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Settlement ?
#1
I just received a rating of 13% wpi from my ptp for lower back injury. If I settle via stipulations, is this the rating used and is my total settlement amount whatever 13% pays plus open medical? And does a judge have to approve this also? For some reason I thought in a stipulation other things were considered like age at time of injury and future earnings as well.
 
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#2
a rating can be disputed.
each state has it's own rules and dispute resolution process.
a settlement by stipulation could also include other unresolved items like re-imbursements for treatment and expenses or resolution of temporary disability payment issues.
in most states the comp court has to approve all settlements;.
an impairment rating from a physician is not a permanent disability rating.
an impairment rating is used by the work comp system to compute permanent disability benefits.
each state has a formula for the computation and many states include factors such as age, occupation, type of injury, date of injury, etc. when computing a permanent disability rating and resulting benefits.
you should be posting your state so responders can better answer.
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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#3
(02-28-2014, 03:53 AM)1171 Wrote: a rating can be disputed.
each state has it's own rules and dispute resolution process.
a settlement by stipulation could also include other unresolved items like re-imbursements for treatment and expenses or resolution of temporary disability payment issues.
in most states the comp court has to approve all settlements;.
an impairment rating from a physician is not a permanent disability rating.
an impairment rating is used by the work comp system to compute permanent disability benefits.
each state has a formula for the computation and many states include factors such as age, occupation, type of injury, date of injury, etc. when computing a permanent disability rating and resulting benefits.
you should be posting your state so responders can better answer.
Sorry... California
 
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#4
ok.
if you are not represented either party can dispute the treating doctor's opinion thru the QME process.
any stipulated agreement on the amount of disability and other benefits including medical has to submitted to the WCAB for approval and the issuing of an Award of benefits agreed to.

any whole person impairment rating from any doctor has to be modified for age (at date of Injury), occupation, and FEC future earning capacity) for each type of injury according to the rating schedule before it is used to calculate the permanent impairment benefits.
the disability evaluation unit of the DWC is charged with issuing a formal rating once the impairment rating report has been submitted.
the factors modifying the impairment rating are set by law and strictly applied by proper use of the approved schedule.
generally rating factors are not negotiated.

information on Califnornia's QME process and the rating schedules are here
http://www.dir.ca.gov/dwc/DWC_FAQ.htm and here
http://www.dir.ca.gov/dwc/DEU.html
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
(02-28-2014, 12:31 PM)1171 Wrote: ok.
if you are not represented either party can dispute the treating doctor's opinion thru the QME process.
any stipulated agreement on the amount of disability and other benefits including medical has to submitted to the WCAB for approval and the issuing of an Award of benefits agreed to.

any whole person impairment rating from any doctor has to be modified for age (at date of Injury), occupation, and FEC future earning capacity) for each type of injury according to the rating schedule before it is used to calculate the permanent impairment benefits.
the disability evaluation unit of the DWC is charged with issuing a formal rating once the impairment rating report has been submitted.
the factors modifying the impairment rating are set by law and strictly applied by proper use of the approved schedule.
generally rating factors are not negotiated.

information on Califnornia's QME process and the rating schedules are here
http://www.dir.ca.gov/dwc/DWC_FAQ.htm and here
http://www.dir.ca.gov/dwc/DEU.html
I was quite lost on this issue. I do have an attorney and I received a demand letter from my aa that was addressed to the ic stating that he accepts the doctors 13% rating and is will to settle via stipulation for 13%? So, if the ic agrees to settle at these terms, does the dr's rating then get sent to get modified to a formal rating and also to a judge for approval?

 
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#6
yes; you'll get stipulations for whatever figure the 13% modifies to.
after you and your atty sign it'll be sent with the supporting medical to the court to approve. 30-60 days later depending on workloads an award of permanent disability and future medical will issue.
the carrier will have reasonable amount of time (approximately 30 days-any advances and your attys fee will be deducted) to pay the accrued $$ and begin bi-monthly payments for any balance.
you have 5 years from the date of injury to re-open the disability award and make a claim for any new and further disability.
talk to your atty about their representation should there be a future issue on medical treatment.
oftentimes after an award and the atty fees are paid they are reluctant to help clients who have to contest denied treatment.
they are still considered by the court to be your atty of record even after the disability is paid.


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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#7
Thank you very much for the informative response.
 
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#8
1171...
Does this sound right to you... Going over a demand letter that my attorney wrote to the insurance company that states that's he's willing to recommend stipulations at 13% since that's what he rates my ptp's report( had l5 microdiscectomy and rtw full duty) I asked him if this rating is the final rating, or will it be converted to a final pd rating and he said that this rating is final. I thought that California uses the ama 5th edition and 13% is standard for this procedure? What happened to the formula to reach a final pd rating from the doctors report, or do you think that this might have been done already?
 
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#9
the modifications may have cancelled each other out.
Have you seen your rating formula?

here's an example:
15.03.01.00 – 10 – [5]13 – 351G – 15 – 13 PD
(impairment # - WPI rating - FEC#& mod - Occupation# - Occupation mod - Age mod)

The schedule utilizes an impairment number and an impairment standard or Whole Person Impairment rating. The impairment standard is then modified to reflect diminished future earning capacity, the occupation and the age at the time of injury.
http://www.dir.ca.gov/dwc/DEU.html
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
(03-05-2014, 02:22 AM)1171 Wrote: the modifications may have cancelled each other out.
Have you seen your rating formula?

here's an example:
15.03.01.00 – 10 – [5]13 – 351G – 15 – 13 PD
(impairment # - WPI rating - FEC#& mod - Occupation# - Occupation mod - Age mod)

The schedule utilizes an impairment number and an impairment standard or Whole Person Impairment rating. The impairment standard is then modified to reflect diminished future earning capacity, the occupation and the age at the time of injury.
http://www.dir.ca.gov/dwc/DEU.html
I think you are right on this one.. Thank you
 
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