Traumatic Brain Injury in Connecticut

Casper & de Toledo fights hard for its clients by utilizing the latest technologies. To the right are examples of charts used in a traumatic brain injury case.


Connecticut Brain Injury Lawyers Group

At the law offices of Casper & de Toledo, we are committed to ensuring that the legal system works as it should to bring about justice for victims of traumatic brain injury (TBI). We bring to our cases dedication, expertise, and repeated success.

The Connecticut traumatic brain injury lawyers at the law firm of Casper & de Toledo represent victims of mild, moderate and severe traumatic brain injury caused by incidents such as motor vehicle including car accidents, truck accidents and motorcycle crashes; construction site accidents, falls, birth injury and exposure to toxic substances like lead paint. If you or a family member has suffered a head injury, contact us to schedule a free initial consultation with an experienced Connecticut brain injury attorney (C.B.I.A.).

Sometimes a traumatic brain injury is referred to as a “closed head injury”, an “acquired brain injury or gives rise to a medical diagnosis such as “post-concussive syndrome” or PCS. On other occasions, particularly with injuries suffered by children, a diagnosis following a car accident or a sports related injury, may be simply “concussion.” In any case, your lawyer’s understanding and knowledge of the highly technical field of brain injury, traumatic brain injury or acquired brain injury is essential. This can make a difference not only in the way your case is presented but also in the way your case is perceived by an insurance company. At Casper & de Toledo, our brain injury lawyers have considerable experience. Our team is led by Stewart M. Casper, a past President of the Connecticut Trial Lawyers Association, the Past Chairperson of the Traumatic Brain Injury Litigation Group of the American Association for Justice “AAJ”, and the past Editor-in-Chief of the “Traumatic Brain Injury Litigation Group Newsletter” that is disseminated throughout the country to other lawyers who devote themselves to brain injury cases. Mr. Casper also serves on the National Legal Advisory Board of the Sarah Jane Brain Project and he has lectured on Traumatic Brain Injury througout the country.

Moderate and Severe Brain Injury

The type of injury typically associated with moderate and severe traumatic brain injury usually involves brain damage that is easily identified on imaging studies that yield diagnoses such as subdural hematoma, epidural hematoma, contusion of the brain, brain hemorrhage, skull fractures, subarachnoid hemorrhage, intraventricular hemorrhage, and other types of head injuries. These examples of acquired brain damage are routinely discovered on a CT scan examination performed in the Emergency Department after trauma. However, a CT scan cannot be relied upon to identify all brain damage. Injuries classified as moderate or severe may have a catastrophic impact not only on the life of the injured person, but on the lives of his or her family members and loved ones as well. Generally, the most contentious cases involve diagnoses of mild traumatic brain injury (“mTBI”), complicated mTBI and concussion. Emphasis should be placed upon the diagnostic criteria and the capability of the diagnostician. Included among the among the important early criteria are: 1) the length of any period of loss of consciousness; 2) the existence of any full or partial amnesia for events that precede the injury (“retrograde amnesia”) or follow the injury (“anterograde amnesia”) and the existence of any positive findings of damage on clinical neuroimaging including CT scan (the “Gold Standard” for emergent imaging) and clinical magnetic resonance imaging (“MRI”).

The Connecticut brain injury attorneys at Casper & de Toledo are not intimidated by difficult cases and are even willing to take on cases even where liability may not be obvious and clear. Rather, we look closely at cases from various perspectives while examining the nature and quality of the evidence to determine if there is enough evidence to pursue a viable claim.

At Casper & de Toledo, we have frequently been called upon take over a case that has been handled by another lawyer who is less knowledgeable in the brain injury field. Clients retain the right to change lawyers. Successor counsel becomes obliged to protect the financial interests of predecessor counsel. Before doing that, our policy is to not only meet with the potential client but also to review current counsel’s file before making commitments to the client and predecessor counsel. While we do not relish taking over a file, our experience in the brain injury field allows us to plan a strategy to maximize the potential of a case. For example, this was accomplished in 2014 in McCauley v. Designing Nature LLC, a case involving a severe brain injury and serious orthopedic injuries to a 10 year old boy. The lawyers who handled the early stages of the case were planning on taking an easy settlement for the available insurance policy limits. When Stewart Casper was consulted, he recommended abandoning the easy settlement and advocated an aggressive trial approach that resulted in a recovery after obtaining a jury verdict approximately five times that which predecessor counsel sought. In a 2015 case involving a mild traumatic brain injury to a woman who fell in a retail store, predecessor counsel recommended a settlement of $100,000. Stewart Casper devised a plan to fully assess both the difficult liability issues as well as the evidence concerning the client’s brain injury and her problem with chronic pain. After a mediation, the client elected to settle the case for $2.6 million. In many instances of moderate and severe traumatic brain injury,, it is necessary to secure a neurosurgical consultation and in some instances, brain surgery is necessaryto relieve the build up of intracranial pressure caused by a swelling brain, to repair the source of a hemorrhage; to repair damaged brain tissue or to repair displaced skull fractures.These types of brain injuries are frequently caused by occurrences that involve a high rate of acceleration followed by rapid deceleration or a large force of impact that can occur in a car accident, truck accident or serious fall. In such cases, while the injury may be easier to define than milder injuries, it is still necessary to secure the appropriate expert witnesses to outline what is often a lifetime of misery resulting from phsycial injury as well as cognitive, emotional and behavioral problems.

Life-Altering Qualities of a Serious Head Injury

There is no such thing as a “good brain injury to have.” A traumatic brain injury is serious and life altering. Brain damage often affects body functions, from speech, to senses of taste and/or smell, to visual distrubances. Brain injury can also cause damage to the pituitary gland that in turn can cause hormonal problems. One client in her twenties experienced a hormonal disruption that resulted in infertility. It is widely recognized that TBI can result in physical, cognitive, emotional and behavioral changes to the patient. People with traumatic brain injury often require long-term or even lifetime medical care, and many never recover from their injuries. Traumatic brain injuries of all types can have devastating consequences on a patient’s life and the lives of family members. In many cases, cognitive losses may result in the loss of relationships and careers with concomitant emotional and financial consequences. To measure such losses for compensation purposes, the Connecticut Brain Injury Attorneys at Casper & de Toledo rely upon a diverse group of interdisciplicary experts who are knowledgeable and can quantify the diverse problems and complications that impact all aspects of life.

The Elusive Nature of Mild Traumatic Brain Injury

While moderate and severe brain injury is generally easy to identify, mild traumatic brain injury is another story entirely. In fact, many cases of mild traumatic or acquired brain injury are overlooked entirely. Many health care providers are not properly trained to screen for mild traumatic brain injury; sometimes other acute injuries such as fractures or internal injuries suffered in a car crash can distract attention from a head injury; sometimes health care providers simply diagnose a concussion without focusing on the potential that the concussion may result in lasting cognitive deficits, personality changes, and/or secondary alterations to brain structure. In addition, even mild traumatic brain injury can result in loss of taste or smell, hearing and balance disorders (for example, tinnitus or vertigo), and, in some instances, seizure disorders of various magnitudes.

One reason for the failure to properly identify mild traumatic brain injury is that the system for classification of brain injury is antiquated and focuses on the initial period of the accident and the period that immediately follows the accident. The most common classification system in use in the United States was published by the American Congress of Rehabilitation Medicine in 1993. That system recognized that a brain injury would exist if there was a loss of consciousness for less than 30 minutes or some altered state of consciousness such as confusion or disorientation as well as some other circumstances.

Documentation of very brief periods of loss of consciousness and altered states of consciousness have become the subject of much controversy. In the interval between an accident and a witness coming to the aid of an injured person, there may well be a short period of loss of consciousness. Rarely are emergency personnel on the scene immediately. Once at the scene, even EMTs lack the necessary training to properly document any confusion or disorientation. They use a “mini-mental status” exam which is sometimes noted as “oriented X 3″ meaning the patient knows who she is; knows where she is; and knows the date. Another crude measure is the Glasgow Coma Scale-a crude measure of survivability. On a maximum scale of 15, most mild TBI patients are scored at 14-15. Neither a normal finding on the mini-mental status exam nor the Glasgow Coma Scale is sufficient to rule out a traumatic brain injury.

As noted above and equally disturbing to the brain injury screening process, hospital emergency departments leave much to be desired when it comes to adequately documenting findings that might be consistent with acquired brain injury. One important study that confirmed this was published in the Archives of Physical Medicine & Rehabilitation in 2008, Powell JM et al, “Accuracy of Mild Traumatic Brain Injury Diagnosis”, Vol. 89, pp. 1550-55.

Finally, clinical and research experience since 1993 have provided much new information that tells us that there are other reliable tools for documenting mild traumatic brain injury including advanced neuroimaging techniques and the self report of patients. The latter has proven to be the case based upon nearly a decade of experience with head injuries from concussive events in the Wars in Iraq and Afghanistan. To this end, the American Congress of Rehabilitation Medicine published a “Position Statement: Definition of Traumatic Brain Injury” in the Archives of Physical Medicine & Rehabilitation in November 2010, Vol. 91, pp. 1637-1640. The Position recognized that adjustments to the paradigm of mild traumatic brain injury published in 1993 needed to change.

In addition, as noted above, the classification system is based upon symptoms and levels of consciousness at the time of the injury and initial medical treatment. That system ignores the manifestation of the consequences of the traumatic brain injury over time. While it is expected that the level of consciousness will improve from the acute onset of the injury, there are many symptoms of TBI that actually worsen over days, weeks and sometimes months following the trauma. Ironically, brain injury is one of the few medical conditions that are not reclassified based upon worsening symptoms.

The major dispute that often arises in cases involving mTBI in litigation focuses upon the statistical probability that patients whose injury does not rise to the level of complicated mild traumatic brain injury will fully recover are generally thought to be high – that is, in the range of 75-80%. See Bigler ED et al, “Reaffirmed limitations of meta-analytic methods in the study of mild traumatic brain injury: a response to Rohling et al”, Neuropsychologist, 2013;27(2):176-214. (abstract). The remaining subset of patients that experience chronic post-concussion syndrome are a diverse group who lack common traits for pre-existing phsycial and mental profiles; cognitive reserve; heterogeneity of injury; post-injury psychological sequelae (“Persistent disability is a risk factor for late-onset mental disorder after serious injury”, Holmes, AC et al, Aust N Z J Psychiatry. 2014 Dec;48(12):1143-9 (Abstract); “Predictors of New-Onset Depression after Mild Traumatic Brain Injury”Rao V et al, J Neuropsychiatry Clin Neurosci. 2010 ; 22(1): 100–104. (Open Access)), and even the existence of litigation to induce feigning for secondary gain. Within the “mild” classification of TBI, it is likely that early symptom burden is one of the best predictors of poor outcome. “Early symptom burden predicts recovery after sport-related concussion”, Neurology, 2014;83:2204–2210. The most contentious battles in litigation are joined when the defense retains one member of the group of forensic neuropsychologists whose income has become overwhelmingly dependent upon insurance company remuneration for opinions that are not supportive of a brain injury claim. The theories of these defense witnesses is often at odds with the current peer reviewed literature and repeats unsupported claims that have been made for decades despite advances in the field. In Connecticut, claimants retain the right in personal injury cases to object to defense examiners who repeatedly demonstrate their bias. Two Connecticut based defense neuropsychologists that this office always resists are Stephen D. Sarfaty, Psy.D. of Cheshire and Kimberlee Sass, Ph.D. of New Haven. Notwithstanding our objections, insurance defense lawyers crave these witnesses to such an extent that they will often forego examinations and seek opinions based simply on file reviews.

As should be evident, to properly handle a case involving a traumatic brain injury, it is not enough to simply be a trial lawyer. Rather, it is important to master the complexities of the medicine, the technology and the specialists in the field. This cannot be accomplished “on the fly” but rather requires an ongoing devotion to the brain injury field.

A Commitment to Results and Justice

Experienced Connecticut brain injury attorneys, the lawyers of the Stamford, Connecticut, office of Casper & de Toledo, are prepared to fight for justice for victims of many unfortunate incidents. These include children who experience Shaken Baby Syndrome in daycare settings, victims of car accidents, truck accidents, falls, workers who suffer loss of cognitive function due to exposure to toxic chemicals, and assault victims who suffer because they have been attacked in public places with inadequate security or lighting. Casper & de Toledo’s attorneys also have a strong track record of advocating on behalf of people injured due to falls, sports and recreational injuries and other accidents.

How We are Prepared to Help You

Here at Casper & de Toledo, our brain injury attorneys in Stamford, Connecticut are in a select group of lawyers nationwide who have attended advanced seminars for lawyers dealing with some of these very significant issues. Not only has Partner Stewart Casper attended these advanced educational programs for lawyers (which teach specifics in the areas of medicine, brain imaging, neuropsychology, life care planning, and retention of proper experts) but he has also taught at several of these programs. He has attended a special programs taught by experts on “Advanced Techniques in Neuroimaging” that included the subjects of CT Scans, Magnetic Resonance Imaging, MR Spectroscopy, Functional MRI, Diffusion Tensor Imaging, PET Scans and SPECT Scans and courses on neuroscience and seminars for health care professionals sponsored by the North American Brain Injury Society.

Our firm is located in the heart of Stamford, Connecticut. Our Stamford brain injury lawyers practice regularly throughout Fairfield County (major court facilities are located in Stamford, Bridgeport and Danbury) and throughout the state of Connecticut.

Explore our website to learn more about our experience with traumatic brain injury cases, as well as other types of law. Contact our Connecticut brain injury lawyers to schedule a consultation regarding your legal options after you or a family member has suffered a concussion, loss of consciousness (LOC), post-traumatic amnesia (PTA), chronic headaches or other physical, cognitive, or behavioral abnormalities after an event such as serious car accident or truck accident, sporting event mishap, or workplace injury.

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