How A $475,000 Settlement Put Over $800,000 In The Pocket Of A Client

A couple of years ago a potential client called me with a major injury case.  It was in central Illinois and you don’t want a Chicago attorney for a downstate case, so I referred him to a great workers comp attorney out of Decatur to handle the matter.  This is exactly why we have created a state wide network of like minded attorneys.  We make sure that every person who calls our office gets with the best lawyer for their particular case.

Fast forward and the case is settling for $475,000.00.  Attorney fees are capped at a little over $72,000 for a case like this one, but the client is going to walk away with over $800,000.00.  How is that possible?

When you are hurt at work, you can either settle and close out your medical rights as relates to your injury or you can go to Arbitration and assuming you win, keep medical rights open for life.  But if you settle and it’s known that you will likely need more medical treatment as relates to the work accident, the insurance company has to fund a Medicare Set Aside which is an account to pay for future medical bills.

In essence, the insurance company has to protect the Government from having to pay your bills for a work injury.  So in a case like this, a study was done and it was determined that this client needed over 400k in future medical treatment.  This happens a lot when someone has had a fusion and will need one in the future or is undergoing a lot of pain management treatment.

The catch is that the insurance company doesn’t hold the money.  They have to write you a check and that money goes in to your account for you to manage. Your attorney can’t take a penny of this money and while it could come back to bite you, if you take that money and spend it on a vacation or a fancy car or whatever you want, that’s your call.  I don’t recommend that, but there’s not a law against it.  And if you can get a new job with health insurance that will pay for the future care, what you do with this money won’t likely ever matter.

Bottom line for you is that when you are thinking about settling an Illinois workers comp case, you should talk to your doctor about any future medical care you may need before you settle.  And if you hear about an injured worker pocketing $800k or a million or some other really large number, it’s probably because of future money for medical bills

Bonus tip. Some insurance companies will ask to hold the money for you or offer to pay out those bills as needed.  Don’t do it. It’s not how the law works and not to your advantage at all.

By Mike Helfand

Courtesy of Illinois Workers Compensation Law Blog

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