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Original injuries were fractured proximal humerus (2 surgeries) and fractured hip (no surgery, but had a previous hip replacement). Accident happened at work 6/06. Last operation on arm was 12/07. Physical therapy is long done. My PPD ratings from my orthopedic doctors are 30% for arm and 55% for hip. So far I have continued to receive the same WC benefit but category is now changed to PPD. I do have an attorney, but I think he is anxious to go for a settlement. I will have to put money in a MSA. My employer (who refused to rehire me, even though my exact job was available), is self-insured. I know I may need future surgery to injured body parts. What should I expect to happen next? Any advice or suggestions would be appreciated. Thanks.
MMI changes things significantly. In Connecticut you will receive PPD benefits calculated by a formula. The current table in Sec 31-308 says that the loss of use of your master arm is worth 208 weeks total.
If your disability is 30% then you will receive 62.4 weeks x your weekly benefit rate (30% of 208 weeks). Your non master arm is worth 194 weeks. Your pelvis is worth 374 weeks (percentage of back) total. Using a figure of 55% you will receive 205.7(374x55%) weeks x your weekly benefit rate. Adding these two figure will tell you your PPD subject to other factors (whether insurer tries to reduce award by IME, if your award is calculated in accordance with the current table rather than the table that existed on the date of injury (I'm not sure), whether you had an existing percentage of disability on your hip etc.) These awards are for Permanent Partial Disability or PPD.
What is important to know is that weekly checks for PPD will be deducted from that amount. The PPD that is finally agreed to is done by a "voluntary agreement" which is signed by all parties and submitted to the commissioner for approval. This is then your money whether you settle or not. When you think of settling you must remember that this is already your money! Your attorney will be entitled to around 20% and the check for the total may well go directly to him. He will deduct his and then give you yours so depending on what your agreement with him says he may be able to deduct more (out of pocket expenses, cost of transcripts etc.) so you need to know what will be deducted in writing from your attorney prior to settling.
The insurer is responsible for any medical bills related to your work injuries for the rest of your life if you don't settle. This is want they want to escape by settling. Depending on what the future holds, the cost of your future medical care related to the work injury can be significant. There's danger here because private insurers may not cover you work related injuries if you settle. Social Security may not either.
Any other money owed to you (milage, unpaid medical bills etc.) need to be paid beforehand.
Just as an example let's say they offer 100k for a final settlement. You PPD is 65k and you have another 5k in unpaid expenses. The lawyer will take at least 20k off the top leaving you with 80k. You pay the 5k in unpaid bills leaving 75k. 52k is already yours( in your PPD minus the lawyers 20%) which gives you a real settlement of 23k which isn't a lot to accept responsibility for your own future medical.
Muffy, there is a lot to think about. If you settle, it's over and the insurer and your lawyer will be of no further help. You have to know exactly what you will end up with before anybody pushes you into anything.
Additionally it seems very close to you last surgery (depending on what the surgery was) to know your O.K. If I'm not mistaken its been less than two months.
Hope I didn't confuse you. Connecticut is my state so I know quite a bit and will try to help if I can.
And as you said Lost. They could very well dispute the 30% and 55% and send Muffy to have a IME. Just when i thought it was over and the check was being cut, the ic lawyer wanted a IME to compare percentage's and try to take away what i received as a fair rating. Good luck Muffy, but please keep medical open and do not settle that out.
an IME is only an opinion of another Dr. and if your Dr. goes by medical guidlines and can show that, I believe you are most likely to receive what your Dr. has reported, besides he is the one you have been dealing with time and time again, the IME only sees you for 5 minutes.
Thanks for all of your replies. I did make an error on the date of my 2nd arm surgery, which was 12/06, not 12/07. So that is the reason for the MMI ratings. I finally got to speak with my attorney today, who said the IC felt the 55% rating on my hip was too high, so I am going to be sent to an IME for another opinion. There seems to be such differences of opinions as to whether to make a final settlement or whether to keep the medical open and not make a settlement. In CT it seems that PPD will last only "X" number of weeks, so are you left without any WC checks after that? I have already been approved for SSDI, based on my current injuries, plus 4 previous joint replacements. I was working full time up until my fall on in 6/06. From my discussion with my attorney today, it seems the settlement he would like to see is compensation for my inabillity to work in the future, cost of future medical in addition to the PPD award. I guess I will have to wait to see if my previous employer is negotiable on these issues. No simple answers!!
Your right about no simple answers. Just keep in mind that it is very important to understand everything and what it means to YOU in the long run. If you have questions, ask them. If you need help, someone will be here.
Muffy, Given that you have been rated and converted to PPD checks, the clock is now ticking on your WC case.
Your case will never have any more value than it has now for settlement purposes. You can either cash in your chips and close out with a full and final settlement or collect the specific PPD payments (plus 31-308a) and leave your case open. It would be your choice.
The MSA Trust means it would take considerably longer for all the details to be worked out were you to settle.
Life is all about choices. You have to decide which is best for you.