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4 posts from September 2009

September 29, 2009

Jury Awards Truck Driver $9.5 Million for Permanent Damage from Erectile Dysfunction Treatment

Ed sad

    This absolutely fascinating story comes out of Georgia where plaintiff John Henry Howard (a Georgia truck driver) sued defendant Boston Men's Health Center, Inc. for damages suffered after treatment for erectile dysfunction (ED).  A Dekalb State Court Jury of his peers awarded Howard $750,000 in compensatory damages. However, the jury also found that the defendant acted with an intent to cause harm and further awarded Howard $8.5 Million in punitive damages.  Howard was brilliantly represented by attorney W. Fred Orr II, who himself received bear hugs from 10 of the 12 jury members after the trial was over.

Viagra pills

    Howard went to the clinic in an effort to resolve his ED.  The waiting room was filled with literature warning about the dangers of Viagra and Cialis, ED medications which are administered orally (i.e., the little blue pills).  The clinic staff advised Howard that their therapy was painless and based on a proprietary formula.

    They injected medication, whose primary ingredient was papaverine, directly into his penis. Papaverine was the treatment of choice until the introduction of Viagra in 1998.  Since that time, the Food and Drug Administration has warned that papaverine should not be used to treat ED.

    A macho man, Howard did not run scared when faced with the injection. However, he testified that "Not a man on the face of the earth would go into one of these places if they knew what they were going to do to them."   True, how painfully true.

    Not surprisingly, the injection gave him immediate results and Howard shelled out $1,200 for a six-month supply of the clinic's medication.  He was instructed to inject it into himself in the same location. He did and had "the best erection he's ever had in his life."  Unfortunately, that best erection lasted for a couple of days.  It had become painful, so he visited the clinic.  

    The staff removed blood from his penis in order to provide relief but that didn't work.  He wound up in the emergency room.  Eventually, he discovered that the medicine caused fibrosis and scar tissue to form.    

    Read the complete story from Law.com.

If you, or someone you know, has been similarly injured, 

please contact me immediately at

(323) 852-1100


Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve" 

September 26, 2009

Choosing to Sue in Small Claims Court: When Is It Appropriate?

Small claims gavel

  Small Claims Court handles civil cases where the plaintiff (person or entity who sues) is asking for $7,500 or less from the defendant (person or entity being sued). Disputes are resolved quickly and inexpensively in Small Claims Court.*  

    Although you can ask a lawyer’s advice before or after the court hearing, in California you are not allowed to have a lawyer represent you at the Small Claims Court Hearing.

    The hearing is relatively informal: no lawyers, no rules of evidence, no juries.  A judge, or a judge pro tem, will hear and decide your case.

Why Do I Occasionally Advise Clients To Go To Small Claims Court?

    Why my interest in telling you about Small Claims Court?  Most of the cases that I handle are personal injury cases.  If it’s a small case, then I often recommend that instead of using my services to litigate the matter then you, the client, might be better served by taking it to Small Claims Court.  

    When I handle a case, it may take months or years to get resolved.  This makes practical sense when the case value exceeds the maximum, jurisdictional amount that you are allowed to sue for in Small Claims Court. However, for cases valued at less than $7,500 (in California), going to Small Claims Court might bring you to resolution within a much shorter period of time while keeping your costs to a minimum.

Wondering (aka Worrying) About How To Present Your Case?

    I’ve thought about this over and over.  My style of representation is based largely in part on my wanting to fix things for my clients, to make things better for you, to get justice for you.  The last thing that I want you to do is struggle or stress out over your case.  

    Small claims court is appropriate for cases of all kinds, not only personal injury. For example, clients just like you have come to me with a myriad of legal issues for which I've directed them to Small Claims Court: 

  • Landlord will not return your security deposit
  • You bought something that doesn't work and the store won't fix it
  • You lent money to someone who refuses to pay you back
  • Tenant damaged your property and their security deposit won't cover the repairs
  • You've performed services and the customer refuses to pay 
  • Your neighbor's dog tore up your screen door
  • and a myriad of other situations

    ...and justice for all

    So, just because a lawyer can’t represent you in Small Claims Court doesn’t mean that the case can’t be prepared for you by a lawyer in a professional manner.  After all, you are in court to win your case and want to persuade the judge that your position is the winning position . 

Small Claims Package

Legal justice

    At your request, and for a much lower fee than the 1/3 to 40% that I charge to handle your case, we will prepare a Small Claims Package which will include a professionally prepared brief, exhibits (color photos, relevant medical records and bills, witness statements, property damage bills, etc.), help you fill out the proper Judicial Council Forms and get them filed with the court, pay the Court Fees, find the proper courthouse (venue) for your case to be heard and get the defendant(s) served. We will even subpoena records and witnesses, if necessary.  I, or another lawyer on my staff, will prepare you for the court hearing, advise you what to expect in court from the judge, the court clerk, the defendant and then what to do after the judge decides the case.

    I’m a firm believer in doing what’s right for my clients.  

If you, or someone you know, has been injured in an accident, please contact me immediately at

(323) 852-1100


Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve"

*The facts and figures in this posting are based on small claims cases brought in California.  Monetary figures and other rules will likely vary depending on what state you are in.  Check your local and state rules for specifics that will be applicable to you!!!

September 18, 2009

Medical Billing & Legal Records A Legal Nurse Consultant's Perspective by Guest Blogger, Susan van Ginneken, RN

Many times I have to ask Legal Nurse Consultants to review an injured client's medical records and the related bills.  I'm fascinated by the complexity of this process.  Guest Blogger, Susan van Ginneken, a Legal Nurse Consultant, was kind enough to write the following article to help illustrate what it is that she does when reviewing the billing and legal records.

Medical Billing and Legal Records by Susan van Ginneken, RN

Harried Nurse As if attorneys and nurses do not have enough to be aware of in the medical record, now someone tells us that billing codes are being misused to render higher bills than the actual services given would suggest. There was a time that if you knew the main diagnosis being treated (Principal Diagnosis), you basically knew what would be billed. Well, that does not hold true any longer. There are now “relative weights” given to various diagnosis groups, and the groups are determined by the amount of care they may require to treat. There is a book of “Diagnosis Related Groupings” or “DRGs” that outlines these, and the average course to learn how to use these codes is two weeks in length. Why is it so complex? Well, because there are “modifiers” such as “co-morbidities” and “complications” that increase the relative weight (amount of money paid) of a diagnosis group when present. Not just any secondary diagnosis will fulfill this category, so you have to know which diagnoses affect which group. There are new modifiers that apply to Acute Renal Failure, and they are not always coded correctly, particularly on emergency department charts. A notice in my latest DRG newsletter warned us to watch for inaccurate coding on those charts. 

How does this affect those of us in the legal field? Well, when you are trying to calculate damages, you cannot always go by the coding and figures offered on the bill. If those are inaccurate, Medicare or the Insurance Company may (and probably will) find the error and make the facility correct it. In fact, there is an entire group of coders and nurses working for companies in 3 areas of the country to review and find billing errors, because Medicare feels there is enough billing error in their favor to more than pay for this work! If we use billing information to help us calculate the amount of care a person required, we may well be accepting faulty material. We will then be using information that is obsolete. Better to have someone knowledgeable about the appropriate coding of a chart go through it, before attaching your final dollar figures. The billing people may also see something that everyone else missed, just by noting a code used (for example, a code for Fractured Leg with ORIF and the modifier for the co-morbidity of diabetes). If the co-morbidity was mentioned only very briefly in the chart, it is possible that it may have been over-looked. However, the presence of diabetes on the healing of that fractured leg could be big. This would make a difference in the total medical and long-term healing prospects for the client. On the other hand, if the modifier was used, yet diabetes is never mentioned in the chart, neither they nor we can use that in our work. Copying diagnoses off the face sheet of a chart is risky business. Mistakes can and do happen often.

Susan van, RN Ginneken

Legal Nurse Consultant

Nurse Life Care Planner


Eagle Eye Record Review


“I do Chart Review and Life Care Plan preparation for the care, assistive devices, and services needed after catastrophic injury or illness, as well as billing and coding consultation.”


Coding – the review of a chart by a specialist trained specifically for the task in order to discern the principal diagnosis on a chart and any modifiers that will affect the final relative weight of an assigned DRG category.

Complication - a condition that arises during the hospital stay that prolongs the length of stay by at least one day in approximately 75 percent of the cases.

Co-Morbidity – pre-existing condition that, because of its presence with a specific diagnosis, causes an increase in length of stay by at least one day in approximately 75 percent of cases.

Diagnosis Related Group (DRG) – one of the 579 (538 valid) classifications of diagnoses in which patients demonstrate similar resource consumption and length-of-stay patterns.

Modifier – a “CC” (complication or co-morbidity) that affects the relative weight of a DRG category.

Relative weight – an assigned weight that is intended to reflect the relative resource consumption associated with each DRG. The higher the relative weight, the greater the payment to the hospital. Relative weights are calculated by CMS and published in the final perspective payment rule.

Definitions obtained from:

Ingenix. (2007). DRG desk reference: The ultimate resource for improving DRG assignment practices. 

If you, or someone you know, has been injured in an accident, please contact Attorney Lowell Steiger immediately at

(323) 852-1100


Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve"

September 12, 2009

Auto Insurance Coverage from A Personal Injury Lawyer's Perspective

Insurance-policy A friend, Johnny, asked me to evaluate his auto insurance coverage.  He lives in Los Angeles and drives an Audi TT, a small sports car.  Although my often tongue-in-cheek responses are geared for California auto coverages and, in particular, Los Angeles, this should give you an idea of what to look for in your own venue.  Most importantly you must be aware that if you do not have insurance coverage that is sufficient to compensate someone for injuries sustained in an accident that is wholly or partially your fault, you could be on the hook personally for that amount which exceeds your policy limits.  And, as we all know, accidents happen in what seems like a millisecond – it’s not something that we anticipate BUT it is something that we can prepare for.

I want to stress that laws and insurance policies and coverages are different in different states so please contact your insurance agent to be sure that you’re complying with local and state laws and are getting the coverage that best suits your own particular needs.

Please also note that I’m being relatively specific in my responses to Johnny.  I’m just being illustrative when referring to a crosswalk accident.  You can replace “crosswalk” with “running a red light,” “making an unsafe U-turn,” “rear-ending the car in front of you” or 25,000 other possible scenarios!

    Dear Johnny,

In response to your questions regarding your current auto insurance coverage:

Bodily Injury

Your Bodily Injury Coverage is $50,000/100,000.  Increase it to at least $100,000/300,000 -- right nowCrosswalk mva  you have $50/100 which means that if you accidentally whack someone in a crosswalk and break their hip, the most they can recover from you is $50,000.  Also, if there are more than two people in that crosswalk, and you hit and injure all of them, then the most that will be paid out is $100,000 somehow divided by those 3 people.  You risk them getting an excess judgment against you and garnishing your wages.  In general the best coverage, in my opinion, is the maximum coverage your carrier allows.  It usually doesn't cost much more to maximize.  

Property Damage

Exotic car accident Property Damage: Right now you have $50,000 in coverage which means that the most that your insurance carrier will pay for damage to the other person’s car, his/her rental coverage while his/her car is being repaired or evaluated for a total loss, towing and storage is $50,000.  Get the most PD coverage you can -- in L.A., the cheapest car is $50,000 so, if you cause an accident and total out a Bentley, they could sue you for the difference between $50,000 and the value of the car.  I carry $500,000 Property Damage because I know that with my luck, if I get into an accident it will be with a rock star being driven in a $250,000 tricked out Lincoln Limo

Medical Payments

I cannot stress the importance of Medical Payments Coverage: Get the most that you can get.  I don't remember if you have health insurance or not but, if you get into an accident, regardless of fault, you and each of your passengers will be entitled to have your reasonable medical bills paid up to the limits of Hospital_logo your med pay coverage.  Most people have $5,000 but, in today's world, if you can get $25,000 or more that would be great (it depends how much your carrier provides). Also, tell them you do not want excess coverage and you want it to be NON-REIMBURSABLE in a third party claim.  This means that if someone rear-ends you and they are obviously at fault, then when you get a settlement from their insurance company you do not need to pay your carrier back for the medical payments that they made on your behalf.  This also covers each of your passengers for the same amount. I always worry that if a passenger in one of our cars doesn't have health insurance and we get into an accident, that they will be unable to pay their medical bills.  With this coverage, that isn't a problem (subject to the policy limits).  Your med pay can also kick in if you're hurt in an accident in someone else's car, are on your bicycle, in a crosswalk, etc.  That's tricky but I've invoked it for many, many clients.  My carrier allows for $100,000 Medical Payments Coverage (which I have) but this is rare.  Again, check with your own carrier.


Premium bank As for deductibles, ask how much increase your premium will suffer if you lower your deductibles to $500, $250 or even zero.  It may be de minimis and therefore worthwhile to decrease your deductibles.  It’s human nature to try to save where we can but I’ve heard many a client scream “What? I have to pay the deductible? It’s $1,000!!!” Maybe they saved a tiny bit on their premium by having a high deductible but, when the unforeseen accident occurred, it bit them in the rear.

Rental Coverage

Car rental logos ental Coverage: I don't like the fact that you have to pay 20% of the rental bill and that you're capped out at $500.  This means, with today's rental prices, you'll be covered for a max of approximately 20 days or so.  It sometimes takes longer than that just for the insurance carriers to get the preliminaries started!  I know you don't really care what type of car you rent so ask them to give you different options for rental coverage and then ask me and I'll tell you which is the best.

Uninsured/Underinsured Motorist Coverage

Uninsured motorist Uninsured / Underinsured Coverage: Just like with Bodily Injury, get the most that you can afford.   You're driving a small car.  If someone whacks into the back of your TT, you and your passengers could get seriously injured.  Right now you've only got $30,000/60,000 coverage which means that if the other party is uninsured or only has a $15,000/30,000 policy, the most that each person in your car is entitled to is $30,000 -- up to a maximum of $60,000 for all of the people in your car (again, having to divide the $60,000 between everyone).  Not good.  What if you need surgery or other extensive short or long-term treatment?  Your case could be worth in the six figures yet there's no coverage for this. You should have as much coverage for yourself and your passengers as you have for the unknown person with whom you might find yourself in a wreck.


Let me know if you have any questions 

Feel free run the new or current coverages by me.  

If you, or someone you know, has been injured in an accident, please contact me immediately at

(323) 852-1100


Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve"

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