Source: https://eupdatelouisianalitigation.com/
Timestamp: 2019-04-22 20:22:42+00:00

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This article appeared in the DRI “In Transit”, Vol.19, Issue 1 on March 4, 2016.
In the past few years, the Center for Disease Control and other organizations have mounted a major public awareness campaign concerning the effects of concussions. In the spring of 2015, the NFL settled a widely publicized brain injury class action lawsuit for close to one billion dollars. Coincidentally, March 2015 marked the first annual National Brain Injury Awareness Month. This heightened attention to brain injuries will most certainly result in an expanded litigation market – much to the future detriment of the trucking industry.
The plaintiffs’ bar is now ramped up and ready to make trucking companies their number one target. A simple internet search of “trucking and brain injuries” will net results from a multitude of law firms soliciting individuals involved in trucking accidents, encouraging them to file claims. As we know from past experience, an uptick in awareness coupled with an aggressive solicitation strategy by plaintiffs’ lawyers can result in questionable and fraudulent claims. This article will provide the trucking industry with tips on what to look for when confronted with what may seem to be a questionable brain injury claim. This article will also provide the trucking industry with advice on how to respond.
There are several “grades” or degrees of brain injuries. This article focuses upon the MTBI, or Mild Traumatic Brain Injury, because this injury has the greatest potential for fraud due to the self-reporting nature of the diagnosis criteria and the lack of objective medical evidence necessary for diagnosis.
But what does that mean? Perhaps it is easiest to think of a MTBI by comparing it to a Traumatic Brain Injury (TBI) which is much easier to understand and quantify. A TBI involves a severe brain injury. For example, the plaintiff fractured her skull, her brain was bleeding, or she lost consciousness for more than a half hour and/or had posttraumatic amnesia lasting over 24 hours. There will also be objective evidence of a TBI, such as a MRI or CT scan. A MTBI is of lesser severity than a TBI but is much harder to diagnose and quantify, due often times to a lack of objective medical evidence. Because a MTBI can be diagnosed solely upon the self-reporting of the patient, much like a soft-tissue claim, there is ample room for interpretation/debate, and therefore fraud.
Consider this scenario: The defendant truck driver rear-ends a sedan at 15mph. The sedan is operated by a 55-year old who gets out of car and tells our long haul trucking client that she was feeling “a little excited” but otherwise not injured. The trucker and the operator of the sedan have a seemingly normal conversation at the scene. Everything seems fine but an ambulance transports the accident “victim” to the hospital out of precaution. The repair estimate to fix claimant’s bumper cover vehicle is less than $3,000 and it seems the claim is closed. Then, almost two years later, the trucking client is sued by the driver of the sedan who is claiming she has a MTBI and demanding over $1,000,000. She claims her symptoms worsened over time. Now she can no longer concentrate, is sensitive to light and sound, and has severe depression and anxiety. Plaintiff further claims she will never be able to work again and has been on disability since the accident. In support of her claim, plaintiff offers a host of medical records from treating physicians who based their diagnosis of MTBI solely upon symptoms reported to them by the plaintiff. All of the test results, including multiple post-accident MRIs, CT scans, and MRAs in our hypothetical scenario are “normal.” Photographs from the accident scene certainly do not show a million-dollar hit and the truck driver is in disbelief that plaintiff is claiming a brain injury because everything seemed fine at the accident scene.
1. Did plaintiff lose consciousness?
This is a key question when deciphering whether there could be a MTBI because the medical community is in agreement that the loss of consciousness is a key (but not required) marker when identifying a MTBI. In a fraudulent or questionable MTBI case, the plaintiff will often say she lost consciousness or “thinks she may have” lost consciousness. Oftentimes plaintiffs will testify that they are now so brain-injured as a result of the accident that they cannot remember either way. This is where the driver plays an important role. Speak to him about his interactions with the plaintiff at the scene. Ask him how much time elapsed between the impact and when he first observed the plaintiff. Did she exit the car immediately? Could the truck driver see plaintiff moving about in her car after impact? Find out whether the truck had a dash cam or other audio/video system that could provide clues. Of course check the driver’s written report regarding these issues. Also, obtain the EMS report and police report as they may provide clues as to whether plaintiff lost consciousness at the scene. The testimony of independent witnesses may also be helpful. Keep in mind, even if they did not witness the impact, they may have observed plaintiff’s behavior afterwards.
2. Did plaintiff have amnesia?
The more detail plaintiff can provide about the accident, whether at the scene or later during deposition, the more likely it is that plaintiff did not sustain a MTBI. Again, ask your driver exactly what plaintiff said at the scene. The more detail he can recall about plaintiff’s statements the better. And when it comes time to depose the plaintiff (we always recommend doing so on video), have her provide as much detail as possible about the accident and the accident scene. The more she can recall, the less likely it is that plaintiff sustained a MTBI.
3. Biomechanics – Can a Minor Hit Result in a MTBI?
Anyone defending against a MTBI should consider reading the 2008 book, “Mild Traumatic Brain Injury and Postconcussion Syndrome” by Michael A. McCrea. In chapter five, entitled “Biomechanics of MTBI,” the author outlines several studies/experiments that used video reconstruction, Hybrid III crash test dummies, and live instruments in the helmets of Virginia Tech football players to conclude that there is a minimal threshold of acceleration/deceleration to cause a MTBI. The studies show that the minimum threshold for in the range of 80-100g. In real-world terms, a 100g translational force is equivalent to a 25-mph motor vehicle crash into a brick wall, striking one’s head against the dash board. Hence, if your client’s truck rear-ended plaintiff’s vehicle at less than 25 mph, you may want to consider consulting with an appropriate expert(s) concerning this potential defense.
While the events that unfolded at the accident scene can show many important key facts indicating whether or not the plaintiff could have sustained a MTBI, important clues will likely be developed during the post-accident investigation phase. Below is a discussion of facts and circumstances unique to MTBI claims.
A MTBI is ostensibly a high-grade concussion. The medical community is in accord that concussions and MTBIs are at their worst when they immediately occur. Recovery begins within an hour or at the most, within a day or so. Unlike some back injuries, MTBIs are not progressive conditions and symptoms do not begin later in the future.
So in the example of our hypothetical plaintiff above, is it possible she could have a MTBI when our truck driver said plaintiff showed no symptoms at the accident scene? As part of the post-accident investigation, you must obtain all of plaintiff’s medical records both before and after the accident. If they show that plaintiff’s symptoms did not manifest until several days after the accident, the plaintiff does not have a MTBI.
One of the leading medical texts on the condition is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). This manual is widely used by clinicians and researchers to diagnose and classify mental disorders and is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. At page 624, the manual discusses the diagnosis criteria for MTBI and states, “the neurocognitive disorder presents immediately after the occurrence of the . . . injury or immediately after the recovery of consciousness . . .” Simply put, if the records and/or testimony show that the plaintiff did not have symptoms immediately after the accident, or immediately after regaining consciousness, she does not have an MTBI.
Our hypothetical MTBI plaintiff is alleging she can no longer work as a result of permanent cognitive deficits stemming from the accident. Is this possible? The answer is no. She may have a TBI but would need objective medical testing to prove it. More likely than not our hypothetical plaintiff has a pre-existing mental disorder or is falsifying her claim because one cannot have permanent sequelae from a MTBI.
Older, less refined studies from the 1980s and 1990s suggested that a small percentage of patients with MTBI could have permanent debilitating cognitive deficits. However, medical science and brain injury research techniques have advanced significantly since then. The consensus in the scientific community now is that symptoms from a MTBI resolve in a short period of time – usually a few days but not more than three months. The 2002 book entitled “Brain Injury and Mental Retardation: Psychopharmacology and Neuropsychiatry”, by C. Thomas Gualtieri is an authoritative resource on how to treat brain injuries. It states that there are no credible descriptions of patients with MTBI who have developed a declining IQ, psychosis, seizures or any catastrophic disability unless the patient has a preexisting or some other condition.
In sum, the post-accident investigation must include a thoughtful, deep dive into plaintiff’s pre-accident medical records. Employment and school records should be obtained and scanned for pre-existing mental conditions, including depression and anxiety. Importantly, the post-accident medical records should be analyzed to determine whether plaintiff’s symptoms worsened with time after the accident.
MTBIs bear a resemblance to soft-tissue injuries in that there is no reliable medical test that can objectively and definitively diagnose the injury. As the trucking industry is well aware, many compensation seeking individuals claiming soft tissue injuries are not completely honest about their symptoms. The same could be true for plaintiffs claiming a MTBI.
One of the criteria for a MTBI includes “any alteration of mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused).” Hence, one can have a MTBI without presenting any objective medical evidence. For example, a plaintiff can claim she was dazed and confused at the time of accident, and now suffers from persistent headaches, dizziness, memory loss and other debilitating cognitive defects all of which could satisfy the medical definition for having a MTBI. Even worse, plaintiffs’ treating physicians can be deceived into believing plaintiff has a MTBI if they accept a plaintiffs’ self-reporting, which is common. Of course, the treating physicians have a vested financial interest in providing “treatment” as they know well in advance whether they will be fully compensated for services rendered. Further, the “treatment” methods are non-invasive and carry zero-consequence side-effects. Much like soft-tissue cases there is no incentive for treating physicians to root-out those who provide false self-reporting symptoms. To the contrary, as with soft-tissue claims, the system is ripe for fostering false claims and the potential for fraud is high. Unlike a soft-tissue claim, however, a MTBI claim can have a jury verdict value far exceeding a few thousand dollars. Given the minimum mandatory liability limit of $750,000 applicable to the trucking industry, all of the pieces are in place for plaintiffs to take advantage of the system by falsely self-reporting symptoms of a MTBI – at the expense of the trucking industry.
Malingering is always a concern in MTBI cases, especially when the individual is seeking compensation. However, the trucking industry has a few unique tools at its disposal that can help combat against specious MTBI claims. Dash cams are more prevalent than ever and can provide key evidence showing whether the plaintiff lost consciousness at the scene. They can sometimes show plaintiff’s behavior, including whether or not the plaintiff appeared to be dazed, dizzy or confused in the aftermath of the impact. Further, advances in GPS and EDRs can indicate the speed and velocity involved, including whether or not the impact took place at or below 80-100g or 25mph.
Because the trucking industry has more at stake (i.e., high liability insurance limits or SIRs) it is well suited to invest in a competent defense. Defending these claims is very expensive, and should almost always include a neuropsychological examination. One little publicized fact about the neuropsychological examination is that it contains a series of validity sub-tests that are designed to detect whether or not a plaintiff is malingering. These sub-tests are called “Performance Validity Tests (SVTs),” “Word Memory Test,” “Repeated Battery for Neuropsychological Testing (RBANS),” “Reliable Digit Span,” “Victoria Symptom Validity Test,” and “Test of Memory Malingering (TOMM).” Another validity test, called the “Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF)” has two subparts called the “Fake Bad Scale (FBS)” and the “Response Bias Scale (RBS).” A competent neuropsych doctor can utilize the results of the above-referenced tests to conclude whether or not the plaintiff is over-reporting symptoms and/or exaggerating memory complaints and/or providing full effort on the overall neurophysiological exam. Otherwise stated, these sub-tests are the only known way to show that a “self-reporting” MTBI plaintiff is exaggerating or lying about her symptoms. Not surprisingly, when plaintiffs are not being truthful about their MTBI, they fail these tests with such flying colors that the results are comparable to those of someone that barely regained consciousness following a ten-year coma.
With the increase in awareness of concussions and brain injuries, the plaintiffs’ bar is poised to bring a new wave of litigation. Their primary target is the trucking industry. Due to the self-reporting nature of the MTBI, and the lack of objective medical testing proving or dis-proving the same, there is ample room for fraud and deceit. Factors to consider include whether the impact was at 100g (akin to 25mph), and whether the plaintiff lost consciousness or had amnesia. If plaintiff is claiming her symptoms worsened over time, or that she is not back to baseline after three months, the claim is likely exaggerated. The trucking industry has certain tools, including dash cams, GPS and EDRs that can assist it in identifying and defending against false MTBI claims. Further, special attention should be paid to validity test neuropsych results that are designed to detect whether a self-reporting plaintiff is providing false and misleading symptom reports.
Robert S. Stickley is a partner at the Philadelphia law firm of Langsam Stevens Silver & Hollaender, LLC. He focuses his practice on the defense of commercial vehicle and auto accident cases. He has tried numerous high-severity trucking accident cases to verdict and has extensive first-party commercial and personal lines claim handling experience.
This entry was posted in POSTS on April 6, 2016 by ksintz.
Plaintiff failed to state a claim for relief in her Complaint against Bayer Healthcare Pharmaceuticals, Inc. (“Bayer”), the maker of the Mirena intrauterine contraceptive, Id. at *5, and her case was dismissed, without prejudice, pursuant to Rule 12(b)(6) FRCP.
Plaintiff used a Mirena intrauterine contraceptive from 2007 until 2012 when she underwent surgery to have the Mirena removed because it had become embedded in her uterus. Id. at *2. Plaintiff sued Bayer, alleging that the Mirena device was defective under the Louisiana Products Liability Act (“LPLA”), along with theories of negligence, breach of implied warranty, breach of express warranty, negligent misrepresentation, fraudulent misrepresentation, and concealment. Id. Because Plaintiff’s claims arose out of her use of the Mirena product, the LPLA establishes her exclusive avenue of recovery. Accordingly, the court held that Plaintiff could not recover on any theory of recovery besides her claims under the LPLA. Id. at *3.
Ashcroft v. Iqbal, 556 U.S. 662, 678-79 (2009). The Court found that Plaintiff failed to state a claim under the LPLA because she failed to state how the Mirena device deviated from its intended design, failed to allege how the device was improperly designed, how the alleged defect caused her injuries, and failed to state how any allegedly inadequate warnings caused her injuries. Id. at *4-5. The Court ruled that the Plaintiff could seek leave to file an amended complaint. Id. at *5.
Once upon a time, federal court product liability and toxic tort practice involved “notice” pleading: a plaintiff filed a complaint identifying defendant and mentioning a LSA C.C. art. 2315 and maybe a statute or two – and that was all you needed to “notice” plead. Specific facts to support the claims would be developed in discovery.
In 2008-2009, the Supreme Court refined “notice” pleading in the Ashcroft v. Iqbal, 556 U.S. 662 (2009) and Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) cases. Defendants in products and toxic tort cases have used the new “notice” pleading in Rule 12(b)(6) motion to dismiss practice to require a plaintiff to make detailed, fact-specific allegations on technical matters involving the product at issue, e.g., pharmaceutical or chemicals, that historically were developed in fact discovery. The penalty for failure to make these fact-specific allegations is dismissal of part or all of Plaintiff’s suit before discovery even starts.
In Hargrove, Plaintiffs, a husband and wife, alleged that the wife developed chronic pancreatitis after a medical device manufactured by defendant broke apart in her body. Plaintiffs filed suit based on the LPLA in federal court. Defendant filed a motion to dismiss under Fed. R. Civ. P. Rule 12(b)(6), because the Complaint failed to state a claim upon which relief could be granted.
The court first dealt with Defendant’s assertion that Plaintiffs’ claims had prescribed. Noting that federal Fifth Circuit jurisprudence holds dismissal based on prescription under 12(b)(6) is improper if “prescription presents questions of fact that cannot be conclusively resolved on the face of the pleadings,” the court denied Defendant’s motion to dismiss on the basis of prescription. It held that the facts alleged in the Complaint supported application of contra non valentem to toll the running of prescription while Plaintiffs attempted to determine what had gone wrong with the device and by whom it was manufactured.
The court next examined whether Plaintiffs had alleged specific facts for their claims falling under the LPLA. The allegations were sufficient to state a claim that the product was unreasonably dangerous in construction and composition because Plaintiffs alleged that the product was “not properly manufactured,” was “inadequate or insufficient to maintain its integrity,” and was “sold in a defective condition.” But, the court then held that the Plaintiffs failed to specifically allege facts sufficient to state a claim under the other three theories of liability.
On the design defect claim, although the Plaintiffs’ allegations “address[ed] the [product’s] design,” Plaintiffs failed to allege an alternative design existed and could not elevate their allegation above a speculative level by stating that defendants committed “other acts and failures” in the design as would be learned in discovery.
Plaintiffs failed to state a claim for inadequate warning based on the “learned intermediary doctrine,” under which manufacturers must only warn the doctor, not the patient. The court held that because Plaintiffs’ Complaint alleged that Defendant failed to warn the “end user” of the risks of using the product, Plaintiffs failed to address whether “a proper warning would have changed the decision of the treating physician” and thus failed to state a claim under the inadequate warning prong of LPLA.
On the warranty claim under the LPLA, the Court found no facts alleged to support these claims.
The Jenkins case illustrates a more traditional, related notice pleading standard.
In Jenkins, Plaintiff alleged that ingestion of the drug Abilify caused him to develop Tardive Dyskinesia, a “neurological disorder characterized by involuntary movements of the face and jaw.” Plaintiff asserted liability under LPLA for failure to warn and defective design.
Defendants moved to dismiss the defective design claim under Fed. R. Civ. P. Rule 12(b)(6), arguing that Plaintiff merely pled that Defendants failed to consider an alternative product design and the LPLA requires that such design exist at the time the product left the control of the manufacturer and that the danger of the damage outweighed the burden of adopting the alternative design. Defendants argued that Plaintiff’s claim for failure to warn should be dismissed because the Complaint failed to mention the adequacy of warnings provided to Plaintiff’s prescribing physician, nor did it allege that the physician would have prescribed a different drug with a different warning.
In opposition, Plaintiff argued that Louisiana law recognizes “much of the evidence in pharmaceutical products liability cases may be in the defendant’s possession, and thus, without the benefit of discovery, stating more specific allegations may be nearly impossible” at the motion to dismiss stage. On the failure to warn claim, Plaintiff argued that his reference to “health-care providers” should be read to include his prescribing physician, but if the court finds this to be unclear Plaintiff requested leave to amend his petition.
To allege a failure-to-warn claim upon which relief can be granted under the LPLA, Plaintiff is not required to detail what an adequate warning would be and how an adequate warning would have caused Plaintiff’s treating physician to act differently. Plaintiff is merely required to allege that Defendants did not adequately warn Plaintiff’s treating physician and that the inadequate warning constituted the proximate cause of Plaintiff’s injuries.
Payne v. Gardner, 2010-2627 (La. 2/18/11); 56 So. 3d 229.
Payne involved injury to a 13 year-old boy who climbed onto an oil well pump’s pendulum to ride it up and down like a seesaw. During this ride, the plaintiff’s pants caught in the pump and he was hurt.
Plaintiff sued the pump manufacturer for manufacturing an unreasonably dangerous pump (in the 1950s when the pump was built). The manufacturer was granted a summary judgment in its favor based upon the fact that plaintiff’s use of the pump as a seesaw was not a “reasonably anticipated use” that the manufacturer foresaw. In the words of the court, “reasonable persons could reach only one conclusion, i.e., riding the pumping unit was not a reasonably anticipated use of the unit at the time it was manufactured.” Payne, 56 So. 3d at 232.
Matthews v. Remington Arms Co., 641 F. 3d 635 (5th Cir. 2011).
The plaintiff in Matthews, supra, lost an eye when the Remington rifle he had borrowed exploded in his face. When plaintiff pulled the trigger on the rifle, it was missing a pin that was approximately 7/10” long and 1/4” in diameter. The manufacturer apparently conceded that the rifle would either misfire or explode if it was fired without the pin in place.
Batiste v. Brown, 11-609 (La. App. 5 Cir. 1/24/12); 86 So. 3d 655.
In Batiste, the plaintiff worked at a steel plant. In performing his job, plaintiff occasionally had to stand 40 feet above the plant floor on a 14” wide beam to screw in electrode cylinders that were used in the steel furnaces. In order to install the replacement electrodes into place, plaintiff also had to use a chain wrench to tighten the electrode. Plaintiff slipped on the electrode as he was tightening it, and fell 40 feet to the plant floor, injuring his spine in the accident.
Plaintiff sued the manufacturer of the electrode and the manufacturer of the chain wrench under the LPLA.
The electrode manufacturer was sued based on a failure-to-warn claim. Under the LPLA, a manufacturer need not give a warning where the user or handler knows or reasonably should know of the characteristic of the product that may cause damage. Here, it was undisputed that the plaintiff had actual knowledge of the dangers associated with installing an electrode 40 feet above the floor, and therefore, there was no need to warn the plaintiff of the potential hazard of falling while installing an electrode by standing on a 14 inch wide beam 40 feet above the floor without railings or a safety harness.
McDaniel v. Terex USA, LLC, 466 Fed. App’x 365 (5th Cir. 2012).
In McDaniel, supra, the plaintiff was injured when a drilling bit fell onto him. In order to do his job, the plaintiff had to work under the suspended drill bit. The manufacturer of the drill bit (and related equipment) argued that the operator’s manual for the drilling machinery warned against workers working underneath the drilling bit, and therefore plaintiff’s work under the bit was not a “reasonably anticipated use” of the bit.
The U.S. Fifth Circuit reversed the trial court dismissal and held that a jury should have decided what the “reasonably anticipated use” of the drilling bit was, particularly where there was evidence in the record that the normal operating procedure for the drilling machinery required that workers – like plaintiff – work under the drill bit suspended overhead. The Fifth Circuit found that plaintiff had presented evidence in his case-in-chief that the manufacturer should have known that persons were acting contrary to the operator’s manual warnings to not work underneath the drill bits. It also distinguished the Kampen case on the grounds that the manufacturer in Kampen was unaware that users were ignoring the express warnings by the manufacturer in the operator’s manual for that product.

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