Expert Witness Corner: Maximising Quantum – A Physiotherapist’s Role

Traditionally, personal injury cases involve a report from an orthopaedic consultant or general practitioner to help establish the nature of the medical condition and its causation and prognosis. An experienced clinical physiotherapist can offer a complete understanding of the whole process from first injury right the way through to recovery. Armed with this knowledge, a more thorough and wide-ranging report can be provided that will accurately reflect the extent and timing of patient recovery – essential when considering issues of quantum and future care costs.

Soft tissue injuries are injuries not involving bony damage such as fractures. They are often incurred as a result of whiplash or repetitive strain and, as the name implies, only involve damage to muscles, tendons, ligaments, fascia and nerves. The damage is usually invisible on x-rays and scans and can be detected only by skilled examination. Torn muscles, ligaments, nerves and cartilages may require a surgeon’s skills. But once this primary care has been administered, the client will invariably be referred to a physiotherapist. A physiotherapist can provide specific and individually tailored treatment aimed at assisting the body’s natural healing and restoring full function.

Examples of relevant soft tissue injuries include:

•Tendonitis
•Tenosynovitis
•Muscle strains
•Lifting injuries
•Lower back pain
•Epicondylitis
•Carpal tunnel syndrome
•Whiplash injuries
•Work-related upper limb disorders.

When examining issues of quantum and future costs, it is essential that a lawyer receives the whole picture: the exact nature of the injury, detail of treatment, likelihood of full recovery, timing of recovery, and an indication of future care costs, if any. An experienced physiotherapist in clinical practice has a wealth of relevant expertise.

A clinical physiotherapist is usually involved with a patient from presentation of the injury through to the end of rehabilitation. Treatment can be broadly divided into four stages:

1: Conducting a detailed specific examination to identify the body structures damaged and any loss of function.
2: Devising a treatment programme.
3: Implementing the treatment programme.
4: Seeing the patient through to the end of rehabilitation – hopefully back to ‘normality’.

The ‘hands-on’ nature of the patient–therapist relationship, plus the inevitably regular patient contact, give physiotherapists an enormous advantage when it comes to diagnosing and treating a complex soft tissue injury. In addition, the wealth of knowledge relating to rates of recovery from the various soft tissue injuries means that when it is applied to cases requiring an evaluation of quantum and likelihood of recovery, the lawyer receives an opinion from an expert with an understanding of the whole rehabilitation process.

Client history:

Any comprehensive account of the background to an injury (particularly where it is work-related) should include information about the claimant’s regular daily activities, whether in a work environment or home situation. A physiotherapist is accustomed to observing and assessing the impact of a client’s environment on his or her injury. This is an essential consideration when seeking to restore full function.

Case Example:

Mr T had been using an improvised workstation and subsequently incurred severe soft tissue injuries. The physiotherapist identified how the postural stresses on the body had resulted in the patient’s symptoms. Excruciating pain along the spine – relieved only by lying flat – and severe pain and tenderness of the forearms were the consequence of sitting for 3 months of intensive work on a laptop.

Client Examination:

Soft tissue injuries are difficult to assess accurately, with x-rays and scans rarely providing useful evidence. Even nerve conduction tests are of little value when assessing damage to nerves subjected to excessive stress. What is required is an evaluation of any adverse mechanical tension within the nervous system which may be restricting movement.
Physiotherapists are used to palpating and testing specific structures within the body to diagnose exactly what has been damaged, i.e. whether it is a tendon, a tendon sheath, muscle, fascia, a nerve or any combination of these. A physiotherapist can help in differentiating between whether the client’s condition is constitutional and has been aggravated by work or trauma, or is caused by work or trauma.

There is a growing acknowledgement of the need for a biopsychosocial assessment when examining people, and this is the approach traditionally taken by a physiotherapist. Social history and status, mental and emotional states, as well as working situation and lifestyle, can all contribute to how the patient reacts to and copes with symptoms.

There are many standard tests that can help with the assessment of the physical condition. One such example is the straight leg raise. The test involves the patient lying comfortably relaxed on his back. The examiner places one hand under the Achilles tendon and the other above the knee. The leg is lifted perpendicular to the bed, with the hand above the knee preventing any knee bend. The leg should be lifted as a solid lever moving at a fixed point in the hip joint.

This is a simple biomechanical test that has been recognised for hundreds of years as a way of identifying lumbar spine (lower back) problems. However, it is of limited value only. When the leg is lifted in the manner described, many structures move – the hamstring muscles, the lumbar spine, the hip and sacro-iliac joints and fascia, as well as the nerves. Pathology of any of these structures may affect the client’s reaction to the test.

An experienced physiotherapist will combine such tests with detailed palpation and observation of functional movements to arrive at the all-important specific diagnosis. In addition, the patient’s posture and manner of movement will be analysed and the results added to the overall assessment.

Case example:

Mrs B was secretly videoed by an insurance company while shopping. A physiotherapist was able to identify how the client had become so used to coping with her injuries that she avoided a lot of the normal, potentially painful, actions employed by other women shopping, e.g. standing upright with arms by her side most of the time, avoiding heavy or bulky items, loading carrier bags lightly, and using both hands to carry each bag.

Expert opinion:

An experienced clinical physiotherapist possesses an unrivalled knowledge and comprehension of how the body works under normal conditions and when coping with a disability or soft tissue injury. With regular and prolonged experience of treating soft tissue injuries, a physiotherapist can offer a valuable and meaningful opinion about all aspects of treatment and recovery.

Prognosis:

An essential component of any medico-legal report is a prediction of future developments on a balance of probabilities basis. A clinical physiotherapist sees large numbers of similar injuries from first contact through to recovery, and can thus give a reasoned prognosis based on experience. This should include the likelihood and anticipated timing of resolution, the need for further treatment and any possible long-term disability.

Conclusion:

When a lawyer is trying to find an expert witness that can help with soft issue PI cases it is worth considering an experienced physiotherapist can bring a unique and valuable perspective in any personal injury case involving a soft tissue injury. Experience of patients from first injury right through to recovery gives such specialists the widest professional knowledge when it comes to assessing future treatment and costs thereof, and arming the lawyer with the necessary detail to fully assess quantum.

Rosemary Quinn is an experienced physiotherapist based in the North West of England. You can view her profile and find an expert witness at X-Pro, the innovative expert witness directory.

Construction Dispute Resolution Expert Witness Assistance

The construction of a new home or office building can be a daunting task to manage. From the beginning of the process, stress immediately sets in. The finding and selection of a contractor is not an easy task. In fact, the pre-construction part of the project can often be the most stressful part of the project.

However, if you have ever had to go through the process of having something go wrong with the project, and the subsequent legal action, then you know pre-construction stress is nothing compared to the stress of the possibility of needing construction dispute resolution.

The Legal Aspect of Contract Disputes

When you are in the legal realm of construction dispute resolution you will likely have to rely on a construction expert witness. If you are bringing legal action against the builder you will need to prove that the builder, or builders, breached their contractual obligation. In the area of construction there are often many gray areas that a homeowner or a business owner might not be fully aware of.

These gray areas typically involve things like disclosure of building practices and codes, the pulling of city or town required permits, and various kinds of hold-harmless agreements. The legalese involved in most construction contracts should signal to buyer that he or she ought to seek legal advice before entering into any agreements.

Getting an Expert for Your Case

Most people who are engaging a construction company for work are not experts in construction themselves. Therefore, when something goes wrong with the structure of the building or elements of the structure (like electrical work, mold issues, and settling issues) it is hard for the buyer to know who is legally liable. This is when a construction expert witness is helpful.

You can hire a construction expert to come in and review the contracts and workmanship. When it comes time for trial you can call this person as a construction expert witness to bolster your case against the defendant.

If something happens to your new home or office, and really even before anything happens, you should consider bringing an expert on board to help spot any issues before the situation turns into a complex, expensive, and stressful legal process that neither side wants to deal with.

Construction dispute resolution is really a stressful process unless you have the right construction expert witness.

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How To Choose A Property Expert Witness For A Valuation Report

Under the terms of Part 2 of the Landlord and Tenant Act issued in 1954, should a dispute arise over the renewal of a lease for either a commercial or business property the issue is taken into the hands of the county, and should you find yourself in this situation the aid of a property expert witness report will be invaluable to your case. The report emerges after the exchange of factual information from the two respective parties, each of which will then use the information gathered to produce a property report to argue their side of the case. Once exchanged with the rival representative on a date well in advance of the court hearing, the report will be analysed and be the central component in the court case.

The Landlord and Tenant Act of 1954 is intended to give business the additional security of tenure and under the act a tenant using property for a business of commercial act cannot merely be evicted in the procedure of providing a notice to quit or the ending of a fixed term agreement tenancy. The Act indicates quite clearly that in the case of a property owner wishing to seek the end of a tenancy that a notice must be served allowing the tenant to respond and this is where the services of an expert witness may come into play. The case will, if not resolved between the parties, result in a County Court case in which property witnesses will be called upon to produce expert reports in order to fight and defend the case of the individuals or companies being represented.

If you are involved in any case or situation with disputes regarding commercial or business property then a property expert witness will be required and this can be sourced by a wide variety of means including solicitors and chartered surveyors. In return for the fee paid, the property witness will act on your behalf to compile the expert witness report to present your case. The property expert will provided you with knowledge, expertise and a wide range of relevant experience to assist you in the disputed property case. Not only will the expert provide you with their expert property witness report but they will also attend court, as per the norm, and present the evidence gathered and issue professional witness evidence.

As in any case centring on a form of dispute with two sides being presented the witness will be cross examined and the property report will be part of this. The property expert provided, for instance, by the charted surveyor will be fully prepared, trained and experienced in such a matter and present your case in a confident and convincing manner. The service may be offered under the title of valuation expert witness or a valuation expert witness report depending on the nature of the case but both function in the same nature and with the same purpose, to assist you in a victorious case.

In this respect therefore as with all legal matters the property witness or valuation witness has a obligation and duty to the court to ensure the information provided in either the valuation report or witness report is honest, reliable and bears credibility otherwise the whole case may be placed in jeopardy but using an expert witness from a reliable company, such as a chartered surveyor, should see you avoiding such problems.

 

For help with compiling a property expert witness report or valuation expert witness report speak to Mackenzie Associates.

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Rewards for Evidence of Ambulance Fraud Available to Whistleblowers Under the False Claims Act, According to Young Law Group


Philadelphia, PA (PRWEB) April 28, 2014

The fraudulent billing of Medicare by ambulance companies is an area prime for whistleblowers with the U.S. Department of Health and Human Services estimating that ambulance providers were overpaid more than $ 300 million last year.* Employees who identify that their company is charging Medicare illegally may earn a substantial reward if they report their evidence through the procedures set up by the False Claims Act and the United States recovers money from the company as a result.

Medicare pays for transportation by ambulance when it is medically necessary. “Although there are dialysis and cancer patients who may appropriately require rides for treatment, unscrupulous service providers will offer ambulance rides to patients who they could safely transport in a wheelchair van or could drive their own vehicle. The owners implement this practice in order to line their pockets because the government will reimburse more for ambulance transportation,” commented Eric L. Young, Esq., Managing Partner of Young Law Group.

Other practices which may violate the False Claims Act include the billing for emergency services in non-emergency situations, business acquired by referral agreements prohibited under the Anti-Kickback Statute and under the table payments to patients are also prohibited.

“Employees at companies engaged in this misconduct should consult with an attorney to determine their rights,” said Young. The Young Law Group offers a free, confidential evaluation to potential whistleblowers who have evidence of fraud by ambulance providers against the U.S. government. Please call 1-800-590-4116 for additional information.

“The federal government revised the False Claims Act in 1986 to strengthen the public-private partnership in the fight against fraud,” declared James J. McEldrew, III, Esq., Of Counsel to Young Law Group. “The government can not investigate every bill submitted by Medicare service providers in order to determine whether the charge is valid. It relies, in part, on ethical individuals working for the companies and others who come across evidence of fraud to report it.”

The False Claims Act authorizes individuals to report fraudulent bills submitted to and paid by Medicare in a qui tam lawsuit. If the government or the relator, as the whistleblower filing the lawsuit is commonly known, is able to recover money paid out by the government through litigation, the relator may receive between 15 and 30 percent of the amount recovered. The law also provides whistleblowers with protection against retaliation by authorizing a federal lawsuit for damages when an employer changes the terms and conditions of their employment due to lawful whistleblowing.

Earlier this month, the payment data for $ 77 billion paid through Medicare Part B to 880,000 providers in 2012 was released by the Centers for Medicare and Medicaid Services (CMS).** The $ 5 billion paid by Medicare to ambulance companies in 2012 was more than was paid to orthopedic surgeons or cancer doctors.*

The Medicare data reveals that the program pays fifty percent more per patient, on average, to providers in West Virginia, Massachusetts, South Carolina and New Jersey for transportation. This may signal fraudulent billing but insiders are needed to confirm it with actual evidence of fraud. The U.S. government has already identified Houston, Texas and Philadelphia, Pennsylvania as areas where illegal billing is likely to originate. New ambulance companies are not permitted to register with Medicare and Medicaid in these two regions at present.

About Young Law Group, P.C.

Young Law Group represents whistleblowers reporting health care fraud to the U.S. Government via qui tam lawsuits permitted by the False Claims Act. Young Law Group also represents individuals reporting securities fraud to the SEC/CFTC programs and tax evasion to the IRS.

Eric L. Young, Esq., Managing Partner of Young Law Group, represented the first whistleblower awarded compensation by the IRS under the mandatory reward program created following the Tax Relief and Health Care Act of 2006. Young has also served as an expert witness in areas of U.S. whistleblower law and represented clients in some of the largest qui tam recoveries, including United States ex. rel. Lucia Paccione v. Cephalon Inc., E.D.P.A., 03-CV-6268.

For a free, confidential case evaluation and discussion about whistleblower laws and rights, please call Eric Young, Esq., at 1-800-590-4116.

Young Law Group, P.C., is a private law office located at 123 S. Broad St., Ste 1920, Philadelphia, PA 19109 with attorneys licensed to practice in Pennsylvania. The firm will associate with local counsel in other jurisdictions when necessary. Young Law Group may not be able to represent residents of all states.

Learn more about Eric Young, Esq., and Young Law Group at http://eganyoung.com

For attribution purposes:


http://www.bloomberg.com/news/2014-04-24/medicare-s-5-billion-ambulance-tab-signals-area-of-abuse.html

** http://money.cnn.com/2014/04/09/news/economy/medicare-doctors/







Integrity Consulting Group Successfully Managed the Reinvention of New York City Landmark Restaurant Tavern on the Green

New York, New York (PRWEB) April 26, 2014

Integrity Consulting Group (ICG), industry leaders in strategic real estate project management headed by Richard Jantz and Michael d’Orlando, was hired by restaurateurs Jim Caiola and David Salama, licensees of the new Tavern on the Green. ICG coordinated and organized the extensive team of builders and contractors needed to build out the interiors and exterior gardens of the landmark restaurant in New York City’s Central Park.

NYC Department of Design and Construction and the NYC Parks Department performed the significant structural and exterior work, allowing Integrity Consulting Group the opportunity to focus on building out the interior and kitchen to meet their clients’ specifications as well as the naturalistic park setting exterior design.

Integrity Consulting Group’s role expanded to be the conduit between the City’s team and the needs of the restaurant. ICG immediately began overlaying the developing design of the interior infrastructure and spaces to the established design of the core and shell to avoid rebuilding any items that could be in conflict with the restaurant. In addition to these tasks, ICG was tapped to coordinate the approvals of the Public Design Commission and the Landmarks Commission in close coordination with the Parks Department.

ICG managed every aspect of the project from coordination of the implementation of the work to providing strategic advisory to Caiola and Salama to managing the procurement of the custom furniture and light fixtures that highlight the space.

Tavern on the Green at 67th Street and Central Park West reopened today, Thursday, 24 April with an official ribbon-cutting ceremony overseen by NYC Parks First Deputy Commissioner Liam Kavanagh, with both ICG’s principles Richard Jantz and Michael d’Orlando on hand to proudly reveal the new incarnation of the beloved New York City icon.

About Integrity Consulting Group

Since 1996, Integrity Consulting Group’s (ICG) partners have been industry leaders in the field of Strategic Real Estate Project Management providing invaluable service to our clients (property owners and developers) for projects totaling over 25 million square feet of space. ICG offers comprehensive services for businesses at every point in the Real Estate project lifecycle including: Due Diligence, Real Estate Market and Needs Analysis, Project Analysis, Project Planning (Scheduling and Budgeting), Design Management, Contracting, Implementation Management, Project Close-Out, Expert Witness Service.







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Ways to determine a reasonable moving quote

If you want a smooth moving, look for a licensed and insured mover. But most of the people choose moving companies on the basis of their quotes. They are unaware of the fact that going with a less expensive moving company will end up paying in frustration. Some of your delicate things may get scratched or damaged by hiring cheaper and less trustworthy movers.

Usually all the professional moving companies London will give you an estimate on how much it would cost you to move your possessions. You first thing while planning to seek a professional help from a moving company is to get an accurate quote, to avoid any kind of dispute towards the end.

Research a lot before hiring movers London. You may check their history with the Better Business Bureau for complaints. Following steps should be taken to get an estimate from the moving company before you enter into any agreement with them.

Inventory of the items

Usually moving companies base their quote on the weight of the items, if your move goes over 40 miles. It also depends upon the number of items that are required to pack at the time of moving. So, it is better to make a list of items to be moved. Some good moving companies send their representatives to the homes to be moved, to make an inventory of items, so that they can offer you an accurate quote. Always ask for a copy of inventory and counter check whether all the items are included in it.

Weight and shape of things

Heavy things will cost more while moving. For instance, books may not consume much space while loading onto a truck, but too much of them can make a box weigh about 50 pounds, consequently augmenting the cost of the move. Similarly, odd shaped things, which require creative skills to move also, cost more. Sometimes, a piece of furniture with a weird shape is taken out of a window, instead of a narrow staircase. Moving a piano may require third party services, leading to an increase in the total estimate of the move.

Compare quotes from various companies

Get as many quotes from different companies as you can. Compare them on the basis of the facilities being provided by moving companies London. This way, you will not fall into the trap of companies which are charging a much higher price than the going rate in the market.

Ask whether the moving company is charging for additional services like insurance, fuel and staircase. Feel free to ask as many questions as you can before finalizing the deal. A good moving company will whole heartedly satisfy all your moving related queries.
 

Author has been associated with professional london man with a van services from a long time. Presently with his vast experience, He is helping others in choosing the best service provider for them in london and its surroundings.

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