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Workers Comp Claim

Workers Compensation Law Discussion

Workers Comp Claim

Postby egann » Sun Mar 09, 2014 2:39 am

my question is i was hurt in at work and had surgery on my back disc surgery l4 microdisectomy  that is done and i got paid for time off now im back to work working normal with slight pain  . but the workers comp insurance called me and send me mail to settle the case they offering me 15% impairment of hole body 75 weeks at $666 from 500 max weeks what comes to $49999 to settle my case without lawyers i did not ask anything they called me and offered me .

what do i do ?can settle it my self and how

do i take the money and that would be the best solution for me without making my employment at risk ?

is it better to get lawyer and why ?

what can i do to improve my case with the workers comp insurance?

do i have to settle the case ?

what amount can i accept with a lawyer if take him to represent me tell me rough your best guess realistic number?
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Joined: Thu Mar 31, 2011 10:15 pm

Workers Comp Claim

Postby Concetto » Sat Mar 15, 2014 7:46 am

The good thing about accepting this low-ball offer is that Insurance Company doctor returned you to full duty with no restrictions, so you know you keep your job in this horrendous job market.

The bad thing is an adjuster's first offer the lowest possible amount of Permanent Disability you could receive for this injury.  Often, it is so low, the Workers Comp judge refuses to approve it, even after you've signed it!

IF you are in California, you may(1) object to the findings of the Treating PHysician Request a Qualified Medical Evaluation(QME), or(2) Request a Consultative Rating of the Treating PHysician's Permanent & Stationary report.

You probably already received a QME Panel Request Form from the insurer(IF you are in California).

BUT CONSIDER:   WHAT IF the QME Doctor writes that you should NOT go back to the same job with no permanent restrictions??   If this 2d Opinion by the Qualified MEdical Evaluator says that you cannot do the exact same job as you had at the time of the injury, the employer has the option to terminate you.

Can you run the risk the employer could terminate you because you can't go back to all the pre-injury job duties??  

If not, let's just stick with the Treating Doctor's opinion(and skip the QME).

In California, there is the Information & Assistance Officer... NOT an Attorney, but a California State Worker who will tell you how to get the Treating Doctor's report rated at the state's Disability Evaluation Unit.

The Disability Evaluation Unit will take the Treating Doctor's "Permanent & STationary" report(the report releasing you back to work with no restrictions) to see if that "15% Whole Person Impairment" really does work out to $49,999 paid out over time.

A 15% Whole Body Impairment on the Lumbar Spine RATED for a 39-yr-old laborer at a plastics production plant comes out to 21% Permanent Disability.  

21% Permanent Disability results in 80.5 weeks of PERMANENT DISABILITY payments @ $230(NOT $666) per week, for a total(pd over time) of $18,515.

Just FYI, 15% Permanent Disability is only $11,615 paid over 50.5 weeks.

For you to get $49,999, you would have to get $230/wk Permanent Disability payments for 217 weeks, a little over 4 years.   I don't think the employer would take you back to Full Duty With No Restrictions with that much residual Permanent Disability.

Finally, you never HAVE TO settle the case; but the alternatives are(1) Dismissal for Failure to Prosecute(results when you ignore everything), or(2) Trial.

So, rather than Dismissal or Trial, try to settle on the Treating Doctor's opinion, but get the STate DEU to give you the REAL Permanent Disability found in that Treating PHysician's Permanent & Stationary report.

Looks like your first mission is to get your hands on the P&S report, see if you agree or disagree with that doc's findings.

Then get into the Information & Assistance Office at the local Workers' Compensation Appeals Board(presuming you are in California).

Then, if it still is too difficult, it's time to get an attorney.  The Attorney takes just 15% of the agreed-upon Permanent Disability total, so for most folks that is well worth it.  
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Joined: Thu Feb 20, 2014 10:42 am

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