MSA. PD and C&R - Printable Version
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MSA. PD and C&R - casual1 - 06-22-2012 03:24 PM
I have been injured since 2005. I have not been paid PD by the carrier, even though they agree with the AME report performed in November 2011. Now that want to pay my PD in June 2012, want a MSA, want to do a C&R. The MSA is less than 25K, not a required by CMS.
I am owed PD plus penalities. Same with Mileage plus penalities.
Will the C&R include everything (PD, penalities, Future Medical, Mileage, etc.)
I have an E-Mail from DA stating that they are paying me X amount for PD (no penalities) in a check today, then state the MSA is worth 20K, going through the process.
Will the C&R total include the PD plus the MSA total or one total.
Lets say I get 5K for PD and the MSA is worth 20K. Will the C&R be for 25K or 20K? Is the C&R for the total case or just for future medical?
RE: MSA. PD and C&R - 1171 - 06-22-2012 06:28 PM
(06-22-2012 03:24 PM)casual1 Wrote: I have been injured since 2005. I have not been paid PD by the carrier, even though they agree with the AME report performed in November 2011. Now that want to pay my PD in June 2012, want a MSA, want to do a C&R. The MSA is less than 25K, not a required by CMS.
the settlement should include everything that is being negotiated.
if those benefits are not addressed then the C&R does not inclulde them.
in any event the C&R language generally will close out all liability so that acceptance of the amount will resolve all disputes.
read the language carefully to make sure it's all covered.
without knowing how the set aside account was set up i don't know if there will be separate check to a third party MSA administrator.
if you have an atty should should make a list of questions for them before signing the C&R.
RE: MSA. PD and C&R - casual1 - 06-22-2012 09:42 PM
There cant me a MSA since the dollar amount is not greater than 25K, as stated by law. So the MSA is a waste of time, does not to go to CMS for review. The DA has stated in E-Mails that MSA is not going to CMS. I dont know the reason why the IC insists on one when it does not legally require one, nor serves any purpose.
How long does it take a DA to prepare a C&R and send it to an AA?
Da states that they are waiting for the MSA back. Back from SS I assume. Dont know how long that takes. How do I know if the PD dollars are correct on C&R? I need to see the C&R to see if the late PD payment (by years) has a penality, plus 3 month old Mile Reimbursment with penality plus what the dollar amount in for future medical. I dont know if these dollars are in the future medical amount, what makes up future medical dollars.
RE: MSA. PD and C&R - 1171 - 06-23-2012 02:42 AM
I don't think you understood the MSA rules correctly. all cases are reported to medicare.
CMS has a cutoff limit amount for prior approval/review purposes.
Medicare will still extract your settlement amount before extending any coverage of your comp injury regardless of the
time depends on their workload. SS doesn't review or care about MSA.
you don't understand the MSA process.
how do you know there are PD $$ stated in the C&R if you haven't seen the paperwork? what makes you think there is an itemization?
most C&Rs have just the settlement amount and no breakdowns.
I don't think you know much about settlement negotiation. did you do it ? or did you have a representative?
it's not a list of menu items you check off on your order and a settlement pops out of the computer.
If you don't have an atty, please get one that specializes in workers comp.
you can find one here
RE: MSA. PD and C&R - casual1 - 06-23-2012 11:54 AM
I have yet to see The C&R, MSA or any other document from the DA. All I have is an E-Mail showing what is going to happen. The DA informs me of the value of the PD, does not explain how he reached this number, nor when this will be paid. He also tells me there is a MSA of 20K going through the process.
I have a book by Christoper Bell called Ca WC, How to take charge.....
It states "To determine the value of a C&R when you have an MSA, you add the value of the MSA to the value of your PD. I would assume that would be X dollars for PD plus 20K for the MSA.
When the C&R is approved, will I get a check for the PD $ plus the MSA $?
I thought the C&R would show me separately the PD $, Penalities, Mileage Reimbursement Owed and Future Medical dollars, then a total. I am trying to figute out how future medical dollars are determined. That would allow to figure out if settlement is correct.
What will I see in this C&R?
RE: MSA. PD and C&R - 1171 - 06-23-2012 12:30 PM
I see, you are doing this on your own.
chris ball's book is pretty good.
did you get rating from the Disability Evaluation Unit on your medical impairment report?
a copy of any PD rating should accompany the C&R filing to the WCAB
how did you decide the C&R amount was acceptable if you had no idea of the value of the benefits?
PD value table is here:
the medical portion may or may not be stated in the papers.
here is a sample of the C&R data document that has to filed with the court:
generally figuring out the value of your settlement is done before agreeing to an amount.....
RE: MSA. PD and C&R - casual1 - 06-24-2012 12:10 PM
I had a rating from the DEU which had 2 major injuries. After deposition of doctor (changed his mind), I now have one major injury to both wrists that was caused by work. Both injuries were caused by work. No one went back to the DEU to get this rating for one injury so I have no clue what it is worth. The IC just came out with a PD number, dont know where this number came from or how it was detemined. The DA gave us one number, IC Admin a different number.
I have yet to see the C&R so I dont know if its acceptable or not. My AA states that she will do the C&R once I receive PD dollars from IC. Dont know why it cant be performed now to get this 7 year case settled.
Who is responsible to do a C&R, AA or DA? Can either perform this function? I notice that the C&R has a total dollars for claim, does not break down PD, Mileage reimbursement not paid, penalties for late payments, future medical, etc. I have provided a list to the AA for all that is owed, minus the future medical because I dont know how this is determined. The MSA performed by IC is 20K, so I assume that this is the future medical. I am left in the dark with what the total amount of the C&R will be.
RE: MSA. PD and C&R - 1171 - 06-24-2012 04:32 PM
generally once the amount is agreed upon the papers are drawn up by the carrier and sent to the applicant and atty to sign.
carrier will file and serve completed documents.
that's what I posted- it's not usual to break down the settlement amount only the paid amounts.
you negotiate a single settlement amount --not individual benefits.
RE: MSA. PD and C&R - casual1 - 06-24-2012 05:09 PM
Thank you. So the DA/IC prepares the C&R, not the AA. That is what I thought.
I have the numbers for the PD from the IC, know the numbers for the Mileage Reimbursement owed. Since the PD is 4 years late, can I put a 25% plus 10% penality on PD based on Code? What would be the correct amount to apply? Then can I apply a 25% penalty for Mileage R. that is over 3 months old, unpaid today? How do I figure future Medical Expenses? Will the DA/IC figure this total out with the AA? Is that a negotiable amount based on the parties? How is this number developed? The MSA is for 20K. Can I assume this is for Future Medical? I would think so, just want to concur.
Im trying to come up with a total amount, a number that I will agree on. Can you help me figure this out based on my assumptions. Are my assumptions correct?
RE: MSA. PD and C&R - 1171 - 06-24-2012 06:05 PM
you really need to have this discussion with your atty.
what if it doesn't settle?
at what amount will you and your atty rather take it trial?
on which issues is your evidence the strongest?
the value of any benefit has to modified by the strength of the evidence and the chance of wining at trial.
if it doesn't settle will your atty continue to represent you on future medical issues?
settlement values in complex cases are difficult even if the details are known and next to impossible on a message board.
you also have to factor in the present value of future $$. there is a discount when it's paid upfront rather then over time.
future medical is usually the largest amount and the most difficult to estimate. it's especially hard when the laws give the carrier so much control and the worker has little ability to contest denials long after the atty has gotten their fee and lost interest.