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I have an work injury (repetetive stress - with computer usage as I work in technology) that happened in California more than 5 years ago in California. After initial treatment of 2 years doctors kind of gave up on treatment sugegsting me to just take pain medication. Early part of 2007 I went abroad to try alternate therapy on my own and had benefitted, but that did not cure. I had a QME (panel doctor) evaluation later in 2007 where QME found I became permanently disabled just the day I left for abroad. I never claimed any benefits other than treatment until I left abroad. I took 12 weeks disability benefit from workers comp insurance when I was out of work for treatement. QME initially mentioned I have around 18% disability and then insurance brought it down to 12%. Now my workers compensation lawyer, judge and insurance is making a settelemnt proposal that (1) I get around 20% disability for which compensation is around $17,000. (2) They will only pay 6 weeks short term disability - so I have to repay them around $5,000. (3) They will provide treatment for rest of life but they have the right to litigate that. My employers long term disability will not cover me any more as I am permenantly injured. By God's grace, I am still able to work with regular pian medication. I may not able to do this long time and has a family to support. At this point I do not have any immediate financial concerns, but I wonder if I should go for a trial or go for settlement. I understand workers compensation laws are currently in favor of employers and not to protect employee.
Anyone has input on if I should go for trial? I am also not sure why insurance put they can litiagate future medical benefits. What are the things I should be aware if I decide to go for settlement. $17,000 is no way going to help me to repair the damange done towards my ability to work and keep up with the pressure.
If it were me I would not go to trial, if you have a good attorney you trust let them handle it, that is what they will get paid for. If you go to trial that is a gamble. As for future medical I think any future medical you receive is handled at that time just like it is handles currently, your Dr must get approval or authorization for treatment, which they can approve or can deny as they have done previously.
i don't understand what issue would be disputed at trial.
it appears that your permanent disability has been calculated and they are willing to pay it and have agreed to future medical.
with open medical this is more of a finalization then a settlement.
they can litigate future treatment if they have medical evidence it maybe due to another injury or condition.
also utilization review controls what treatments will be approved.
has there been any discussions about a lump sum buyout of all benefits including future medical (compromise and release)?
Thanks Cervical Fusion and 1171. There has not been any discussion about a lumpsum buyout of future medical benefits.There are few things I am still not convinced.
(1) My present injury is slowly but steadily leading me to full disability. It is just a matter of time I reach that state. Would a trial help to establish that case?
(2) QME determination of I became permanently disabled in early 2007. That is causing my claim to short term disability getting denied.
(3) Methods of evaluation used by QME is not applicable to my situation. He has used just range of motion which has nothing to do with the injury I have (pain while typing).
(4) Lawyers in California just get 15% of the settlement and now a days it is very hard to get a lawayr to take workers comp case. So there is no motivation for the lawyer to really spet time on the case.
(5) Would this settlement clear employer of all liabilities relating to this Injury. I have had issues where employer just did not care to provide ergonomic evaluation and the required support in a timely manner.
Other things considered are:
(6) Would State Disability benefits cover when Workers compenastion demy short term disability benefit? Can I file for 2007 claim now? This is in California.
(7) Would Insurance lawyer harass injured worker durng trial? I hear that is typical of Insurance companies.
(8) Any idea how long it will take for a trial in California to complete?
you have been determined to have reached maximum medical improvement or permanent and stationary condition.
if you want to dispute the QME you'll have to have medical evidence.
do you have medical opinions that you are not mmi or P&S?
rating factors are determined by the AMA guides which have been legislatively fixed;
the courts can't change the rating method.
a comp settlement/finalization only closes comp benefits. other emloyer liabilities remain.
SDI would only cover disability that is temporary and would not apply to post MMI or permanent disability.
hearing times depend on the issue and the amount of evidence-generally anywhere from a half day to a full day.
Thank you soum much user 1171 for the information. Your help is much appreciated.
Follow up question as I have never heard this from my attorney or HR at compmnay.
>a comp settlement/finalization only closes comp benefits. other emloyer liabilities remain.
What are the potential employer liabilities in this case. I was told there is nothing that employer need to do other than making reasonable adjustment to accomodate my requirements like having a ergonomic friendly keyboard, chair etc. I am expected to perform like anyone else inspite of 20% permanent disability. With all the pain I can do this for some time but not many more years ((25 years remaining on mortgage and I am in my mid 40's).
looks like you are referring to ADA law and reasonable accommodation.
you can find out more here http://www.ada.gov/
or discrimination law
in califnornia the Fair Employment in Housing Commission: http://www.fehc.ca.gov/
Thank you 1171 for additional information. What are the potentail employer liabilities in my case (You mentioned earlier settlement doesn't limit employer liabilities)? I am new to these things so i wanted to make sure I understand this before I make the decision.
I assumed you had something particular in mind since you asked the question.
I do not know the details of your 5 yr old claim and cannot speculate on other actions your employer's behavior may have subjected them to, other then ADA and discrimination.
comp has it's own legal system and it's settlements only settle comp benefits.
you cannot insure an illegal act.