Category: Traumatic Brain Injury

Children’s Medicaid Reimbursement

Wrongful Death

As personal injury lawyers, our primary duty to our clients is to maximize each client’s net recovery. So, while it’s great to get a significant settlement on behalf of a child, such a settlement is much smaller when a large portion must be repaid to a health insurance company or Medicaid. At Gomez & Golomb, we work hard dealing with and extinguishing any Children’s Medicaid Reimbursement claims not allowed under Georgia law.

An example is when a minor is injured. PeachCare/Medicaid often pays the medical bills and claims a lien against future settlements in these situations. After careful review, we interpret Georgia and federal law to hold that PeachCare has no right to reimbursement for any settlement with a minor. We, therefore, fight these reimbursement claims tooth and nail.

In Georgia, an injured child only has a claim for pain and suffering. Southern Guaranty Ins. Co. v. Sinclair, 228 Ga. App. 386 (1997) discusses this concept. In that case, the Court held that a minor has no claim for medical expenses because that obligation rests with the child’s parents. This reasoning makes sense because until a minor child reaches the age of 18, they cannot be bound under contract. Therefore, in a Children’s Medicaid Reimbursement situation, a child cannot be liable for medical expenses nor claim reimbursement of medical expenses.

The United States Supreme Court held that Medicaid/PeachCare can only reach settlement monies paid to reimburse medical bills following an injury. Thus, PeachCare/Medicaid can claim a lien against that part of an injured person’s recovery only for money received for medical expenses. Arkansas Dept. of Health and Human Services v. Ahlborn, 547 U.S. 268; 126 S. Ct. 1752 (2006).

Reading Sinclair and Ahlborn together, Medicaid/PeachCare cannot claim a lien against a minor child’s settlement proceeds. To shield a settlement from Peachcare/Medicaid, we structure the settlement between the wrongdoing party and the minor child. The settlement clarifies it only covers pain and suffering.

If you have a question about these issues, please call Gomez & Golomb LLC at 404-382-9994. 

Wrongful Death in Georgia – Who Makes the Claim

If your loved one has recently passed, we offer our sincere condolences. Losing a loved one is tragic, but at some point, the living must go on living. This means educating yourself regarding your family’s legal rights in order to make a full recovery on behalf of your loved one.

If your loved one’s death was caused by the negligence of another, who is entitled to make a claim? A claim may include include funeral expenses, medical expenses, pain and suffering before your loved one’s death, and the value of your loved one’s life that has been cut short?

To understand who can make a claim, we must first understand that Georgia law allows two different claims following a wrongful death: one is just referred to as a “wrongful death claim”, and the other is referred to as an “estate claim” or “survival claim”. The same person can bring both claims, but this isn’t necessarily the case.

Wrongful Death Claim

Under Georgia law, this claim belongs to the loved one’s spouse and children. See OCGA § 51-4-2. If the loved one had no spouse or children during their life, the loved one’s parents are entitled to make the claim. See OCGA § 19-7-1. Finally, if no spouse, children, or parents are alive, the court can appoint an administrator or executor to make the claim. See OCGA § 51-4-5. Relatives such as a sibling, uncle, aunt, or grandparent have no right to prosecute the wrongful death case.

We will discuss this in further detail in another blog. However, generally, a wrongful death claim includes recovery for the value of your loved one’s life had he or she not died prematurely.

Estate/Survival Claim

The administrator of your loved one’s estate is the party entitled to make claims for funeral, medical, and other necessary expenses and any claim for pain and suffering before death. OCGA § 51-4-5.

If you have any questions about who can make a wrongful death claim on behalf of your loved one, please call us. We have provided a very general overview, but many details and complications come up when applying these rules in real life.

Negligence law in Georgia

What is negligence law? At the risk of sounding overdramatic, at Gomez & Golomb LLC, we believe negligence law is similar to the golden rule, which is “do unto others as you would have them do unto you.” Here is why.

Long ago, the first laws developed to discourage citizens from intentionally harming each other. Under this system, when someone intentionally harms another, the state prosecutes the responsible person. If found guilty, the state puts the person in jail.

But what about when someone unintentionally harms another? Clearly, it would be unfair to put someone in jail for conduct that lacked intent, but, at the same time, it would also be unfair to the injured person if there were no consequences? As a middle ground, we created a set of rules known as negligence law in which a negligent party isn’t prosecuted or jailed for wrongdoing, but is liable for the monetary damages caused to the harmed party. In other words, as we go about our daily business in our communities, we are obligated to act in a manner consistent with that of an ordinarily prudent and reasonable person. Georgia law confirms this principle. See O.C.G.A. § 51-1-2.

The personal injury cases we handle at Gomez & Golomb LLC all involve negligence. This means the responsible parties harmed our clients but did so without any intent. Examples of cases we’ve worked on are drivers who didn’t pay close enough attention to the road, manufacturers who design products without attention to safety, or doctors who provide medical treatment that isn’t as good as it should be.  None of these parties woke up with up plans to harm to anyone, but, for various reasons, each acted in a way that a careful, responsible, and reasonable person would not.

In our view, our society is better off when someone who intentionally harms another is put in jail and someone who unintentionally harms another is responsible for paying for the damages. While not everyone agrees with this system, and there is no doubt abuse, the alternative is a society without incentive to treat each other as each of us would like to be treated (the golden rule).

At Gomez & Golomb LLC, we see our job as making sure our clients are fairly compensated for legitimate injuries sustained because another person or entity failed to act responsibly.

Gomez & Golomb LLC Resolves Traumatic Brain Injury Case Against Textron d/b/a E-Z-GO

Confidential Settlement with Textron, Inc. d/b/a E-Z-GO

We represent a young man ejected from a golf cart (more accurately a personal transportation vehicle) resulting from a sharp left-hand turn. The photo above is the cart immediately after the incident. This happened in 2012. The ejectment threw the young man head first onto a paved road. The young man spent many months in the hospital with his family. He is a fighter and made a miraculous recovery (he had to relearn how to walk, talk, and eat). Despite his recovery, because of the severity of the impact to his head, he left the hospital with permanent traumatic brain injury (T.B.I.). This is an injury that rarely improves, and, unfortunately, is permanent. Needless to say, brain function is critical to every aspect of life, and this was a devastating injury to our client and his family. 

After hiring experts to investigate the cart and the circumstances of the incident, we determined that the manufacturer of the personal transportation vehicle, Textron, Inc. d/b/a E-Z-GO, had been warned by and well-known engineer in 2007 about passengers being ejected from these types of vehicles because of inadequate passenger-side hip restraints. This engineer was particularly concerned with the rise in injuries to children between the ages of 12-16. Textron, Inc. d/b/a E-Z-GO were also aware of a 2006 peer-reviewed journal article raising these same concerns.

From 2007 until 2012, Textron, Inc. d/b/a E-Z-GO had more than 10 meeting with the engineer who issued the warning, yet failed to make any safety changes to the passenger hip restraint, failed to issue any warnings to existing customers, and failed to recall any of the unsafe vehicles already on the road.

After getting no response from Textron, Inc. d/b/a E-Z-GO, we filed a lawsuit in Fulton County State Court. Textron, Inc. d/b/a E-Z-GO hired a large silk-stocking Atlanta law firm to vigorously defend the case. Textron, Inc. d/b/a E-Z-GO’s main claims were that these vehicles weren’t supposed to be driven on public roads. As the risk of sounding glib, Textron, Inc. d/b/a E-Z-GO’s argument that these vehicles shouldn’t be used on public roads was laughable. Textron, Inc. d/b/a E-Z-GO took the position that because there was a warning on the cart against driving on a public road, then E-Z-GO was responsible for injures on public roads, even if there vehicles were unsafe.

Below is an example of some of the marketing material from E-Z-GO’s website and twitter pages that we were ready to show the jury at trial. This evidence shows that EZGO continuously and aggressively marketed these vehicles to families with children to use in and around their neighborhoods. In fact, anyone that’s lived in a suburban neighborhood has seen families and teenagers using these vehicles to get around on neighborhood roads.

During the next several years, we argued summary judgment motions, Daubert motions, discovery dispute motions, and took depositions of experts in Connecticut, Minnesota, Georgia, and Florida. After almost five years of non-stop work, this past Monday, we finally started a jury trial that was expected to last about 10 days.

In total, close to 30 witnesses were expected to testify.Our side had testimony from two engineers and five doctors, while Textron d/b/a E-Z-GO had testimony from two engineers and a human factors expert.On Monday, we spent all day picking a jury. While we were pleased with the jurors selected, and hopeful both sides would get a fair and impartial judgment based on the evidence presented. Opening arguments took place Tuesday morning until lunch, with each side making compelling arguments for their clients. However, during lunch, the opposing sides approached each other, now having heard each other’s full arguments, to explore settlement. After some deliberation, the case settled for a confidential amount. Although we prepared and hoped to take the case to conclusion, our client was very happy with the result and the settlement was truly in his best interest. 

To be clear, we have not and will never advocate against the use of these types of vehicles. They serve an important function in many communities and are flat out fun. However, our profound hope is that Textron d/b/a E-Z-GO will carefully examine the passenger restraint systems on all its vehicles, current and past, and that it will commit itself to designing and manufacturing safe golf carts and passenger vehicles for typical use, which is often by teenagers on public, neighborhood roads. We also implore Textron d/b/a E-Z-GO to consider recalling any unsafe vehicles currently on the roads with unsafe passenger restraint systems.

Click here to see to an article from Courtroom View Network summarizing the case.