyline looks swell and the feeling of being on American soil again was hard to take. It is a wonderful feeling.

August 8, 1946: I sure was sweating it out until we finished processing but finally on the 8th we finished at 12 noon...I fortunately made good connections to Philadelphia in time to get the 1:30 Martz bus...Old familiar scenes were like a dream and the changes that took place seem so strange. Then about 5:15 we started to comedown the East End Boulevard and my heart pounded like the devil...I got home and just seeing mom and dad and everyone again was a thrill I’ll never forget. But then I called Jean and told her I’d be over as soon as I cleaned up and believe me I couldn’t wait. About 7pm I left to see her. Gosh, the happiest day since I left home was when I held her in my arms again and kissed the only girl I ever wanted. I wish I could find the words but they say there is no ending like a happy ending and I can that it was the happiest moment of my life-so far. I hope the Lord will never cause us to part again and we can live a bright happy future together. And so ends the story I hope I won’t have to relive again...







Wednesday, October 13, 2010

Somewhere Over the Rainbow...

Social Security and Retirement Benefits

Photo by Alan Larus

I have recently been exploring information on Social Security (SS) retirement benefits. Although I am years away from it questions about it have come up to me several times in the past few months and I did not have the answers so I decided to take a look and see what the future holds in this regard and to share it with you. The fact is, the answer is that I still don’t have the answer! But there are many options.

More specifically, the big question is whether to retire early at age 62 and what the consequences of that decision might be in regard to your benefits. In reality, most people are putting off their retirement in a bad economy, working simply to pay the bills, with little thought to something called early retirement. In fact, a large percentage of the American population has little or no private retirement savings. In 2008, 64% of Americans relied upon SS as their primary source of income and 33% relied upon SS as 90% of their income. In short, most Americans will depend to a large extent upon their Social Security benefits someday to make ends meet. For them, waiting until the end point age of 70 is inevitable, as they need to make as much money now as they can, because they have no savings to fall back on to tide them over and they will need the largest possible SS benefit they can receive to pay their bills. http://www.comcast.net/articles/news-national/20101011/US.Social.Security.No.COLA/

Still, if you were considering it, there are many variables which affect this decision and no clear cut answer. The wisest approach short of hiring a financial planner for a fee only basis to assess your situation is to venture into the SSA’s official site where you can actually input your scenario and get projections which will help you see how much you will get and base your decision on that information. What is clear is that your monthly benefit amount is reduced if you take early retirement. Conversely, it increases by certain percentages for each year that you delay retirement up to age 70. The benefit increase stops at age 70 even if you delay taking benefits, so there is no logical reason to delay beyond age 70. http://www.socialsecurity.gov/retire2/delayret.htm

Whether you are single or married makes a difference. Whether you think you might live a longer or a shorter life makes a difference. Whether you have any private retirement savings makes a difference. Whether you intend to continue to work past official retirement age makes a difference. Once you reach full retirement age there is no limit on your income. Prior to that, there is a limit on how much you can make while you receive early benefits with an offset being taken. For some in depth thoughts on these variables, take a look at this article. http://www.nytimes.com/2009/07/11/your-money/11retire.html?_r=1

The SSA maintains an elaborate site which provides information and advice about when to retire and what your benefit will be. To determine what is considered full retirement age for you, go to
http://www.socialsecurity.gov/retire2/agereduction.htm  where you will find a chart indicating the full retirement age by year of birth. For example, 65 is no longer full retirement age for everyone. Instead, it is extended in increments for those born after 1938 and is now up to 67 for those born 1960 and later. Still, there is a note on this page which advises:

Note: If you decide to delay your benefits until after age 65, you should still apply for Medicare benefits within three months of your 65th birthday. If you wait longer, your Medicare medical insurance (Part B) and prescription drug coverage (Part D) may cost you more money.

This is critical since the age for eligibility for Medicare has NOT changed and remains at 65 no matter year you were born. For information on Medicare go to www.medicare.gov

There are so many issues which can affect you when the time draws near, you need to research the issues and make a decision. http://www.socialsecurity.gov/retire2/otherthings.htm

If you are already there and are near retirement go here http://www.ssa.gov/retire2/near.htm

You can also call the SSA on their hotline, although you should be prepared for a long wait to talk to a representative. 1-800-772-1213. TTY users should call 1-800-325-0778. Here is a link to the SSA’s official site where you can find the answers to questions. http://www.nytimes.com/2009/07/16/your-money/16retire.html

Monday, August 23, 2010

Social Security Disability Offsets

Social Security Disability Offsets


Earnings from Substantial Employment

Many people think you cannot work at all when you receive Social Security Disability (SSD) benefits or you will lose your benefits. This is not true, although there are limits on how much you can earn before it affects your benefits. In most cases, your Medicare benefits will continue and you are also allowed to deduct certain work expenses from the gross income for purposes of calculating your earnings. If you are going to make an effort to work, you should review the Social Security Administration (SSA) rules very carefully. Also, before you make that effort, to see if you are able, you might want to volunteer somewhere for a short time and see if you can handle the consistent effort required.

Trial Work Period
The SSA allows you a trial work period followed by an extended eligibility work period. If you can work 9 months (they do not need to be consecutive) within a 60 month period, the trial work period ends, followed by the extended period of eligibility. There will be no loss of benefits no matter how much you make during the trial work period months. The minimum amount of money to establish a trial work month is $720 in 2010. This amount increases each year, and the specific rules vary for employees, self-employed and blind persons. Although the monthly amount of money you make during the trial work period does not matter, during the extended period of eligiblity which follows, a key factor is the amount of money you make.

Extended period of eligibility
After your trial work period, you have 36 months during which you can work and still receive benefits for any month your earnings are not deemed “substantial.” In 2010, earnings of $1000 or more ($1,640 if you are blind) are considered substantial. This amount also increases each year. The SSA will deduct work expenses from the gross amount of your earnings. No new application or disability decision is needed for you to receive a Social Security disability benefit during this period.

Workers Compensation Benefits

You can receive both Workers Compensation(WC) and SSD benefits but you cannot receive a combined benefit of more than 80% of your average current earnings as calculated by the SSA. The SSA will take the offset from your SSD benefits. If your WC stops, your SSD will usually increase.


Unemployment Compensation

The interplay between Unemployment Compensation (UC) and SSD is a complex one. People often ask if they can receive both. The general rule is that the SSA will take an offset on retroactive benefit awards for any UC you might have received while your SSD claim is pending.  Although one can be available for UC purposes for work within their limitations, in a claim for SSD one is alleging that they are unable to engage in substantial gainful employment.


Long Term Disability Insurance

Although there is no offset to your SSD if you receive Long Term Disability benefits, the LTD carrier might take an offset for receipt of SSD. This varies, so you need to check with your LTD carrier and LTD contract to find out how it might affect you.


For official information on this subject go to these links:
http://www.ssa.gov/pubs/10095.html
http://www.ssa.gov/pubs/10029.html
http://www.ssa.gov/work/