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How is a WC settlement calculated in California
12-04-2012, 03:33 PM
Post: #1
How is a WC settlement calculated in California
Four years ago I suffered from a bi-lateral wrist fractures. I just received a whole body MMI rating of 24% PPD for upper extremities. I never received workers comp payments due to benefits denial because a QME rated me at 0% impairment. After appealing to his opinion I seen a couple doctors and after an EMG exam findings were ulnar nerve damage. Treatment and surgery took place a year and a half after the injury. Lack of any benefits were because the insurance company was going by the first QME's rating. Surgery had me off of work for 7 weeks but I had to use personal sick time, disability is not offered by my employer. I have read that there's a 10% penalty if payments are delayed/late. The second QME who seen me twice before his MMI rating of 24% and lifetime medical stated in his report that I was entitled to workers comp benefits. So was wondering if someone can help me in trying to figure out what this case is worth. I was also told that the insurance company will not offer a cash out benefit for the medical because I'm still employed there. I would actually rather be in charge of my medical than to have them continue to do so with all the difficulty I've had dealing with them.[/size] I don't want to get taken advantage of. Thank you in advance.
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12-04-2012, 05:04 PM (This post was last modified: 12-04-2012 05:05 PM by 1171.)
Post: #2
RE: How is a WC settlement calculated in California
a wpi rating alone does not determine PPD benefits .
you need a permanent disability rating from the Disability Evaluation Bureau.

until/unless the carrier or the court has determined which QME is correct, benefits are not due and therefore there is no penalty for being late.
unless the parties can agree on buyout amount the carrier is not required to offer one.

generally any buyout settlement -Compromise & Release - will include a requirement for your resignation.
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12-04-2012, 07:19 PM
Post: #3
RE: How is a WC settlement calculated in California
1171, thank you for your response. I have read many different ways on how insurance companies come up with a figure, how a chart indicates number of weeks paid, what my earnings were at time of incident, future earnings, life expectancy. Feeling lost and slightly confused with all the different input. 66% of weekly earnings is $735. What is the actual formula. As far as buyout why is resignation is required, can this be disputed? On my case I have something wrong with me I have asked for treatment and pain medication but I have had a hard time getting results. It's been like that for years. If considered how do you put a dollar amount on future medical since medical cost rises each year. I'm 36 now and the QME stated in their report lifetime medical. If I do consider resignation is future earnings considered or how does it all work. Again thank you for your input.
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12-04-2012, 08:17 PM (This post was last modified: 12-04-2012 08:19 PM by 1171.)
Post: #4
RE: How is a WC settlement calculated in California
you can't convert a wpi directly into payments or $$. you must first start with a permanent disability rating which you do not have.
the formula for converting a wpi into a pdr is in the rating schedule here:
http://www.dir.ca.gov/dwc/PDR.pdf
doing a rating is complicated and most wait for the DEB to compute one.

the table of PDR values is here:
http://www.pdratings.com/storage/2012pdchart.pdf

generally when settling a claim the employer/carrier wants to close out all potential litigation against the employer.
the only way to prevent further claims by the worker is to terminate the employment.

yes,you can try to negotiate the resignation clause out of the agreement.

future benefits like medical can be estimated with an inflation factor. you also need to discount it using a present value calculation.

here is an on line settlement calculator that may help but settlements are complex:
http://www.settlementevaluator.com/
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12-05-2012, 01:05 AM
Post: #5
RE: How is a WC settlement calculated in California
If you expect to have issues for the rest of your life and will require medical and possibly surgeries there is no way in heck I'd cash out. The number on settlements are are generally much lower than the true cost of medical expenses and where would that leave you when the funds run out if you live in a state where your personal insurance can't not be used on WC injuries?

A lot to consider.

I live in CA, it's not always sunny... And the Workers Comp sucks! Smile
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12-05-2012, 05:52 AM
Post: #6
RE: How is a WC settlement calculated in California
Painandsmiles- as far as surgery goes I already underwent nerve decompression but it wasn't done to the fullest or so the QME stated on their report. QME also clarified that no matter what my medical condition was not going to improve. There's a possibility that I am in the condition I am because I never received the proper medical care to begin with. Medical care was delayed for a long period of time. The report also states that surgery or therapy did not take place until a year and a half after the injury so I didn't heal properly. Because of my bad experience with these people I prefer to look out for my own medical. I agree it does suck!.
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08-06-2013, 04:50 AM
Post: #7
RE: How is a WC settlement calculated in California
My case was settled in April with future medical and other stipulations. I'm trying to receive medical care but the insurance carrier is slowly making it difficult. I seen a doctor and therapy has been requested, 3 weeks have passed and nothing, no action. Also I was deducted personal time for having surgery in regards to my industrial accident, it was agreed that the 2 months taken away from my sick time would be reimbursed, still no action. 3 months after and still nothing. Is there anything I can do, my attorney has been ignoring me for over a month.
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08-06-2013, 08:41 PM (This post was last modified: 08-06-2013 08:42 PM by 1171.)
Post: #8
RE: How is a WC settlement calculated in California
Utilization review still controls treatment even after an award.
your physician can use the appeal process when care is denied/delayed
there is also an Independent Medical Review process now available.
more on UR and IMR here
http://www.dir.ca.gov/dwc/MedicalUnit/imchp.html

was the sick leave terms included in the stipulation?
if so, you can file for penalty with the comp court.

to file a complaint with the state bar
http://www.calbar.ca.gov/Attorneys/Lawye...ation.aspx

you can also look for another atty or represent yourself.
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08-06-2013, 10:06 PM
Post: #9
RE: How is a WC settlement calculated in California
I was forced to use sick time because the defendants had delayed/ denied my case due to a bogus report a QME had done. Weird thing is the surgery was approved and covered through the insurance company. The QME report was dismissed after I was reviewed by another QME twice. I never received any workers compensation paid to me because of this and it was agreed that I would be reimbursed my personal time but they have failed to do so. I hired a lawyer listed on super lawyers . com but he didn't turn out to be so super. It's been very frustrating working with him and his firm. I sometimes feel that he might have been bought out.
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08-06-2013, 10:40 PM (This post was last modified: 08-06-2013 10:41 PM by 1171.)
Post: #10
RE: How is a WC settlement calculated in California
without proof of that you can't do anything about it.
those that don't get what they think they should often feel that way.
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