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CA state WC board for neck fusion
#1
Hello. I just found your forum and wanted to ask if anyone knew what a good settlement for the following is:

2013 injury at work, WC begins, doctors bad, no MRI for neck injury until 4 mo post accident. said I was a baby and had whiplash (treating WC doctor)
2014 spring WC MRI shows 2 level neck fusion needed d/t 2 discs pushing on brain stem. WC Travelers Drops me stating I was in the area on personal time not work (have tickets and sites visited for job).. I have been carrying my own insurance and forced to work until now. 
2014 Oct -emergency surgery for neck/brain injury/issues-2 level fusion of C4/5 and C5/6. jump to this year, still having residual issues and need further care, neck too straight and QME labeled me in 2016 as 28% PD with fusion and noted deterioration of vertebrae and discs above and below fusion.  Prior to this injury I worked out 4 x/wk for 2 hours/time and now I can do nothing like that. repetitive motion makes my arms numb and shoots pain from my neck everywhere.PT stopped d/t max amount reached. can't afford to continue by self.
I have an attorney and Travelers  in 2016 acknowledged this was a WC injury and only wants to give me 75k. what about future medical issues and if I'm comatose from another next injury? I can work from home but only bc I move all the time and now the issues have gotten so bad I cannot concentrate and I do high level functioning work on global study budgets and manage a large study.
Can't I have Travelers pay for future surgeries and bills related to this and I can't believe this is the crap they offer for a ruined life..what are my options? my lawyer says I can't ask for some things and 75 k is good but I think it's crap. Travelers just thought I would be broke and want to settle by now. Thing is now that I'm not able to work well, I may not have a job as I have to have them accommodate me and they may not have anything for me at this time that I can do.  
Any help or suggestions on where to look in the CA WC laws I would be great ful.
 
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#2
You do have an option.
Take the 28% in disability payments and leave your medical open.
THis is risky as the carrier can deny treatment if it doesn't conform to accepted treatment standards and utilization review rules. if your atty is not aggressive in challenging the denials and your regular health insurer won't step In and cover the treatment, you will have very few alternatives.
Find out if your atty will handle appeals if you leave your med open.
Some carriers (and most attys) want to avoid an open medical award and yours may be willing to increase their offer to get a buy out and close their file. 
If there's another injury you'll have to file a new claim as it won't be part of this one.
What laws are you looking for?
There are no laws on how much your future medical might cost; is there other information you need?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
I agree with what 1171 wrote.

Your attorney should have told you that you can have open medical for life, but what that means is dealing with the insurance companies utilization review company deciding what treatments and tests your doctors orders gets approved and getting whatever PD amount you were provided and foregoing the additional settlement money, if they offered any. Are you still employed by the same employer and currently working for them with accommodation?

What is going on as far as your medical treatment? It does not sound like you are doing very well post fusion. Have you seen another spine surgeon for a second opinion on your current condition? Was your work comp spine surgeon at a decent hospital and did you review his background and reviews? Are you currently receiving treatment by a work comp doctor?

If you have private insurance you can see if you can get PT for your work related injury through them.

This is a good link for CA WC.

http://www.dir.ca.gov/dwc/InjuredWorker.htm
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#4
(03-01-2017, 12:57 PM)California_Help Wrote: I agree with what 1171 wrote.

Your attorney should have told you that you can have open medical for life, but what that means is dealing with the insurance companies utilization review company deciding what treatments and tests your doctors orders gets approved and getting whatever PD amount you were provided and foregoing the additional settlement money, if they offered any. Are you still employed by the same employer and currently working for them with accommodation?

What is going on as far as your medical treatment? It does not sound like you are doing very well post fusion. Have you seen another spine surgeon for a second opinion on your current condition? Was your work comp spine surgeon at a decent hospital and did you review his background and reviews? Are you currently receiving treatment by a work comp doctor?

If you have private insurance you can see if you can get PT for your work related injury through them.

This is a good link for CA WC.

http://www.dir.ca.gov/dwc/InjuredWorker.htm

Hi thank you so much for your response. I am not even getting 28% disability now. My attorney told me I dont know the CA WC laws and cant ask for future medical coverage and thinks 75 plus what I spent for gss co oays etc will be covered. Im very frustrated. How do I apply for disability? I have not been told anything from attorney. How many lawters van I change from or does this look bad? Thank you again.
 
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#5
(03-01-2017, 01:47 PM)PridedImp Wrote:
(03-01-2017, 12:57 PM)California_Help Wrote: Sorry I think I posted at the bottom and not top. If I collect the disability do I have to stop working? I can work but not a stairght 8 hours and need to get up every 15 min. If my job wasnt at home I would not be able to work probably at all. How do I get this assessed? The QME as seems to be the case everywhere shorted the percentage of my disability and I am rendered useles to do anything besides sit and type.so if I collect disability what do I give up for that?

 I agree with what 1171 wrote.

Your attorney should have told you that you can have open medical for life, but what that means is dealing with the insurance companies utilization review company deciding what treatments and tests your doctors orders gets approved and getting whatever PD amount you were provided and foregoing the additional settlement money, if they offered any. Are you still employed by the same employer and currently working for them with accommodation?

What is going on as far as your medical treatment? It does not sound like you are doing very well post fusion. Have you seen another spine surgeon for a second opinion on your current condition? Was your work comp spine surgeon at a decent hospital and did you review his background and reviews? Are you currently receiving treatment by a work comp doctor?

If you have private insurance you can see if you can get PT for your work related injury through them.

This is a good link for CA WC.

http://www.dir.ca.gov/dwc/InjuredWorker.htm

Hi thank you so much for your response. I am not even getting 28% disability now. My attorney told me I dont know the CA WC laws and cant ask for future medical coverage and thinks 75 plus what I spent for gss co oays etc will be covered. Im very frustrated. How do I apply for disability? I have not been told anything from attorney. How many lawters van I change from or does this look bad? Thank you again.
 
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#6
you get future medical for the 2013 injury at work only.
this is work comp insurance and only applies to that one injury for that employer. it's not you that is covered or has insurance. It's the employers policy that is protecting them from your claim. you can't file a civil suit or collect damages when the employer is protected by comp coverage; you only get comp benefits.
what kind of disability?
if your disability is total and only temporary and denied by comp you can apply for SDI thru EDD
http://www.edd.ca.gov/disability/SDI_Online.htm
if it's total and has lasted or will last a year or more you can apply for Social Security Disability
https://www.ssa.gov/disabilityssi/
if your disability is permanent (i assume the doctor that gave the 28% said so), then your only benefit is the work comp permanent disability payments.
use the link you were given by cal help to find out more about workers comp in california. a knowledgeable client has a more successful outcome to litigation.
since you are not working, have your atty request the carrier/employer begin advancing payments on your 28% rating.
there is no limit on changing lawyers.
it looks worse if you stay with a lawyer that is not helpful.
you can find work comp specialist lawyers here
caaa.org
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#7
(03-01-2017, 01:47 PM)PridedImp Wrote:
(03-01-2017, 12:57 PM)California_Help Wrote: I agree with what 1171 wrote.

Your attorney should have told you that you can have open medical for life, but what that means is dealing with the insurance companies utilization review company deciding what treatments and tests your doctors orders gets approved and getting whatever PD amount you were provided and foregoing the additional settlement money, if they offered any. Are you still employed by the same employer and currently working for them with accommodation?

What is going on as far as your medical treatment? It does not sound like you are doing very well post fusion. Have you seen another spine surgeon for a second opinion on your current condition? Was your work comp spine surgeon at a decent hospital and did you review his background and reviews? Are you currently receiving treatment by a work comp doctor?

If you have private insurance you can see if you can get PT for your work related injury through them.

This is a good link for CA WC.

http://www.dir.ca.gov/dwc/InjuredWorker.htm

Hi thank you so much for your response. I am not even getting 28% disability now. My attorney told me I dont know the CA WC laws and cant ask for future medical coverage and thinks 75 plus what I spent for gss co oays etc will be covered. Im very frustrated. How do I apply for disability? I have not been told anything from attorney. How many lawters van I change from or does this look bad? Thank you again.

I agree with everything 1171 wrote.

I want to make sure you are clear on this. You CAN have open medical for your work related injury of your neck. This does not cover anything other than your injury. You do not have to settle and close out this medical. There are 3 ways to settle a case in California. One, you receive your PD payments as you are and keep your work comp medical open and try to get treatment through work comp and deal with insurance company's utilization review. #2 close out your medical for a limp sum amount. It sounds like this is what your attorney is attempting. Do you know if that $75. includes PD payments you are receiving as it usually does? Either he is lying to you or you misunderstood him about ways to settle your case.

If you click the link I provided you can click settling claim under injured worker, or place in the search engine. There you can read the different ways I just mentioned.

Did you receive any TTD (temporary disability ) payments when you were off of work during your surgery? This is different than PD.

Have they been paying you for your mileage to and from work comp doctors?

Are you currently seeing a doctor for your neck because that is who you need to take you off of work not QME. If you have not applied for state disability for this injury, you may qualify for up to a year of state disability if your doctor agrees with you. I will provide the link and you can print out the page but you need a doctor to take you off of work. They/EDD usually help injured workers even if it is past the time for them to be able to apply.

So with work comp I our state you can receive RRD which is similar to what you made at work after taxes up to two years, but it can stop once your doctor or a QME states you are MMI/P&S permanent and stationary. After that ends and if your treating doctor believes your condition prevents you from working, you can apply for state disability, which I do not know how much they pay and it is up to a year.

This is a link on how to apply for state disability, but you need a treating doctor not QME to fill out paperwork, and I recommend trying to get TTD through work comp first if you qualify.
http://www.edd.ca.gov/File_and_Manage_a_Claim.htm

 I asked you several questions above to try and get a better idea on your status to help you. Without knowing certain things it is extremely difficult to help a person online. Do you currently see a treating doctor through the work comp system? Have you been taken off of work in the work comp system by a doctor and given TTD payments and if so for how long? The max in CA is 104 weeks.

Did your QME evaluate you before or after your fusion and has your condition worsened since he evaluated you? If you were not paid 104 weeks of TTD and your condition has gotten worse you may be eligible for TTD. You need a good treating doctor (not QME) to help you with making these decisions. I am going to be honest, if your employer is accommodating you right now and it is not making your condition worse I highly recommend staying with what you are doing. If it is unbearable then talk to your work comp treating doctor about taking you off of work. First try TTD with work comp and if they fight it try state disability. Do you have a good treating doctor you are seeing regularly for your neck injury through work comp? I ask these questions to better help you.

With your date of injury, and if your employer does not accommodate you and lets you go you are eligible for vouchers, but having a job is worth more than the vouchers so try to keep your job.

One more ting, does your attorney expect you to quit your job for the $75, 000. settlement? With closing out your medical with work comp they usually expect a resignation but not always. This may mean you cannot qualify for the vouchers, but I am not sure about that. So check on it.

Click the link I provided above and read about settling your case and TTD.

It may be a good idea to make a phone or in person appointment with your attorney to discuss settlement and what it exactly entails, and that you are aware you can keep your work comp medical open but may be giving up lump sum.

In your current condition you should still be seeing a treating doctor (not QME) through work comp. Are you?

Having a fusion is life changing. You will need to be extremely careful with what you do for the rest of your life. Did you ever receive aqua therapy? If not it is not land therapy so you are not capped on it. You should ask your doctor to request aqua therapy and find a good rehabilitation facility on your medical provider network for him to make the request. It may get denied through work comp and if so you have a short window I mean days to appeal it. I will help you with that of you doctor is not well versed.

If you have already maxed out on land and water PT through work comp you can try to use your private insurance and see if they will allow you. Many California injured workers are using private insurance due to limits on PT, but it depends upon the policy, some will refuse with open work comp case. If that happens you should be doing home exercise guided by your doctor for the rest of your life and do not rely upon these insurance companies. You can also ask your doctor to request an at home tens unit, this may help with the pain and allow you to continue to work.

How many attorney's have you had? I don't think it makes you look bad changing attorney's. This may be a communications issue so meet with your own attorney first is what I recommend. Make sure you google any attorney and their reviews before hiring them.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#8
(02-28-2017, 08:53 PM)PridedImp Wrote: Hello. I just found your forum and wanted to ask if anyone knew what a good settlement for the following is:

2013 injury at work, WC begins, doctors bad, no MRI for neck injury until 4 mo post accident. said I was a baby and had whiplash (treating WC doctor)
2014 spring WC MRI shows 2 level neck fusion needed d/t 2 discs pushing on brain stem. WC Travelers Drops me stating I was in the area on personal time not work (have tickets and sites visited for job).. I have been carrying my own insurance and forced to work until now. 
2014 Oct -emergency surgery for neck/brain injury/issues-2 level fusion of C4/5 and C5/6. jump to this year, still having residual issues and need further care, neck too straight and QME labeled me in 2016 as 28% PD with fusion and noted deterioration of vertebrae and discs above and below fusion.  Prior to this injury I worked out 4 x/wk for 2 hours/time and now I can do nothing like that. repetitive motion makes my arms numb and shoots pain from my neck everywhere.PT stopped d/t max amount reached. can't afford to continue by self.
I have an attorney and Travelers  in 2016 acknowledged this was a WC injury and only wants to give me 75k. what about future medical issues and if I'm comatose from another next injury? I can work from home but only bc I move all the time and now the issues have gotten so bad I cannot concentrate and I do high level functioning work on global study budgets and manage a large study.
Can't I have Travelers pay for future surgeries and bills related to this and I can't believe this is the crap they offer for a ruined life..what are my options? my lawyer says I can't ask for some things and 75 k is good but I think it's crap. Travelers just thought I would be broke and want to settle by now. Thing is now that I'm not able to work well, I may not have a job as I have to have them accommodate me and they may not have anything for me at this time that I can do.  
Any help or suggestions on where to look in the CA WC laws I would be great ful.

I do not think you should "stip" out your injury yet. Its too soon. It is very common for the levels above and below to "go", following a fusion. I had a cervical fusion (not WC) and a lumbar fusion that is WC, and the levels above went on both surgeries.
That $75,000.00 minus the 20% the attorney gets, is poo-poo.
Did they tell you that the money goes into a fund, to be used by your private insurance until it is used up?
After that, it is all out of pocket for you. Can you afford to pay hospital expenses if this happens on that amount?

Most jump for the lump, but if you are still complaining of pins and needles, this is not a good deal for you.
It is a good deal for your attorney and the insurer.
I refused to stip out and I am glad I choose to just get the "rating money" plus TTD post surgery payments and gas money for all the driving.

I have been sent to 4 IME's since this began in 1997 and I am still here!
The TRUTH rose to the top.
[color=#181818][size=small][font=Merriweather, Georgia, serif]The greatness of a man is not in how much wealth he acquires, but in his integrity and his ability to affect those around him positively~[/font][/size][/color]
 
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#9
You are wrong about settlement $$ going into a fund and used by private insurance.
Most compromise and release buyouts are paid out by checks directly to the injured and their attys.
Don,t confuse what happens in one case in another state you heard about with every case.
You are making misleading generalizations.
Where are you getting such bogus information?
POST YOUR SOURCE
You are misleading the poster with false information.
Stop it.
Sharing your personal experience is fine and is encouraged.
Misquoting the laws and rules is not.
Putting out bad information could sabotage a claim. Who are you trying to help?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#10
Agree BIG TIME with 1171.. I'm in NY and my lawyer is starting my settlement.. haven't heard anything yet, may at my Comp hearing next Wednesday. But here, whatever my settlement is with open Medical, my lawyer gets his part and the rest is mine... Nothing is put aside unless I was on Medicare, which I'm not.
Also, from what I've heard and read, a lot of private insurance hates paying for anything pertaining to a Comp injury. I know my husband's insurance is like that.
 
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