The Process

There are four basic considerations in granting or denying an application for social security disability insurance.  They are:

• A Qualifying Medical Exam
• Medical History
• Work History
• Education Level

While the Social Security Administration determines eligibility using all of the above factors, the most crucial element may be the qualifying medical examination.  When a person applies for benefits, the SSA may ask the individual to be examined by a doctor who works for the Social Security Administration. This may not be in the best interest of the applicant, and it may be better for the applicant to get his or her own doctor to perform an exam.  The opinion of the doctor(s) about the nature and severity of a person’s impairment – including symptoms, diagnosis, and treatment – can be the deciding factor in whether an application is approved or denied.

Controlling Factors

Under Social Security Regulations, the doctor’s opinion is the most important medical opinion evidence.  The doctor’s opinion may be given “controlling weight” in the case.  That means that the SSA will adopt the doctor’s opinion as its own.   The SSA imposes many requirements to get to the point where a doctor’s opinion is given “controlling weight.”  It is important to know that not all doctors qualify to provide such opinions. Also, other medical professionals, such as nurses and rehabilitation consultants, will fall into the category of “other sources,” and their opinions will not carry as much weight as those of doctors who are deemed “acceptable” by the SSA.

Importance of Advice of an Attorney

If an applicant’s original claim is denied, and the applicant’s request to have the application reconsidered is denied, the next step is to request a Disability Hearing with an Administrative Law Judge.  Since over 60% of disability applications are denied at the application level, it is best to seek the counsel of an experienced attorney from the start. Success at a disability hearing turns on being able to present the judge with the right kind of evidence that gives a clear picture of the injury. At the same time, the applicant has to be able to respond to the vocational and medical experts who may be asked to testify about the severity of the injury sustained.

Call San Diego Law Firm for Help

The experienced injury attorneys at San Diego Law Firm can advise you on your potential eligibility for social security disability benefits and help you through the application process.  Please contact us at (619) 794-0243 for a consultation.

Proving Causation in a California Mold Injury Claim

In mold claims in California a person must prove causation in two steps. First, a person must show that mold exposure can cause a physical illness.  Second, a person must show that the exposure did cause their particular illness.  A recent California case demonstrates just how important it is to make a causal link between illness and exposure when suing to recover money for personal injuries.

Consider the Case of Dee v. PCS Property Management

In the case of Dee v. PCS Property Management, Darcee Dee lived in an apartment for slightly over four months. She sued her landlord and the property management company for physical injuries from being exposed to toxic mold.  The experts in the case argued that Dee’s exposure to mold caused her symptoms, but did not present any evidence that she was exposed to the harmful toxin at her apartment. In the end, Dee’s claims were rejected by a jury and she got nothing. 

It is clear that bringing or defending a mold claim in California requires the testimony of experts that show or rebut a causal connection.  It you are in either situation you need a  legal team that understands the complexity of mold lawsuits in California. The attorneys at San Diego Law Firm can help with this unique type of claim. Please call us at (619) 794-0243.

What is Bad Faith?

Simply put, an insurance company acts in bad faith when the company acts unfairly towards its policyholder.  An insurer cannot unreasonably deny a covered claim, or deny the claim without proper cause. Bad faith exists when the insurance company acts with malice or in a way that exceeds all bounds of decency. 

If My Insurance Company Denies My Claim, Have They Acted in Bad Faith?

Not necessarily.  An insurance company may have a legitimate reason for denying your claim. For example, an insurance company can deny your claim if you fail to meet your obligations under the policy – for example, if you do not make your premium payments on time, or wait too long to ask for benefits once they are due.  It can also lawfully deny a claim for a loss or event not covered under the policy.  If your insurance company erroneously denies you benefits that you are entitled to under the policy, that may violate your insurance policy contract, but it does not necessarily reach the level of bad faith

What is The End Difference Between  a  Mistaken Violation of an Insurance Contract and A Bad Faith Violation?

The main difference is the amount and type of damages that an insurance company will likely have to pay if a jury decides the insurance company acted in bad faith.  If an insurance company acts in bad faith, it can be sued for punitive damages, the sole purpose of which is to punish and deter outrageous behavior.  Outrageous behavior may exist where an insurance company claims manager or executive acts with malice or reckless disregard for the rights of the insured person.

Consider The California Case of Patsy Bates vs. Health Net, Inc.

In the California case Bates vs. Health Net, Inc. , Health Net, Inc. was ordered to pay more than $9 million to a breast cancer patient, Patsy Bates, whom it dropped while she was in the middle of chemotherapy.  Patsy Bates was left with more than $129,000 in medical bills and as a result was forced to stop chemotherapy for several months.  Newspaper reports said the private arbitration judge who decided the dispute called Health Net’s actions “egregious” and said that Health Net demonstrated little interest in its insured; had this case gone to trial, it likely would have resulted in a verdict of bad faith.  A verdict of bad faith requires a showing that an insurance company did something for which it should be seriously punished.

What Should You Do If Your Insurance Claim Is Denied?

If your claim for benefits under any policy of insurance – health, disability, homeowners, auto, or business – has been wrongfully denied, please contact the experienced attorneys at San Diego Law Firm.  We can quickly determine whether your claim is covered under your policy, and evaluate the grounds for the denial.  If there is a substantial amount of money at stake, we will make a written demand to the insurance company for payment of your benefits.  If that demand is refused, we will take your case to arbitration, mediation, or a trial, and will seek justice and full compensation for you. For more information or an appointment, please call San Diego Law Firm at 619-794-0243.  We look forward to helping you.

Many unsafe products make it onto the market and into consumers’ homes, only to cause serious and even fatal injuries.  Sometimes manufacturers and sellers don’t do enough to ensure safety because they don’t want to cut into profits or delay sale of the product. 

Product recalls are an unavoidable part of our consumer-oriented world.  The widespread Toyota recalls over vehicle acceleration and other safety issues probably come to mind.  Mariko Sanchanta and Yoshio Takahashi of The Wall Street Journal report that over the next year, the financial hit to the carmaker because of these recalls could potentially total over $5 billion. 

Injuries have been caused by dangers and defects found in a wide range of products, including:

    ●  Household products and appliances

    ●  Electronics

    ●  Medical products

    ●  Prescription drugs

    ●  Foods

    ●  Toys

    ●  Cribs and other children’s products

    ●  Vehicles

    ●  Tires

What makes a product defective?

Your right to sue manufacturers and sellers for your injuries caused by a faulty product comes from “products liability” laws. 

These laws identify three basic types of defects:

1.  Manufacturing defect – The product is dangerous because of a mistake in how the product was made or assembled. 

2.  Design defect – Even if the product is put together properly, the product is dangerous because of the risks created by its design. 

3.  Marketing defect – You weren’t given proper warnings about the product’s risks or the product’s label was misleading.  The product could also be defective because you weren’t given proper instructions on how to safely use the product. 

If a manufacturer should know that a product could be used in a wrong way, then its design or warning has to address the possible misuse to reduce the chance you’ll be harmed.

What you can do if a defective product seriously injures you

The injuries caused by a defective product can be serious and even life changing, but the maker and seller of the unsafe product could potentially be held responsible.  In these situations, San Diego Law Firm can seek financial compensation for injury to yourself or a loved one.  Start your case as soon as possible, because the law limits how much time you have to start a lawsuit.  Find out how we can help by contacting San Diego Law Firm’s experienced and dedicated products liability lawyers at (619) 794-0243.

The lawsuit itself is officially started by filing a “complaint” that’s prepared by the plaintiff’s attorney after investigating the facts and researching the law that applies to the case. The complaint will set out the legal grounds for the lawsuit against the defendant and make a request, such as for monetary compensation.  This document, together with a “summons” that orders the defendant to respond to the claim, will be delivered (“served”) to the person being sued. After being served, the defendant’s lawyer must act quickly and within the deadline to respond to the lawsuit and can take different actions depending on the situation.  For example, the defendant can file an answer to the complaint, object to the complaint because it doesn’t state a legal claim, raise defenses, and may even have his or her own claim against the plaintiff.  If so, the defendant’s attorney will file a counter-claim, called a “cross-complaint” in California state courts, to which the plaintiff will have to respond.  If there’s a legal basis for it, one party can also try to get a judgment on the case (or part of it) without a trial, or get the case dismissed. 

The attorneys will also begin “discovery,” which allows more investigation tools to be used so the parties can prepare or defend against the lawsuit.  A few of the most important ways to gather evidence during discovery include interrogatories (written questions prepared by the lawyer that have to be answered under oath), depositions (questions that will be answered orally under oath), and orders for the other party or subpoenaed third parties to produce documents and photos.  Throughout the process, lawyers will meet with the judge for conferences on the status of the lawsuit.  Before the trial is set, the question will come up on whether there will be a jury trial or a bench trial (where a judge will decide your case).  Depending on the lawsuit, you may have a right to a jury as long as a request for a jury is made within the time required, but sometimes the parties may want to waive this right and have the case tried by a judge.  If not, then a jury will be selected.  Then, attorneys for both parties will go through all the typical steps in a trial, i.e. opening statements, examining and cross-examining witnesses and experts, and presenting closing arguments.  During the trial, either side may continue to try to cut the trial short and get a judgment in its favor.  If the trial continues, lawyers will prepare jury instructions for the court’s approval.  Jury instructions explain the laws that jury members must apply to the case (in other words, the specific things that must have been proven), and the judge will read approved instructions to the jury.  After jury deliberations, or after the judge has reached a decision in a bench trial, the verdict will be read.  A party might decide to challenge the judgment with a post trial motion, or by filing an appeal. 

While it’s easy to focus on what lawyers do during a lawsuit, we’ll also advise you on what you can do from the start to help improve your chances of winning.  For instance, it’s key that you tell us not only everything that can help your case, but also anything that has the potential to hurt it.  Also, be careful to provide complete and accurate answers to interrogatories and during depositions, because dishonest answers are usually caught later and can significantly damage your case.  Your credibility and truthfulness will influence the judge or jury’s decision as they weigh the evidence in your case.  In doing our part to maximize the likelihood of success, we’ll identify your goals with you, thoroughly investigate your case, and persuasively negotiate with the other side.  Although we’ll strive for settlement from the outset, we’re fully prepared to litigate your case in court.  If you’re faced with a legal dispute, act quickly so that you don’t lose your right to sue or defend a case because you’ve waited too long.  Reach San Diego Law Firm’s experienced trial lawyers at (619) 794-0243.

- A breach of contract lawsuit must be brought within 4 years from the date of breach if the agreement is in writing, or within 2 years if you had an oral agreement, but it may be possible to shorten the period by contract

- A claim for fraud must be filed within 3 years from the date the fraud was actually discovered

- A defamation case (libel or slander) must be filed within 1 year

For the most part, these are strict time limits, so if a case is filed with the court after time has run out (even by just one day), then the defendant can assert that the claim is barred, leaving the plaintiff out of luck.   Even so, sometimes it’s possible to “toll” the statute of limitations period.  If tolled, time is essentially paused.  There are several different situations when time can be tolled, and one common example involves minors.  For instance, if the would-be plaintiff is still a child when the claim arises, then this is considered a legal disability and the limitations period will be tolled until the minor turns 18 (in most cases), although a parent may prefer to file on behalf of the child instead of waiting.  In addition to tolling, an exception to the statute might apply in your situation.  Also keep in mind that the limitations period is often much shorter when suing the City of San Diego and other government agencies.

What’s more, depending on the circumstances, there isn’t always a black and white answer as to when the clock should start ticking.  In a personal injury case, it may be obvious when the date of the injury occurred.  Then again, what if it’s the type of injury that isn’t immediately apparent?  Here, the limitations period starts when the injury was (or should have been) discovered, which may be arguable under the facts, but this “discovery rule” doesn’t apply to all types of claims.  While all these time limits may seem arbitrary, there are practical and policy reasons behind these deadlines.  The sooner a lawsuit is filed, the better the chances of gathering important evidence, not to mention that your memory and that of any witnesses will be fresher and probably more reliable than if you wait seven years to start your case.  From a public interest standpoint, it’s unfair to allow the threat of potential liability to hang over someone’s head for the rest of his or her life; meanwhile a plaintiff shouldn’t be allowed to sit on his or her rights for years on end after suffering an alleged injury or harm. 

As you’ve probably guessed by now, there are times when the seemingly simple task of applying the statute of limitations to your case can turn into a complex legal analysis, but we’ll carefully research these issues when bringing or defending your case.  If you’re a potential plaintiff, then it’s crucial that you do your part to get your case started well before your claim expires to protect your rights.  We’ll advise you early on and help you avoid potentially costly missteps that can happen when communicating with insurance companies or others whose interests conflict with yours, even when they seemed to be on your side.  To reach San Diego Law Firm’s experienced attorneys for help with your litigation, business dispute, or personal injury matters, call us at (619) 794-0243.

For instance, what if the other driver involved in a car accident was driving in the wrong direction, but you were distracted while talking on your cell phone and didn’t see him coming.  Depending on where you live, even if you were found to be only 1% to blame, and the other driver was 99% at fault, you would generally recover nothing, thanks to an old English rule known as “contributory negligence.”  Only four states and the District of Columbia still apply this harsh rule, and luckily for San Diego plaintiffs, California is not one of them.  Instead, California is a “pure comparative fault” state.  This means that even if you’re more to blame than the other party, if the other party shares in at least some of the fault, you can still recover damages.  In these cases, the money you’re given is reduced by your percentage of fault.  Even so, there’s no formula to determine fault, and if you were overwhelmingly to blame, the chances are the jury will find you fully responsible and award you nothing.  Other states have modified comparative fault rules, and in these states an injured person can only recover if their fault is less than 51% or 50%.

We’ll evaluate the accident, and even if you were partly responsible, we’ll negotiate with insurance companies, always working toward reducing the percentage of fault placed on you so we can secure you the best possible outcome.  When it’s in your best interest, we’ll take your case to court and advocate on your behalf.  Remember that the other party’s insurance company is anxious to find a reason to place part or all of the blame on you, which is why you need to contact an experienced accident lawyer as soon as possible, preferably before you first speak with their insurance company (or your own).  Lawsuits must be filed within certain time limits, so be sure to contact San Diego Law Firm’s skilled accident and injury attorneys soon for a free of charge consultation.  Reach us at (619) 794-0243.