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Settlement and Buy Out in Cali... - cookfamily - 12-14-2010

Hey All....

I used to be one of the 1st members on this forum some years ago. Good to be back!

Ok, here goes. The hubby was injured in Cali in July 1999. He was put at 100% permanantly disabled in September 2004. He has been getting his checks, and his atty has already been paid. The IC has stopped paying for the nurse a couple of years ago, so I am his sole caretaker. We recieved a letter from the atty today saying that the IC would like to BUY OUT all medical. They had been kicking around the idea of a Medicare Set Aside, but with his case being as complicated as it is, I believe they feel it was too hard to deal with.

We don't know what would be fair, what to expect, what numbers will be thrown at us or anything. When they decide to do this, I realize it is his decision to accept or not, but what is the amount to look for, ballpark I mean? What, if anything, will they deduct? He has been on SSDI since May of 2000. The IC stopped paying for alot of the meds, and only pay for 2 things now, and havent paid for a doctor appointment in over 4 years. They havent paid for ANY mileage EVER...I mean, they have truly treated him so badly. His surgeon had said he had never seen such a case of medical abuse as badly as my husband. I do realize that no one can say for sure what is fair and not, but I was hoping maybe someone has an idea of what to expect.

I want to thank you all now for any help. It is so good to be back on the forum again. I see 1171 is still here!!! HI 1171!!! Smile

RE: Settlement and Buy Out in Cali... - 1171 - 12-14-2010

welcome back.

the atty still represents your husband on this case and until they are dismissed any settlement negotiations has to go thru them.
the issues with treatment and reimbursements should be part of the settlement and if necessary taken to the comp court for decision.

a medicare set aside would seem to be a requirement and not optional if the settlement includes future medical care.

pricing a complex case is very difficult especially when medicare will be involve.
your husband's life expectancy should be used to compute remaining value of his disability payments as well as future medical costs.
there is also a present value discount factor that would be used to convert the payments to a one time lumpsum amount.

here's a link to an online settlement evaluator that might help

RE: Settlement and Buy Out in Cali... - jayne - 12-14-2010

welcome back Cooksfamily....did you get to move closer to family? Stick around we sure could use your help....

RE: Settlement and Buy Out in Cali... - cookfamily - 05-18-2013

(12-14-2010, 05:27 PM)jayne Wrote: welcome back Cooksfamily....did you get to move closer to family? Stick around we sure could use your help....

Hi Jayne!! How are you? Oh my things have been so very crazy since I last posted! Hubby had another surgery....can barely walk now. The IC went BK and is now being handled by CIGA in Cali. We are lucky to get his checks, and have still NOT been paid mileage! I have sent in so many forms and they have refused them, because, there is no proof of visits. WHAT?? I called her and asked her...she said, well, I do not see your visits. I started laughing....really I said. I sent you all the receipts and you have them all in your computer. She said, oh well I will have to look. Its been 14 years and counting, no reimbursement for any mileage, half ass getting checks, they dont pay for his meds anymore, our atty is no longer an atty he was promoted to Judge. So...we have been on our own and I have lost alot of hair!!!! heheehehh
So I have been doing more mileage forms and copying forms and called all the docs and pharmacies to get copies of all of our paperwork.....she is going to be bombarded with paperwork now, and its silly cause she KNOWS we went to these appointments! I have never turned them in for non payment or anything, but I think the gloves need to come off now. I am at the end of my rope really.
We are not with family here in NV. Such a long awful story, it plays out like a bad soap opera. I lost my mom a couple of years ago, and my daughter's health was very bad for awhile...she is better now, but she is home schooled because of it. But I am so thankful for being so Blessed to have them in my life. I am happy to see people are still here....I hope to post more I said, Life has been crazy!!! I pray all is well with you! Hi 1171!!!!

RE: Settlement and Buy Out in Cali... - hamrs_62 - 05-19-2013

I guess I am just an idiot, because I am a really floored on what comp is able to get away with, and the workers have very if any recourse, it is appalling to me how they have been awarded so much power by the rich and powerful politicians, seems you have been run through the ringer, and in the end they will somehow get over on you, seems to me it is lawlessness, how they can squeeze people until the people have no other choice but to bend over,,,,

RE: Settlement and Buy Out in Cali... - Manley2 - 05-19-2013

Welcome back, have to agree with 1171 if he is on SSDI I would think a set-a-side is a must. It is so sad they put some of us through all of this but the problem is we are so small in numbers. It is all a numbers game to them and in some cases they would rather spend more to try and get out of paying us what they owe. With the way the laws are changing it is only going to get worse

RE: Settlement and Buy Out in Cali... - jayne - 05-19-2013

we have 2 others that have total body injuries like yours now and one his wife is on here.....Bronco is one guy with the total body injuries and for the life of me cant remember the lady but when the name comes to me I will come back and slide her name in here darn meds......

RE: Settlement and Buy Out in Cali... - 1171 - 05-19-2013

it's suppose to be a numbers game.
health care is a business like walmart, exxon, ford, etc.
if we want as much as we can get and free you'll have to contact your congressional representatives.

RE: Settlement and Buy Out in Cali... - cookfamily - 05-19-2013

Morning All...
Well they won't do a settlement now. Since the IC went BK and the CIGA is handling it, they will not settle, so we are truly at THEIR MERCY! It sucks. Been more than 14 years now...We are so tired. But I know there are people out there that are worse off than us. I just do not understand the whole thing about the mileage!! Seriously...why wont they just pay it??? I am looking for the numbers and such in Cali for the DWC and the I&A Office to file a complaint and such. ugh.

They have not paid for any of his pain meds in over 2 months now...and being on such a strict budget, you all know that things like that cannot be afforded....its been nitemareish......

Hope you all are well and are having a beautiful Sunday!!

RE: Settlement and Buy Out in Cali... - 1171 - 05-19-2013

CIGA is not an Insurance carrier and there are no penalties for them.
CIGA is a special fund that acts as a safety net to catch the liability for workers that otherwise would just be dropped without any coverage.

I'm not sure the usual complaint process would apply to the fund but you won't know until you try.

CIGA created under California law to provide a limited fund for the payment of some, but not all, workers' compensation claims...
CIGA is authorized to pay and discharge only certain "covered claims" as that term is defined under California Insurance Code Sections §1063.1 and §1063.2. The "covered claims" that CIGA is authorized to pay may be more limited and/or restricted than the coverage that would have been afforded under the policy issued by the insolvent and liquidated insurer.

I assume you've tried writing, calling, and emailing them..

You might also consider using their ethics hot line