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long story- attorney suggests proposing settlement before qme
#1
Hi, long story --

I'm in CA, have been going through workers comp for about 7 months after developing bad RSI across neck, both shoulders, both arms, wrists, hands, after working as a typist with terrible ergonomic workspace. It's still impossible for me to pick up anything, carry groceries, cook food, turn faucet on, hold a camera (outside work i'm a filmmaker, so this has really killed me) or type, and my arms are in constant pain all the time, nothing has really improved since this started.

Work comp has been a nightmare so far. I've had a lot of PT and chiro, and the doctors decided against surgery as they all decided I should be given a chance to heal on my own, but nothings improving.

I declared p&s 2months ago, but the doctor has not written his final report nor given a disability rating. I'm still technically employed by the company, and have attempted return to work twice which resulted in the injury getting worse. Employer has put me in temporary position for last 4 months to accommodate the restriction of no typing for more than 10min/day (husband typing this right now).

I've requested a QME but still waiting to hear back. My attorney says my WC doctor is notorious for being very conservative in disability ratings. Despite my condition getting worse since being declared p&s, the doc doesn't want to change the restrictions to say "no typing", and instead told me to quit the job and file for state benefits.

The temporary job is essentially a security guard role, but they didn't train me for it. While on this job, i was sexually harassed by a coworker for a period of time, then recently had to deal with a gunman trying to carry out a shooting. With no prior training provided, this experience was obviously really high stress. Typing I can do, saving people from being shot, I cannot. I'm really at breaking point after the neverending work comp process, being bounced around jobs,sexual harassment and the gunman incident.

After this happened i asked my employer for clarification of the job role, and reassurances that security had been stepped up. They told me more security had been hired, so we mutually agreed that I'd continue at the role.

A few days later, the employer has said they can no longer accommodate the restrictions anywhere in the company and placed me on leave, saying that the insurance would pay TDD in the meantime.

The claims adjuster has come back saying that because I'm P&S, they won't pay any TDD but would give me a one off 'good faith' payment based on my estimated disability rating of 3%, amounting to about $2000. They are still waiting on the doctor's disability rating and the QME form to go through, but say it would be 1-2 months or so before anything happens.

I'm aware that the employer can offer me work, but they're denying that they can. They place all injured workers into security roles, and there's definitely space for more security guards, so this is obviously a decision based on my politely asking for reassurances about security measures (lesson learned - don't ask any questions ever, even if it's about your own safety at work). So right now, I"m technically still employed, but have no income, no TDD, no idea of how long this will all take, with bills and rent to pay.

my husband and I had been planning to move back to my home country at the end of the year (different country, i'm on a green card) as this year has been nothing but misery, nonstop pain and intense stress from the job and work comp. I'm emotionally wrecked after dealing with the harassment and the gun incident, and would just like out. All I wanted was to be able to keep working and saving until the end of the year - crucial to being able to afford to move home. But now we're really stuck.

My lawyer suggested proposing a settlement to the insurance to wrap it up quickly, and negotiating an amount. I've had future medical care left open by the doctor, but I'd be happy to waive that if I could get a lump sum and get as far away from the situation as possible, so I can make my own decisions about what kind and quality of care I get, stop dealing with insurance companies and cover my back financially for a short time. Given that I can't use my arms for anything, I"m not very employable right now, and would struggle to find another job so soon. The lawyer seems to think now is the best time to propose settling, before any other process starts, and seems to think it would be best if I negotiated with the insurance instead of him doing it.

Has anyone heard of a IW proposing a settlement to the insurance before a QME or anything has taken place? How to initiate it? Any suggestions about what to do at this point, id appreciate hearing. Thanks.
Bit more info - doctors have suggested this is a long term if not lifetime injury which is going to require ongoing care. Before anyone tells me 'you're not from here, don't take our benefits' etc - I'm a good, hardworking taxpayer, I ideally dont want benefits and i'm not looking for a huge moneymaking settlement, i just hope to cover what i would've earned through the rest of the year, so i can move home. The rest (ongoing healthcare) i'll happily take care of myself. Glad to hear your views.
 
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#2
Happens all the time. The insurance company would likely be agreeable to settling rather than fork over the money for a medical/legal exam, waiting for the results, etc. Have your attorney send out a settlement demand, that way at least negotiations can begin.
 
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#3
Big thank you for your reply Woodlawn. Do you know what I should take into account (future surgery/treatment, TDD in back payment, etc) in order to come up with an amount? The att suggested $25k.
also does anyone have experience attempting to negotiate a settlement with the insurance themselves? the lawyer i've been speaking to isn't officially representing me yet (because he said it was better to request QME unrepresented), and keeps urging me to ask for a settlement and negotiate on my own. is this to save me his fee, or because he simply doesn't want the case?
 
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#4


without a rating it'll be very difficult for the court to approve a settlement.
they need some medical evidence as to the extent of your permanent impairment in order to compute the benefits you are buying out of.
if the doctor is withholding his report for some unknown reason, your atty can take their sworn statement and maybe get enough to support some kind of settlement amount.
if you are permanent and stationary, you can file for unemployment.

there are very few options for the worker to force the legal system to move faster.
if your condition is getting worse, then the QME opinion could support re-starting your temporary disability.
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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#5
Courts can settle without a formal rating, but 1171 is correct in that it can be tricky. In cases like that, it is ideal to have everyone (including you) down at the board to explain to the judge why you wish to settle rather than going forward with the medical process. Although, this will be extremely difficult without an attorney since the judge will almost certainly order the QME rather than let you settle, citing your best interests. This has it's own set of advantages and disadvantages.

As far as negotiating with the insurance company, here's what I would suggest. If they wanted to make you an offer to settle out your claim, they'll start out with something rather low, say, $7,500. Get a target figure in mind ($25,000+any PD you are found to be entitled to is fine if you aren't expecting any major surgery, and would more than cover many of the more common upper extremity surgeries) and go from somewhere above that figure, say, $35,000. You could also impress on them how you have pain in all these parts and potentially a while lot of treatment would be required, and consider that and the cost of the QME, diagnostic testing if needed, and your figure starts to look much better.)
 
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#6
Just my two sence.

I would never start the negotiation process. I would wait for the IC to start.

Further more, I would question why you are being advised to make the fist offer and to make it without a qme???? HHHHMMMMM???????

8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
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#7
I'm sorry but the main issue here isn't a settlement, it is getting the medical care you need. There is an obvious disagreement between you and your PTP and your so called behind the scenes attorney.

What you need at this point is to see a QME who will determine your status as MMI or continue you on TTD, will opine as to what medical care is needed now, and possibly in the future. If the QME determines you MMI he will rate you.

If the QME is favorable to you, the lawyer will probably represent you and you will no longer deal directly with the adjuster. Unless, or until that happens, you are your own advocate.

You said, "I've requested a QME but still waiting to hear back." What medical specialty are you requesting? Once you mail in the QME request with specialty, you will get a form with 3 doctors to choose from. Usually within 10 working days. You choose the doctor from the list. You make the appointment and notify your claims adjuster the doctor's name and appointment date. Your adjuster will forward your medical records to the QME before your appointment, and also provide you with copies of what he sent and pay for mileage ahead of time.

This may seem complicated but wc is a crazy maze and nothing is done in a hurry.

Let Go, and Let God......
 
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#8
Thanks for all your answers, it's been really so helpful (more than my attorney for sure)

(10-05-2012, 11:18 PM)chrischris Wrote: You said, "I've requested a QME but still waiting to hear back." What medical specialty are you requesting?

I've requested MPA. I was told it should take about a week to hear back, but it's been over that. But I've heard from two different lawyers now to expect it to take up to a month to be given a list of doctors. I know I need the QME (just for my own peace of mind after this charade with occ med doctors) - I just got so confused by the lawyer telling me to settle now.


(10-05-2012, 05:45 PM)AQA Wrote: I would never start the negotiation process. I would wait for the IC to start.

Further more, I would question why you are being advised to make the fist offer and to make it without a qme???? HHHHMMMMM???????

I was wondering exactly that, because it didn't make any sense. Hypothetically what do you think would happen if I made the first offer? Would it work completely against me? I'm not going to do this - I'm just interested to know what would happen.

From what I understood, it would be in their benefit to save paying for a QME, but that still doesn't make much sense. I've gotten in touch with another attorney now, hopefully with more success...

I guess the main factor here is me leaving the country at the end of the year - from what I understand the case will continue wherever I am, but I wanted to get as much sorted out before then as possible, and am not looking for lifetime medical care in the states.
Also - does anyone know if there is anything I could do about the amount of emotional distress caused by the temporary job I'd been put into (sexual harassment, being put at risk/huge position of responsibility without training)? Also the fact they have said they can't accommodate the restrictions when they clearly can.

I know the answer is likely to be to just deal with it, but I desperately need the work and they clearly still have surplus positions available. It seems like I've been taken off the job because they know they made a mistake not training me / having enough professional security on the job during the gun incident and didn't want me to say anything else.
 
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#9
(10-06-2012, 01:01 AM)zzebra Wrote: Also - does anyone know if there is anything I could do about the amount of emotional distress caused by the temporary job I'd been put into (sexual harassment, being put at risk/huge position of responsibility without training)? Also the fact they have said they can't accommodate the restrictions when they clearly can.

I know the answer is likely to be to just deal with it, but I desperately need the work and they clearly still have surplus positions available. It seems like I've been taken off the job because they know they made a mistake not training me / having enough professional security on the job during the gun incident and didn't want me to say anything else.

ask your doctor for a referral for counseling.
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
Sorry for your struggles! I have the same problems but have not been able to get a diagnosis - what type of Dr. did you see? Any chance you'll share the diagnosis?

I'm in NE.

Thank you.

(10-04-2012, 10:36 PM)zzebra Wrote: Hi, long story --

I'm in CA, have been going through workers comp for about 7 months after developing bad RSI across neck, both shoulders, both arms, wrists, hands, after working as a typist with terrible ergonomic workspace. It's still impossible for me to pick up anything, carry groceries, cook food, turn faucet on, hold a camera (outside work i'm a filmmaker, so this has really killed me) or type, and my arms are in constant pain all the time, nothing has really improved since this started.

Work comp has been a nightmare so far. I've had a lot of PT and chiro, and the doctors decided against surgery as they all decided I should be given a chance to heal on my own, but nothings improving.

I declared p&s 2months ago, but the doctor has not written his final report nor given a disability rating. I'm still technically employed by the company, and have attempted return to work twice which resulted in the injury getting worse. Employer has put me in temporary position for last 4 months to accommodate the restriction of no typing for more than 10min/day (husband typing this right now).

I've requested a QME but still waiting to hear back. My attorney says my WC doctor is notorious for being very conservative in disability ratings. Despite my condition getting worse since being declared p&s, the doc doesn't want to change the restrictions to say "no typing", and instead told me to quit the job and file for state benefits.

The temporary job is essentially a security guard role, but they didn't train me for it. While on this job, i was sexually harassed by a coworker for a period of time, then recently had to deal with a gunman trying to carry out a shooting. With no prior training provided, this experience was obviously really high stress. Typing I can do, saving people from being shot, I cannot. I'm really at breaking point after the neverending work comp process, being bounced around jobs,sexual harassment and the gunman incident.

After this happened i asked my employer for clarification of the job role, and reassurances that security had been stepped up. They told me more security had been hired, so we mutually agreed that I'd continue at the role.

A few days later, the employer has said they can no longer accommodate the restrictions anywhere in the company and placed me on leave, saying that the insurance would pay TDD in the meantime.

The claims adjuster has come back saying that because I'm P&S, they won't pay any TDD but would give me a one off 'good faith' payment based on my estimated disability rating of 3%, amounting to about $2000. They are still waiting on the doctor's disability rating and the QME form to go through, but say it would be 1-2 months or so before anything happens.

I'm aware that the employer can offer me work, but they're denying that they can. They place all injured workers into security roles, and there's definitely space for more security guards, so this is obviously a decision based on my politely asking for reassurances about security measures (lesson learned - don't ask any questions ever, even if it's about your own safety at work). So right now, I"m technically still employed, but have no income, no TDD, no idea of how long this will all take, with bills and rent to pay.

my husband and I had been planning to move back to my home country at the end of the year (different country, i'm on a green card) as this year has been nothing but misery, nonstop pain and intense stress from the job and work comp. I'm emotionally wrecked after dealing with the harassment and the gun incident, and would just like out. All I wanted was to be able to keep working and saving until the end of the year - crucial to being able to afford to move home. But now we're really stuck.

My lawyer suggested proposing a settlement to the insurance to wrap it up quickly, and negotiating an amount. I've had future medical care left open by the doctor, but I'd be happy to waive that if I could get a lump sum and get as far away from the situation as possible, so I can make my own decisions about what kind and quality of care I get, stop dealing with insurance companies and cover my back financially for a short time. Given that I can't use my arms for anything, I"m not very employable right now, and would struggle to find another job so soon. The lawyer seems to think now is the best time to propose settling, before any other process starts, and seems to think it would be best if I negotiated with the insurance instead of him doing it.

Has anyone heard of a IW proposing a settlement to the insurance before a QME or anything has taken place? How to initiate it? Any suggestions about what to do at this point, id appreciate hearing. Thanks.
Bit more info - doctors have suggested this is a long term if not lifetime injury which is going to require ongoing care. Before anyone tells me 'you're not from here, don't take our benefits' etc - I'm a good, hardworking taxpayer, I ideally dont want benefits and i'm not looking for a huge moneymaking settlement, i just hope to cover what i would've earned through the rest of the year, so i can move home. The rest (ongoing healthcare) i'll happily take care of myself. Glad to hear your views.

 
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