Vegas Personal Injury Law Blog

Most medical experts do not understand how to articulate their opinions on legal causation.

The pivotal issue on most personal injury cases centers on causation.  A medical witness must, to a reasonable degree of medical probability, relate the injuries to the subject accident.  For future pain and suffering and future medical care, the standard is to a reasonable degree of medical certainty. (Other legal foundational requirements involving medical necessity and reasonable and customary charges will be addressed in future Blogs.  This blog is limited to he issue of medical causation for past injuries).

“Reasonable medical probability, “means “more probably than not probable” (51%).

“Medical certainty”, as it applies to future damages, means that future medical expenses and/or future pain and suffering are reasonably certain to occur in the future.  It is a higher standard than reasonable probability.

The follow-up question in a deposition by the defense and under direct examination by plaintiff’s counsel at time of trial is: “What are the bases of your opinions on causation?  Keep in mind that causation is never a slam dunk; and, no accident case that involves litigation has a perfect causation scenario.  Pre-existing conditions, prior accidents, prior treatment, diabetes and osteoarthritis, even if remotely relevant,  are always raised by the defense to attack causation.  This is a format providing  examples of responses to the question, “What are the bases of your opinions on causation?”

1. My review of the medical records and the medical history provided by Mr. X indicates that Mr. X was asymptomatic in the affected areas prior to this accident for ______ (months) or ______ (years).  His injury symptoms developed within _____(hours) _____ (days) after being involved in this accident.  A delay in the development of  neck and back injury symptoms following a motor vehicle accident is he rule rather than the exception. (Explain why).
2. Mr. X was not taking pain medications before the accident and required pain medication, muscle relaxers and anti-inflammatory medications after the accident.
3. After the accident, Mr. X’s pain scales were high (give them a range) (Explain how pain correlates with traumatic injury).
4. Within ____ (hours) ______ (days) of the accident, Mr. X had positive neurologic and orthopedic test results (For each positive test and explain what injury it indicates).
5. After the accident, Mr. X had reduced range of motion in he following areas:  (give specific examples and explain how reduced ranges of motion correlate with injury).
6. After the accident, Mr. X was referred to a neurologist or neurosurgeon or orthopedic  surgeon for evaluation (explain the reasons why the referral was medically necessary).  Mr. X, prior to this accident had no such referrals. Explain the concern that conservative treatment was not sufficient to resolve the patient’s symptoms indicating a mores serious condition than he had in he past.
7. After the accident, Mr. X was referred to pain management (explain the reasons why the referral was medically necessary).
8. Pain management performed X, Y, Z and the results were A, B, C.  This confirmed the injury because ___________________________________.
9. Although Mr. X had some (neck and back) treatment before this accident (if it applies): a)    he recovered from his injuries and was asymptomatic before this accident; b)    he returned to an active lifestyle without pain; and c)    he participated in sports, fitness and recreational activities without limitations.
10. After the accident Mr. X’s activities were limited in the following ways ________.  These limitations do not appear in his pre-accident  records.
11. The accident as described by the traffic accident report and/or statements and/or answers to interrogatories and/or depositions depict an accident or event capable of causing movement that resulted in probable injury potential. Movement of  Mr. X’s body is confirmed by the entries in the medical records  and/or accident report and/or statements (Interrogatory answers, depositions) that I have reviewed.  These documents indicate that_________________________________________.
12. Although there is no way directly to equate injury to property damage, in my opinion, the significant events about the accident on injury potential are ______________.
13. Mr. X, because of his pre-existing arthritic condition, was more prone to injury than a person without osteoarthritis.  Osteoarthritis is generally an asymptomatic condition that can be made symptomatic by trauma. (Explain how conditions such as diabetes can affect the healing of musculoskeletal injuries and why prolonged treatment may be required).
14. Mr. X was in a posture or position at the time of the accident that made him more prone to injury (head turned to the side, body twisted, looking in rear view mirror, etc.).  He did  not anticipate the occurrence of the accident,  all of which made him more prone to movement and injury. (This is important for minimal property damage accidents).
15. The pain generator for Mr. X’s symptoms was determined to be through pain management procedures and radiology reports at the ___ level of the spine.  (Explain what the pain generator is and link it to the radiology reports and pain management findings to that level of the spine).
16. Mr. X’s symptoms are consistent with a pain generator at that level of the spine. I find this correlation to be significant factor concerning causation.
17. Even surgical candidates have good days and bad days.  Their ability to perform is dependent on their use of medications so its not unusual for Mr. X’s condition to have its ups and downs dependent upon medication consumption and activity level.  It comes as no surprise to me that his medical records indicate that Mr. X had days when he was in less pain and was  functional than others.
18. Mr. X’s prior medical conditions and prior injuries do not explain the acute onset of injuries after this accident.  None of these prior medical conditions or prior injuries in my opinion form a reasonable basis for me to conclude that the accident did not cause Mr. X’s injuries for the following reasons: ____________________.
19. Although there are some inconsistencies in Mr. X’s reporting of his medical history and symptoms to his medical providers, these types of inconsistencies are present in most medical records.  Not all physicians can possibly take down everything that a patient tells them during an appointment.  If it were possible for two doctors to simultaneously  take a history and examine a patient, their notes would be different.  All patients have lapses of memory when giving a medical history.  These are common occurrences.  Inconsistencies in medical records do not necessarily mean the patient is lying.  I found Mr. X to be forthright and a honest historian and his medical records in my opinion do not support a secondary gain motivation in pursuing treatment.
20. Without Mr. X experiencing a traumatic event, it would not be probable for him to coincidentally develop these long-lasting and severe symptoms.  This degree of symptoms would not be caused by performing normal everyday activities.
21. In my opinion, from the documents that I have reviewed and my examination and treatment of Mr. X, I cannot conclude that the accident didn’t cause Mr. X’s injuries and resulting symptoms.  Based on the information that I have, in order for me to reach the  conclusion that the accident did not cause Mr. X’s injuries, there must  must be a reasonable basis for me concluding that something else, other than the subject  accident, caused the onset Mr. X’s symptoms.  Considering all of the evidence that I have, there is no reasonable basis for me to conclude that this accident did not cause Mr. X’s injuries.

Most likely no attorney has ever received a medical expert report that covers all of most of these points on the basis for a causation opinion.  The reason that we don’t get these types of reports is because nobody ever provides medical experts with this type of format.  Now that  you have this format, you can incorporate it into your medical reports and use it to prepare for your deposition and trial testimony?

If a medical expert presents no bases for his opinions on causation other than a temporal link between the injury and the accident, or that the patient relates that his symptoms began after being involved in the subject accident, this is a very weak and insufficient basis for establishing causation on an injury case.

Many physicians who treat patients on crossover personal injury/Medicare cases may have some knowledge or the Liability Medicare Set-Aside Arrangement (LMSA).

Medicare has a issued the following memorandum which deals with the simplification of the LMSA process:

Your certification can serve to expedite the resolution of these crossover personal injury/Medicare cases.  The following is a Physician Certification Form that your office can use to supply your LMSA Certification to the patient, the patient’s attorney or any first or third-party insurance carrier.  If you receive a Certification Request from an attorney when he requests your medical records and bills, you should not be surprised. We recommend a simple certification such as that below:

LIABILITY MEDICARE SET-ASIDE ARRANGEMENT (LMSA)
PERSONAL CERTIFICATION OF COMPLETED TREATMENT

I, (Name of Physician), treated (Patient’s Name), for injuries which the patient has received proceeds from liability insurance (including self-insurance), settlements, judgment, awards, or other settlements, that he/she sustained in an accident that occurred on (Date  of Accident).

I do hereby certify that treatment for these injuries has been completed as of the date of the settlement, and that future medical items and/or services for these injuries will not be required.

Pursuant to NRS 53.045, I declare under penalty of perjury that the foregoing is true and correct.

_________________________________        _____________________________________
DATE                                                                                     PHYSICIAN

This week I called several insurance companies and invariably heard a  greeting which sounded something like this, “This call may be recorded for quality assurance purposes.”  Another common greeting is, “This call may be monitored or recorded for training purposes.”

Is conversation recording legal?

Title III of the Omnibus Crime Control and Safe Streets Act of 1968 (18 U.S.C.A  §2510-2520)

Generally this statute provides that any person whose communication is intercepted, disclosed or intentionally used, can file a civil lawsuit.  Federal law makes it unlawful to record a telephone conversations except when one party consents to the recording under state law.  What this means is that a person can record their own telephone conversations without the knowledge of consent of the other party, in those states that allow “one party consent”.  Federal laws apply to both cell phones and wireless phones. Most scanners that lock onto the frequencies needed to pick up wireless and cell phone conversations are now illegal to possess or sell.

Many states have adopted a version of this federal law, and some state laws  provide greater protection than the federal law. Under these laws, a state court, will first examine the state statue to determine if the communication at issue fits within the scope of the statute.  Next, the state court will determine if any exceptions apply.

The most common issue that the courts must decide is whether the conversation is private.  Most statutes only cover confidential or private communication.  A general rule is that people engaged in personal conversations can reasonably expect their conversations are private.  If the communication is private, these statute will protect that conversation.

Courts generally consider wire and cell telephone conversations to be private.  The exceptions may include:

1. The members of a family picking up an extension in the same house.
2.   An employee using a work telephone to make a personal call.
3. Using a microphone, to record a conversation while sanding outside a first-story apartment is not private communication because the conversation when the conversation can be heard clearly form the sidewalk through a open window.
4. Public conversations, for example when people engage in conversation in an outside restaurant.
5. Emergency calls to fire or police.
6. When criminal activity is involved such as extortion or blackmail.
7. When there is a “beep”  on a  recorded line.
8. Body bugging of a police informant.
9. Any bugging pursuant to a valid warrant.
10. Recorded messages informing you that your telephone conversations may be recorded.

All of these exceptions are fact specific.

One factor that the courts consider to determine is a communication is private is consent. A greeting that informs a listener that his conversation may be recorded is generally sufficient for consent. If you speak after hearing that message, you cannot later maintain a civil suit.

Federal law allows recording of phone calls and other electronic communications with the consent of at least one party to the call.  Most state laws  allow individuals to record conversations to which they are a party, without informing a party that they are doing so.  These  are referred to as “one party consent” statutes.

The remainder of the states require the consent of all parties. You can see that a conflict can arise when a person from a “one party consent”  state records a telephone conversation with a person from an “all party consent”  state.

What is the Nevada Law on recordings?

NRS 200.650 (Unauthorized, surreptitious intrusion of privacy by listening device prohibited) states:

Except as other wise provided in NRS 179.410 to 179.515 inclusive, and 704.195, a person shall not intrude upon the privacy of other persons by surreptitiously listening to, monitoring or recording, or attempting to listen to, monitor or record, by means of any mechanical, electronic or other listening device, any private conversation engaged in by the other person, or disclose the existence, content, substance, purport, effect or meaning of any conversation so listened to, monitored recorded, unless authorized to do so by one of the persons engaged in the conversation.

NRS 200.690 (Penalties) states:

1.     A person who willfully and knowingly violates NRS 200.620 to 200.650, inclusive:

(a)     Shall be punished for a category D felony as provided in NRS 193.130.

(b)     Is liable to a person whose wire or  oral communication is intercepted without his or her consent for:

(1)     Actual damages or liquidated damages of $100 per day of violation but not less than $1,000 , whichever is greater:

(2)     Punitive damages; and

(3)     His or her costs reasonably incurred in the action, including a reasonable attorney’s fee, all of which may be recovered  civil action.

2.     A good faith reliance by a public utility on a written request for interception by on party to conversation is a complete defense to any civil or criminal action brought against the public utility on account of the interception.”

Because monetary and criminal penalties apply, before deciding to record any conversations, you should consult with an attorney to discuss what you want to record and what you want to do with the recording after it is done.

Recently, I was invited to speak to a medical facility’s staff concerning the benefits of hiring an attorney on a personal injury case.  Although there are some articles published that touch on this issue, I could not find any that get into this issue with any great detail.  Therefore, I generated this blog post to address this issue. These are the benefits of hiring an attorney on a personal injury claim:

1. Free Consultations.  Most personal injury attorneys give free consultations to prospective clients.  In some cases, the attorney will utilize hard sale tactics during the initial consultation. Because of this, sometimes it is difficult to leave the attorney’s office without signing a contingency fee agreement.  However, since you do not owe the attorney anything for the free consultation, you can tell him that you want to speak to other attorneys before making your decision to hire one.  You can obtain valuable information about the merits of your accident claim during this consultation.  If the attorney does not spend much time with you during the  initial consultation and doesn’t answer all of your questions, this is some indication of how he will probably handle your claim. Make list of questions for the consultation. This will afford greater knowledge and insight into your personal injury claim.
2. Your attorney should handle your first party coverages: Medical Payments Coverage and Uninsured or Underinsured Motorist Coverage.  First party coverages are those coverages that you have on your own policy that you can use to maximize your recovery on your personal injury auto accident claim.   There is no subrogation (payback) on auto Medical Payments Coverage in the state of Nevada.  There is generally a right of subrogation on health insurance policies.  Medical Payments Coverage can work with your health insurance coverage to reduce your exposure to medical bills and to take advantage of provider discounts on your health insurance policy.  This  interaction is complicated, and it takes specialized knowledge and skill to utilize these coverages to an injured person’s advantage.   An experienced personal injury attorney can save you thousands of dollars on your medical bills.  Uninsured Motorist Coverage and Underinsured Motorist Coverage apply when the at fault driver has no, or too little, coverage to compensate the victims of a personal injury car accident. If your claim involves an Underinsurance claim, it will involve many intricate features that a layperson just cannot handle on their own.
3. Subrogation liens of health insurance carriers.  If your health insurance pays your accident-related medical bills, subrogation (payback) rights or liens of the health insurance carrier will generally be asserted. Some of these liens involve Federal ERISA law,  and some don’t.  There are many technical arguments that a personal injury attorneys can use to reduce these liens, even if  ERISA is involved.  The “make whole doctrine” can  be utilized to drastically reduce or even extinguish the health insurance lien.   All of these aspects of a personal injury claim are very time consuming and are too complicated for you to handle on your own.
4. Reduced stress.  Once you hire an attorney on a personal injury claim, the attorney will deal with the insurance companies on your behalf. The end result will be reduced stress to you.  Some personal injury attorneys don’t handle your property damage, because it involves a lot of time and effort for little, or no, compensation.  Ask the attorney during the initial consultation if he handles property damage.  If he doesn’t, he is not providing you with full service for his contingency fee.  If he does, he is most likely a full-service Personal Injury Lawyer, and he will not take a contingency fee on the property damage and rental car aspects of your claim.  This is major benefit of attorney representation.
5. Statute of Limitations.  Many victims of personal injury accidents who are not represented by an attorney fall victim to Statutes of Limitations such as those contained in Nevada Revised Statutes 11.190.  These are cut-off periods of time that can extinguish your claim.  It these statutes of repose are “blown” by not filing a Complaint with the appropriate Court within the relevant Statute of Limitations, the result will be your inability to recover against the adverse party and/or his insurance coverage. You lose the right to sue the adverse party. Different statutes of limitations apply to third-party claims (claims against  the other party’s liability coverage) and first party claims against your own insurance company.  Your attorney will protect your interests regarding these cut-off dates.
6. How much insurance the does other person have?  It is important to know at the beginning of a claim how much insurance the liable party has.  You do not want to get into a situation where you generate thousands of dollars of medical bills and there is not enough insurance coverage (including health insurance, Medical Payments Coverage, liability coverage from the other party and Uninsured/Undersinsured Motorist Coverage) pay for them.  Lay persons don’t have the know how to obtain this information.
7. What compensation am I entitled to?  An experienced attorney will advise you concerning what you can expect on your claim.  The types of compensation that you are entitled to may change with time and the course of your medical treatment.  Proof of wage loss to an adverse carrier generally involves doctor’s excuses, pay stubs to track your earnings history prior to the accident, payroll records showing your actual wage loss, and a letter from your employer explaining your job and compensation.  If you have a substantial wage loss claim, you need an attorney to handle this aspect of your claim.
8. Knowledge of insurance law.  Lay persons are not familiar with insurance laws that may impact your case. Nevada case law (decisions of our state supreme court) that interpret the provisions of a insurance policy’s language applying to coverages, limitations and exclusions.  If your claim involves insurance coverages issues, you definitely need an attorney involved at the beginning of your case
9. Ability to negotiate.  The hammer that the attorney has on a personal injury claim is that he can file suit causing the adverse insurance carrier to spend time and money to defend it.  The layperson is not capable of putting this pressure on an insurance carrier. Therefore, the claimant  will have much  less negotiating power with the involved insurance company.  The attorney can also sue the insurance company for bad faith on first party claims, if the insurance company doesn’t handle your claim fairly.
10.  Settle or file suit?  This is always the big question on a personal injury claim.  Many factors must be taken into consideration in making this decision.  An experienced attorney can assist you in making this important decision.
11. Minimize the downside risks.  There are downside financial consequence associated with not prevailing in a personal injury lawsuit.  Complicated laws involving Offers of Judgment apply.  An attorney will advise you concerning the financial risks of litigation.  He can do things to reduce your  exposure to these risks. Many complicated rules apply.  If you lose your case, the other side will likely try to get their attorneys fees and costs from you.
12. Someone to talk to.  A personal injury claim is a new and frustrating  experience for most accident victims.  Your attorney will be with you every step of the way to advise you on all important maters involving your case or claim.  You will have someone that you can call or send an  email to, who can answer your questions and to advise you along the course of your claim.  If you don’t have an attorney, you will likely rely on erroneous  information from your friends, that may cause you to make the wrong decisions on your claim.
13. Representation in court.  Most people are overwhelmed by litigation.  I see unrepresented people every day in court struggling with  the court rules and procedures.  Even if you end up in small claims court, the system will eat up pro per (unrepresented)  parties.  Their cases are often dismissed for failure to comply with the rules.  If your case involves any type of litigation, you need an attorney.
14. Advance costs.  Most attorneys will advance costs for medical experts and the costs of litigation.  Litigation is very expensive. Filing fees have more than doubled in the last few years. Most injured parties don’t have the financial means to pay the costs associated with obtaining a report from a medical expert which is often required to obtain a decent settlement.
15. Low impact cases.  If your property damage on an auto accident claim is low, most  insurance companies will take the position that nobody was hurt in the accident.  They will force you into litigation.  You can’t handle these cases yourself.  Many attorneys don’t want to take these claims because of the work involved and the low settlement amount that insurance companies are willing to pay on these claims.   You need an attorney to get an adequate settlement to cover your medical bills when your property damage is under $1,000.00.
16. Fighting big entities.  It is impossible for unrepresented persons to handle claims against large companies on product defect cases.  You must have attorney representation to prevail on a bad drug or bad product case.
17. Accident reconstruction.  If you are involved in a multiple vehicle car accident where liability of multiple drivers is involved, an accident reconstruction may be necessary to sort out the various claims against the adverse drivers.  You as a layperson do not have the means to hire and accident reconstruction expert. If the other side has one, you will probably need one on your side.  Attorney representation is imperative for these types of accidents.
18. Disputed liability and traffic tickets.  Just because you were cited does not necessarily extinguish your claim against the other driver.  Your  attorney can fight the ticket and deal with the liability aspect of your claim.   When you are less at fault for an accident than the other driver, complicated comparative negligence laws apply making litigation necessary to resolve these claims.  If comparative negligence is involved with your claim, you need and attorney representation form the get go.
19. Advantage of experience.   Each Insurance company has its own personality.  Insurance companies have their own ways of handling auto accident claims.  Sometimes they are in a strict mode and won’t settle cases. And, at other times, they may be in a more lenient mode.  Companies that only write minimum liability policies ($15,000.00 per person and $30,000.00 per accident) are difficult to deal with. You need an attorney on these claims, because these companies do not give their  adjusters authority  to pay out the minimum limits, even though your claim may be worth thousands of dollars more than their insured’s liability limits. If you don’t settle for the entire the policy limits of negligent party, you may not be eligible for benefits under your Underinsurance Coverage.
20. Insurance adjusters will take advantage of unrepresented claimants.  Adjusters will offer unrepresented claimants small settlement amounts in exchange for a full release.  Insurance adjusters want to get your signature on a release early on.  They offer a nominal sum that you may accept knowing that you may be under financial pressures. If your injuries take a turn for the worse, you are stuck. Some injuries don’t heal.  Some  get worse with time. Most spinal injuries have some long term effects, which are reduced by proper treatment. One of the benefits of attorney representation is access to proper medical care on a lien basis.  Don’t settle your injury until you have had proper medical evaluation and treatment.
21. Making important decisions to settle or file suit, arbitrate or mediate.  Alternative dispute resolution is often used in an attempt to settle insurance claims.  This is  a complicated process which can occur before or after litigation.  Insurance companies won’t usually mediate or arbitrate your claim when you are not represented.  You need an attorney to represent your interests if your case is to be resolved by alternative dispute resolution.
22. Access to medical care on a lien.  This is one of the biggest benefits of attorney representation.  Health care providers who deal with injury claims want some guaranty that, if the insurance company pays you money, that their interest in getting paid for their services will be protected.  Unrepresented claimants have been known to go south with the settlement proceed and not pay their health care providers. Attorneys are bound by ethical rules concerning liens.  We must satisfy liens (or negotiate liens if the settlement proceeds do not give the claimant adequate compensation) out of he proceeds of a settlement. This is the health care provider’s insurance that they will be paid. Generally, you cannot get treatment on a lien if you are not represented.
23. Federal laws. If Medicaid or Medicare is paying your accident-related medical bills complex state and federal laws apply. Reimbursement to Medicaid and Medicare is required.  If these laws apply to your claim, you will have much difficulty negotiating and dealing with dealing these governmental entities.  Financial penalties and civil  litigation can arise against you if you do not reimburse these entities.   If Medicaid or Medicare paid your medical bills, you need an attorney to get involved in your claim.
24. Underinsurance.  Sometimes an adverse insurance carrier will pay you their insured’s liability limits before you have attorney representation.  This will occur when you have catastrophic visible injuries and your claim is clearly above their insured’s limits. Under these circumstances, unrepresented claimants can’t handle the transition that occurs between an adverse claim and a first party underinsurance claim. The “stacking” of multiple underinsurance coverages may be involved.  If underinsurance creeps into your  claim under these circumstances, you should consult an attorney.
25. Education.  If you have a concerned personal injury attorney on an accident claim, he will educate you, not  only about your claim, but he will advise you about your auto insurance coverages and how you can better  protect you and your family in he event of a future accident.
26. Prior or subsequent accidents or pre-existing conditions.  If our claim involves these issues, you will need both an expert medical witness and an attorney.  Treating physicians are not litigation experts. You will need an attorney to handle the apportionment issues that are involved with these claims.  Your attorney will likely need to hire an expert medical witness.   Insurance companies have data bases, so if your were involved in a prior or subsequent accident they will know it at the beginning of your claim. Hire an attorney to deal with these issues.
27. Accident reporting to your own insurance company and DMV. Did you know that if the police are not involved with investigation of your accident that you must report it to DMV.  You must report any non-investigated motor vehicle accidents involving property damage of  $750.00 or more and all injury accidents to DMV.   Underinsurance claims and uninsured motorists claims must be reported to your insurance company early on, or your claim may be denied because you have taken away your insurance company’s ability to investigate your  claim while the  evidence is fresh.  An attorney can protect your interests on these reporting matters.
28. Cross- over areas bankruptcy, workers compensation and probate.  If you or the adverse party files bankruptcy; or, if the adverse party dies; or, if you are injured at work, and there is  third party liability, these claims are too complicated for you to handle on your own. They involve cross-over areas of law.  Hire an attorney immediately. Most attorneys handling a third-party liability workers compensation claim will advise you on the workers compensation claim at no extra charge.  This is like getting free legal advice on your workers comp claim.
29. Dealing with insurance limitations and exclusions.  Most victims don’t know how insurance policy limitations and/or exclusions affect their first party auto claims. These issues can involved limitation of coverages or denial of coverage due to a variety of policy provisions.  If  your insurance company denies or limits your claim for benefits, its time to see an attorney.  Case law may protect your interests for coverage under these circumstances.
30. Worst possible scenario cases. If you have a lot of medical bills and there is minimum coverage for your auto accident, or if there are multiple claimants against minimum liability limits, you simply cannot handle these situations by yourself.  An Interpleader may be filed with you named as a party defendant. An Interpleader action is where the insurance company deposits the policy limits proceeds with the court, and the parties must litigate to see who gets what amount out of the deposited proceeds. You will absolutely need an attorney if you are involved in this type of case.
31. Property Damage.  Many property damages issues arise on personal injury auto cases.  Your attorney can assist you with reimbursement of your collision deductible.  He can arrange direct billing on a rental car rental car, or he can get you reimbursement for your rental expenses.   He can also assist in getting you adequate compensation for your total loss. Full-service personal injury attorneys will provide you with these property damages services free of charge.
32. Premises liability cases.  Generally, these claims are denied even in good liability situations.  Some premises liability policies contain med pay coverage which can be used to pay your medical expenses.  Premises liability claims are  not easy. Protracted litigation is usually necessary to resolve them.  Medical providers are less likely to take these provide services on a lien basis on a premises case, so get an attorney involved immediately.  If he can find you premises med pay coverage for you, this may be worth  more to you than his contingency fee.