A Guide to Additional Compensation for Your Claim

Over the years our legislature has endeavored to legislate away the ability of injured or disabled people to collect monies from more than one source. Moreover, health and disability insurers, under the euphemism “coordination of benefits,” have clauses in their policy which essentially state:

“If someone else should pay, we won’t. If we do pay, we expect you to repay what we spent on your medical bills.”

Occasionally, we see a few employers, who have paid sick pay during the injured employee’s absence, expecting to be repaid (the sick pay) from the proceeds of legal recovery.

At Plymale and Dingus, we believe the medical insurer or employer should pay the cost of recovering these monies – not you. As part of our service, we often negotiate with the medical insurer or employer to either pay their fair share of attorney fees or reduce the amount they expect to be repaid. Different payers have different policies and different degrees of willingness to negotiate, but we take pride in our ability to obtain maximum concessions from them – our work often results in more money in your pocket.

Sources of Recovery

Most clients are unaware of the sources of recovery available to them. Some of these should be vigorously pursued by you and your lawyer while others should be left alone.

The following are several examples of sources of compensation which should be investigated and pursued:

  • The at-fault party’s liability insurance, whether it be auto, homeowners, umbrella, or commercial.
  • Your own insurance policies: Many drivers are uninsured or have inadequate insurance. We often find additional monies available for you in your own auto policy or that of a family member with whom you live. If you were a passenger, you can recover benefits from the driver’s policy, and if you were in a car owned by another, then we can explore that person’s policy. Whether monies come from medical payments coverage or uninsured/underinsured motorist coverage, there is often compensation available to you – this will become clear after our attorneys investigate all sources of monies with a careful reading of the applicable policies.
  • Workers’ compensation: If you were driving or riding on the job and are injured in a covered car you may collect both workers’ compensation benefits and money from the at-fault person’s insurance company.
  • If your injuries disable you so that you cannot work, you may collect not only the insurance money but also social security disability from the Social Security Administration or pension benefits provided through your employer.

Final Thoughts

In conclusion, you need the guidance of a lawyer or lawyers, knowledgeable and experienced in injury claims, to guide you through legal action and maximize your recovery. Our attorneys are well-versed in cases of car accidents, trucking collisions, motorcycle accidents, back injuries, brain injuries, and more. Our team is passionate about helping you through your case and fighting for your rights. 

A Modest Proposal for the Elderly and Infirm

When families put their loved ones into a nursing home, they expect that they will receive adequate care for their physical, medical, mental, and social needs. Nursing homes have a responsibility and a duty to provide reasonable and adequate care, and when they fail in any area of that care, it may be considered neglect. Regrettably the nursing home industry is dominated by corporations who own and run the nursing home facilities whose main focus in profit. Those few nursing homes that refused to take Medicaid patients because of the rate for Medicaid reimbursement seem to provide an acceptable quality of care. Could it be that this is because their per patient fees are higher? Most elderly people cannot afford to spend $5000 or $6000 a month for nursing home care and are dependent on Medicaid to pay the bill.

Nursing home neglect may include any number of failures, from not providing adequate nutrition to actively ignoring patients who ask for assistance. Families of loved ones who were neglected can file lawsuits against the individuals and the facilities responsible for failing to provide expected care. Neglect in the nursing home is often considered a kind of abuse most seen in the form of inaction, or a failure to act. This failure to act may be unintentional and may result from either understaffing or staffing by unqualified individuals. This is sort of neglect often results from the efforts of the nursing home attempting to increase profits by cutting costs.

In the nursing home context, neglect may happen in several ways. Some of the more common are:

  • Failure to provide adequate medical mental health or dental care
  • Failure to monitor a patient’s health condition
  • Inadequate hygiene such as bathing, toilet use, and clothing changes
  • Failure to change or clean the patient after incontinence
  • Inadequate food, nutrition, or hydration
  • Not aiding the residents with their mobility
  • Failure to provide adequate equipment or assistance for the safety of the patient resulting in falls or other accidents which were preventable
  • An inadequate number of, or inadequately trained staff
  • Ignoring calls for assistance
  • Deactivating call lights

In summary, nursing home operators often treat the elderly and infirm as “commodities” rather than people. The difference between what the state pays the operator and the amount he spends to care for the patient is his profit and the amount of profit determines whether he drives a Chevrolet or a Rolls-Royce.

Sometimes injury is caused, not by the staff at the nursing home or by shortcomings in its’ physical facility, but by the physician retained by the nursing home to provide medical care to their patients. The way medical services are delivered today makes it impossible to find a family practitioner willing to come to see only one patient in a nursing home no matter the strength of their past relationship. Accordingly, the nursing home hires a physician to come in and make the rounds of patients whom the nursing staff indicate needs his service or the patient requests to see him. On average, the patient sees the doctor a few times each week and when a doctor fails to recognize or inappropriately treats injuries caused by a lack of mobility assistance or infections that result from poor hygiene, there may be a medical malpractice suit against the doctor.

So, what do you do upon learning that your loved one is being neglected?

  • Call the Ohio Department of Health complaint hotline at 800-342-0553
  • Email a complaint to the Ohio Department of Health that includes the following: 
  • Your name and address
  • The name and address of the facility
  • The names of the individuals involved
  • Names and contact information for witnesses
  • The name of the patient and room number
  • The date, time, and frequency of the incident
  • Your opinion is to whether the incident is an isolated event or systemic problem along with your reasons for that conclusion
  • And, a description of any other action you’ve already taken.
  • Fill out an Ohio Department of Health complaint form which can be downloaded from the department’s website.

Anatomy of a Personal Injury Case: Motor Vehicle Collision

The Initial Stage: A Collision Occurs

When you are injured in a motor vehicle collision the very first thing you should do is to seek treatment immediately! If you are hurt, go to the emergency room or see a doctor so that they can determine the extent of your injury and recommend a treatment program. Delaying treatment can delay your physical recovery, signal to the insurance companies that the injury “wasn’t that bad,” and can also impact the believability of the claim, and in turn, affect the amount of the settlement or verdict. Additionally, delaying treatment can also call into question whether the injury was sustained during the incident or at another time.

The Claims Stage

In order to open a case, the injured person meets with an attorney todiscuss the case and share information regarding the collision and subsequent injury. During the initial consultation, the attorney gathers pertinent information to your case, including medical treatment, insurance coverage, names and information of the at-fault party, potential witnesses and photographs of the vehicles involved in the collision and evidence of your physical injuries. Once the initial meeting concludes and the attorney is retained, the attorney then delivers letters of representation to the appropriate parties, which typically include the at-fault driver’s insurance company and your insurance company. While the investigation is taking place, you should continue treating for your injuries and share all case-related information with your attorney or his assistant.

The Investigation Stage

After meeting with your attorney and providing all pertinent information, your attorney will take over. During this period, all the important parts of the claim are investigated, which may include speaking with your doctors, expert witnesses, fact witnesses, defense attorneys, and insurance adjustors. Your attorney’s primary responsibility is building a case on your behalf, utilizing the attorney’s specialized knowledge and experience. The role of the attorney at this stage is to do whatever needs done to maximize the client’s monetary recovery.

The Effort to Settle

Once the investigation is completed and you have been released from further medical care, the attorney will then compile a settlement package for the at-fault party’s insurance company. The settlement package is an orderly presentation of documents that demonstrate the loss you experienced as a result of the at-fault party’s negligence. These documents may include witness statements, medical bills, medical records, wage loss documentation, photographs, expert reports, and any other document that the attorney believes will fully demonstrate your loss (including inability to perform your usual activities, pain, loss of enjoyment of life, etc.). Once the package is submitted, the negotiation process begins. If the adjuster ultimately offers an acceptable amount of compensation, the case will be settled, but only with your consent. A Settlement typically requires the execution of a release of liability. However, if no agreement is reached, which is often the case at this stage, the attorney will likely recommend filing a lawsuit against the at-fault party.

Settlement during The Litigation Stage

The litigation stage begins when the attorney files a lawsuit on your behalf. Once the lawsuit has been properly served, the insurance company will hire an attorney to represent the at-fault party, who will file an “answer” on behalf of his/her client. The defense attorney will also submit written: “discovery requests” to your attorney, which are essential questions that you will need to answer and requests for copies of documents. Your attorney will also likely submit “discovery requests” to the at-fault party as well. Once discovery is complete, but some time before it is complete, depositions of the parties are typically scheduled. A deposition is a legal device utilized by attorneys to obtain testimony under oath from the other party or a witness prior to trial. The testimony is recorded by a stenographer that can later be transcribed for use at trial or in support of a motion. Depending on the complexity of the case, the litigation process can take anywhere from six months to two years to be completed.

Resolution Before or After Trial

Once a lawsuit has been filed, there are 4 primary ways that your case will be resolved: 1) an out-of-court settlement through informal discussions with the defense attorney or insurance adjuster or 2) a formal settlement conference with a trained mediator (referred to as a mediation), 3) the issuance of a “summary judgment” (granting judgment in favor of one party on a legal issue), and, finally 4) by a jury verdict. Many times, before a jury trial, the at-fault insurance company will make a final effort to resolve the case. If both parties accept the settlement, then the case is resolved, and the lawsuit will be dismissed. If the parties are unable to reach a settlement, either informally or at mediation, and summary judgment has not been granted to one of the parties, the case will proceed to a jury trial. Jury trials can take as little as two days to complete, or in a complex case, multiple weeks to complete.

Plymale & Dingus Obtain $3,925,000 Verdict on Behalf of Client; Ohio Legislature Will Cause Verdict to Be Reduced by About 90%

Six years ago, 59-year-old May Hicks was struck by a vehicle as she walked out of Scioto Downs Casino and Racetrack in Southern Columbus. In addition to a shattered lower leg and ankle, May sustained head injuries and partial hearing loss. She was hospitalized for eight days, then confined to bed for four months, and for the remainder of her days she will need a cane to aid in walking. Her ankle will never function normally again. The Casino/Raceway refused to pay. Claiming they had done nothing wrong, they offered to pay only $15,000 to May for her injuries and medical bills.

In October 2019, Shawn Dingus and Mike Guluzian represented May in a jury trial against the driver and Scioto Downs. After four days of testimony, the jury found both the driver and Scioto Downs responsible for causing May’s injuries and awarded her the sum of $3,925,000 in damages. The jury found the driver negligent for failing to yield the right-of-way to May and found Scioto Downs responsible for failing to protect its customers, from whom it makes millions of dollars each year. Specifically, the evidence showed that Scioto Downs funneled pedestrians to a dangerous area leading away from the casino to its parking lot, failing to erect any signs warning drivers they were approaching a crosswalk or to take other actions to protect its customers once they left the casino. Compounding these failures, the casino also chose to park a shuttle bus on the roadway that partially obstructed the view of both drivers and pedestrians. These failures played a significant role in the events that would forever change May’s life.

Unfortunately, Ohio law will prevent May from receiving what a jury of eight Ohio citizens determined she deserved. In the end, May will likely receive only one tenth the of the actual verdict amount.

Why? Tort reform.

You may have heard it mentioned in the news once or twice. It sounds like something an older British gentleman wearing a powdered wig might declare in Parliament.

In reality, it’s a very American issue, and it’s costing deserving Ohioans like May Hicks millions in rightful compensation. Which is why at Plymale & Dingus we call it “tort deform.”

Tort reform is politician talk, worded to convince you, the public, that substantial jury verdicts for serious injuries need to be reined in. So, legislation was passed by the Ohio legislature in 2005 which limits the amount of damages an injured person can receive to $250,000 in most cases, up to an absolute maximum of $350,000 where the injured person’s medical expenses exceed $120,000.

It’s a win for large businesses like Scioto Downs and insurance companies that go to trial knowing they can’t be held liable for more than $350,000—a drop in the bucket compared to what they should be accountable for.

It’s a loss for May Hicks, a beloved figure in her community who runs a small market that’s a favorite for local fireman, police, and veterans.

And it’s a loss for democracy. Trial by jury is an essential part of our democratic system and, in fact, that right is enshrined in the U.S. Constitution. Trial by jury does not always yield a just result, but experience teaches us that citizen participation in the process of administering justice is part of the glue that keeps us on the pathway of democracy. The Legislature’s so called “Tort Reform” nullifies the jury’s verdict and renders this and many such jury verdicts nearly meaningless, essentially saying that juries can’t be trusted to decide how to compensate injured victims. Of course, the Ohio “tort reform” says nothing about very low or inadequate jury verdicts. It addresses and greatly reduces only verdicts for the most severely injured. Those citizens who are most deserving of substantial money damages are now, by law, limited in the recovery of those damages. In our opinion, in passing this law, the Ohio legislature has catered to the desires of big business and sent the message that Ohio citizens are too dumb to be trusted with deciding what is just and fair. Instead, the legislature has declared that they are superior to those who voted them into office. Moreover, the imposed limits on damage recovery apply to all jury verdicts without the legislators having heard one word of the evidence in the case. In doing so, our legislature has also sent another message to Ohio citizens: that the bottom line of big businesses is of more importance to them than the safety and welfare of its own citizens.

Tort reform affects every liability case in Ohio, save only the most extreme cases (paraplegia, loss of a limb, death, etc.) and it has been enacted and enabled by legislators in the Ohio statehouse who have failed to amend it in any serious manner over the last 14 years.

Thanks to this law and the legislators who refuse to abandon this incursion on our right to trial by jury, injured Ohioans, like May Hicks, are not only being deprived of millions of dollars, they are also being deprived of their Constitutional right to trial by jury. Instead, as in many autocratic countries, this part of our Constitutionally protected “Right to Trial by Jury” is no longer “inviolate.”

If You are the Victim of an Animal Attack, Do You Need an Attorney?

Animal injury cases can be complicated. If you are the victim of an animal attack, your legal rights and options may be affected by the actions you take immediately following the attack. For the best course of action, follow these steps and then contact an attorney who has experience with animal attacks.

What to Do If You Are Attacked by an Animal

Victims of animal attacks may be able to recover damages for their injuries, as well as medical and psychological expenses, loss of income, and, in some cases, punitive damages.

If you are attacked by an animal, follow these steps to protect your legal rights:

  • Seek medical attention as soon as possible.
  • Take photos of the injury.
  • Keep track of your medical providers and medical expenses.
  • Get the owner’s information (name, address, and phone number).
  • If there were any witnesses to the attack, get their information as well.
  • Ask for proof of rabies vaccination or have the animal tested for rabies.
  • Contact an attorney with experience in animal attacks before signing or agreeing to anything.

What Should I do After an Auto Accident?

When an accident occurs, the people involved usually feel rattled and shaken. The scene of an auto accident is often chaotic and confusing. From assessing the damage done to your vehicle, to making sure that you obtain the other driver’s information, the actions you take following a collision can significantly impact your accident claim. In this blog, we explain what to do after you have been in a car accident.

Don’t Apologize for the Accident

Often, people will feel obligated to apologize to other drivers or witnesses for an accident. Even when the accident isn’t their fault, social conventions seem to force these people to say sorry for the inconvenience. Although our society values politeness, apologizing for an accident can hurt you’re your claim to damages. Any form of apology can be taken as an admission of fault by an insurance adjuster. Although you might feel rude, it’s important that you avoid apologizing at all costs. Don’t say statements like:

  • “I didn’t see you.”
  • “I wasn’t paying attention.”
  • “I’m sorry about that.”
  • “I’m fine.”
  • “I’m okay.”

Each of these statements can potentially harm your accident claim

Take Pictures of the Accident Scene

After an auto accident, you should make sure that all parties involved are safe. Call 911 to report any injuries. After you have made sure that everyone is safe, you can start taking pictures of the accident scene.

The pictures you take should clearly show the progression of the accident. Get quality images of any evidence that can be used to establish property damage or injuries from the accident. This can be very useful later on. Remember, the quality of your pictures will matter in court, so take the best pictures that you can. Avoid taking blurry or pixelated photos that do not make for good evidence.

Filing an Insurance Claim after an Auto Accident

After a car accident, your insurance company may make you an offer, however, it is very important to remember that insurance companies usually have their own best interest at heart, not yours. Often when an insurance company makes an offer, it is not as much as they are truly willing to pay, unfortunately, however, after an offer is accepted you will not be eligible to pursue further compensation from them. This is why it is so important to contact a member of our team for a FREE consultation. Call today and learn what your case may be worth.

U.S. Supreme Court to Decide Constitutionality of Ban on Same Sex Marriage

The U.S. Supreme Court has agreed to hear arguments in four same sex marriage cases this April. The justices will decide whether to uphold bans in Michigan, Ohio, Tennessee, and Kentucky. The court had previously declined to decide the issue because the circuit courts that had previously issued rulings all ruled against the ban. With the 6th Circuit’s decision, the federal appellate courts are no longer unanimous in their decisions. The U.S. Supreme Court’s decision to hear these cases comes on the heels of Florida’s recent January 6th recognition of same sex marriage, the 36th such state to do so, and the critical questioning of state bans in Texas, Louisiana, and Mississippi.

If the ban on same sex marriage is lifted, insurance companies will likely be required to extend insurance benefits to same sex spouses. The decision, however, will likely have no effect on the ability of self-insured plans to implement a plan-specific definition of “spouse.” While employers may use their own terms to define spouse, enacting a definition of spouse that is at odds with state and federal law may expose those companies to lawsuits under the state and federal anti-discriminatory statutes. Many expect a decision by June of this year.

Alabama set to begin issuing marriage licenses to gay couples

Alabama has become the 37th state to support legalizing gay marriage as an Alabama Federal District Court has ordered the issuance of marriage licenses for same sex couples on Monday, despite heavy opposition from the state’s chief judge, Roy S. Moore. This comes following his eleven-hour effort to order local judges to disregard the ruling legalizing gay marriage within the state. “Effective immediately, no Probate Judge of the State of Alabama nor any agent or employee of any Alabama Probate Judge shall issue or recognize a marriage license that is inconsistent with [state law],”Alabama Supreme Court Chief Justice Roy S. Moore said in an order.

The U.S. Supreme Court denied Alabama’s request to stop the issuance of marriage licenses to same sex couples as the District Court ruled last month that the state must issue marriage licenses starting Monday, February 9th. Moore wrote the order alleging that the ruling violates the U.S. and Alabama Constitutions. However, the move drew quick condemnation among legal experts and human rights activists alike as the Federal Court’s decision superseded the state court decision and Moore was in no position to disregard the order. This move drew comparisons to the state’s decision to block the implementation of a federal order to integrate the University of Alabama in 1963.

Ice and snow go away, let the sun shine today

Regrettably, ice and snow are a part of wintertime life in Ohio. Those are not my words, but those of our state supreme court. Unfortunately inclement weather, such as that we’ve recently had, leads to a number of mishaps and injuries caused by slipping and falling on snow or ice covered streets, sidewalks, or parking lots. During such times we receive many calls from our prospective clients who have been injured by such a fall. It’s my unpleasant task to inform them that our supreme court has decided that there is no liability on the part of a property owner for injuries resulting from natural accumulations of ice and snow on outdoor parking lots or sidewalks as the property owner is charged with no duty to remove such hazards. This is true even where a local ordinance requires the abutting property owner to clear sidewalks of ice and snow.

As to ice or snow tracked into a place of business, barring some exceptional circumstances, there is also no liability on the part of the business owner or property owner for injures resulting from a fall caused by the tracked in moisture. Regrettably, the law expects pedestrians who traverse areas of accumulated ice or snow to be aware of and to exercise caution when ambulating over the area. Fortunately, the law treats less harshly those whose injuries have been caused by the business owner or whose neglect in cleaning up hazardous accumulations on the floor of their premises has resulted in an injurious fall to their customer.

I’m sure you hope, as do we for warmer days.

Court of appeals orders new trial after woman breaks neck and is awarded only $2,114.11

In March of 2011, Plaintiff Gerri Thomas, a licensed practical nurse, was injured in an automobile collision when a truck driven by Defendant Nicholas Pisoni struck her while she traveled at approximately 40 mph. At the scene of the accident, she was placed in a neck collar and backboard for immobilization and transported to the hospital. Once there, it was discovered that the force of the collision broke the Plaintiff’s neck at the C-6 vertebrae. Plaintiff’s doctors ordered that she wear a hard cervical collar to allow the bones to heal. Unfortunately, Plaintiff experienced increasing pain and was first treated with steroid injections but eventually required surgery. Due to the injury, Plaintiff testified that she lost wages totaling over $9,400.00, out-of-pocket medical expenses of $4,467.00, and incurred medical bills of approximately $37,000.00.

After hearing all of the evidence, a Stark County jury awarded Plaintiff just $2,114.11. Of this amount, $700.00 was for lost wages, $214.11 was reimbursement for her cervical collar, and $1,200.00 was for pain and suffering. Plaintiff requested a new trial arguing that jury’s verdict was inadequate and contrary to both the law and the facts presented at trial. This request was initially denied but was later granted on appeal by the 5th District Court of Appeals.

The Appellate Court found that “[t]he jury’s award did not fully compensate [Plaintiff] and denied her justice.” Thomas v. Pisoni, 2015-Ohio-376, ¶ 35 (5th Dist. Stark). The court went on to state that the “jury’s verdict was inadequate because there was no evidence disputing the severity of the collision; no evidence, expert or otherwise, disputing the collision neither solely caused appellant’s fractured neck and subsequent surgery; nor disputing the collision resulted in limited life functions, pain and discomfort.” Id. The Court concluded that the damages award could not be reconciled with the “uncontroverted evidence” and was “against the manifest weight of the evidence.” Id. at ¶37. Let us hope that Ms. Thomas’ next trial fully and adequately compensates her for the injuries and delivers the justice she was denied at her first trial.