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Settling Future Medical for PTSD
#1
I am a 25 year fire captain from California. My original date of injury is 2006, but I was able to work until 2013, when I was forced to retire due to this second instance of PTSD. The claim was accepted immediately but I was not entitled to 4850 time since it was not a new injury but an exacerbation of the 2006 injury.  I was awarded a disability retirement and the wc carrier has never denied any treatment. I moved out of state to avoid triggers. WC has provided psychological care, psychiatric care, medications, massage, yoga, gym membership, etc with no denials or delays. I have never been in an adversarial position with them or my employer. Recently the QME (I am unrepresented, btw) declared me P & S and the report was sent to the adjuster, who rated me at 36% PD and has been paying me bi-weekly with back pay to the date I was P&S. The report has been forwarded to the state for rating.

I estimate my medical care and associated costs to have been $30k per year over the last 2 years. The QME stated my condition has plateaued but could get worse or better and recommended future medical care, including the massage, yoga, medications, psych care, etc. 

I have 2 questions. I want to negotiate settling my future medical care into a lump sum payment. I am 54 years old. Assuming I could live another 30 years or more, and my care could cost $30k per year, more or less, what would be a fair settlement amount? I realize it will NOT be 30 years x $30k, but what WOULD be reasonable? It is well known that long term stress causes other medical problems, so I don't want to run out of $ in 10 years.

It is difficult to find care providers in TX who accept CA work comp payments, so I will be paying out of pocket, likely at a rate higher than wc currently pays. For instance, one of my meds costs $1500 a month, but wc only pays $500. My point is that I may be paying more than $30k per year, but I will not have to pay out of pocket and then wait forever for reimbursement.

I would appreciate if anyone knows how they estimate how long you will live and how much they pay, knowing how much your has cost to date.

Thank you.
 
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Messages In This Thread
Settling Future Medical for PTSD - Shortfuse - 04-09-2016, 08:20 PM

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