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(07-07-2015, 12:03 PM)dolphins Wrote: Worse case scenario is no SSD addendum and no
MSA in a large C&R. Applicant may lose SSD
payments based upon weekly TTD rate for entire
C&R amount and Medicare will not cover future
medical treatment for parts of body injured in work
related injury and Medicare will sue the Applicant, his
attorney for past treatment cost.

I was reading this, and wondering, if I sale out fm, can I get my SSD payments included in the non-medical? If I didn't sale out my fm, I would be eligible for ssd for the rest of my life, by selling it off, I will lose those payments.

Or, is the msa only considered monies for medical treatment, and not considered money in an account, and be cut off due to that?

I have to report all monies in any bank account to social security, and I don't want them to say, we don't care what the money is for, we just know you enough money in the bank to support yourself, or some rule saying I can only have so much in an account.

How do I protect my social security disability payments against the medical set aside, and still self administer the money myself?

Hi Dolphins,

I am confused because Social Security Disability has nothing to do with what monies you have in a bank account, however SSI is based on assets.Are you currently receiving SSI (supplemental security income) and not SSDI (social security disability)? I am still a bit confused on what benefits you have and I know I asked you this previously, but I do not remember what you stated. Also, do you currently have Medicare or do you have Medicaid? If you are on SSI and do not have SSDI and do not have Medicare you do not need a MSA (Medicare set aside)unless you will qualify for SSDI within the next 30 months.

If you have SSI, I have very little knowledge about this. This is income/asset/disability based and is different than SSDI (social security disability).

If you have SSDI (social security disability) there is a way for applicant attorney's to structure the payments so SSDI is not cut. This can be done with the Hartman formula for example. They spread out the payments over a period and ensure SSDI payments are not affected.

I also want you to know just because you settle your medical it does not mean you only get a MSA. Often times an injured worker can get a lump sum of money on top of the MSA. This would be the same if the injured worker did not have Medicare or SSDI. Then they get paid a lump sum only.

There is a way to structure a settlement in which there are monies that can be used for co-pays and things Medicare does not cover (donut hole). These are monies you do not have to report back and itemize to Social Security. This can be negotiated in a settlement but not always if the MSA amount comes back so high the IC may not want to do the donut hole monies (unknown). I have no idea if this donut hole monies would be counted as money in an account by SSI and would affect your SSI (supplemental security income) if you have SSI (not sure). This would be a question for Social Security or an attorney. I do not see how Social Security would consider MSA monies the same as monies in a bank account against SSI... but get a professional to discuss this with as I am not qualified to give advice on this. I just barely know the basics. There are others on this site who have closed out there medical and who are on SSDI. I would reach out to some of them about this.

Once your MSA is used completely you can then use Medicare for your work related injuries, but you would have co-payments and Medicare does not cover all of the things workers compensation may have covered.

Also, if you get a 100% PD rating you will be receiving TTD for life and also a small lifetime pension. This is why ICs fight 100% PD ratings tooth and nail. If you close out your claim you will give this up. I would think about your options when you get your final rating and discuss this with an attorney. I have written this too many times to count, but will one last time. I think with the complexities of your injury and the possibility of a 100% PD rating, I would recommend hiring an attorney if you are thinking about closing out the medical in your case. There are too many ways to get screwed.(JMO)

Sometimes the IC will not close out the medical in a claim if the MSA is too large.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
I am on ssi. And medical, have been since 2006.

I agree with you on hiring an attorney, I have been trying to read through all the msa on the wcab web page, and it is over whelming.

I posted on avvo, and was giving a list of attorneys in my area. I called and spoke with one, and was informed to contact the I@A officer, who the attorney said she used to work with in her law office, and she is very good, and free. I called and spoke with the I@A officer, and was told I do NOT need an att. And that the vendor will do the msa and send it to the state, and they will review for approval. As far as the non-medical, she told me I can do a Combined rating and the deu will give me the total of all medical, and non-medical. so I do not need an attorney.

Now I'm just confused, don't know if I need an att, or not. I am trying to learn what I can, so whoever does it, I can check myself, and make sure everything is covered, but like I said, it is ALOT to learn.

Like the lost wages issue. I can't return to any job, so I can't earn a living, am I entitled to lost wages for the rest of my life? And is this something that will be included in the non-medical? I know I get money for future medical, and non-medical. but what about lost wages. I believe it's called indemnity

I was making over a hundred grand a year, and if ssi cuts me off, what am I supposed to live on?

Am I eligible for any type of lost wages?

I plan on self administering the account myself, and have learned everything I need to know about that, but I have so many other questions that I need answers to, and it is going to be along road trying to learn it all.

As far as the 100% rating, if I do get that, they would have to pay TTD for life, and a small pension. This all can be figured out as far as the monies to be paid for the rest of my life,. Is this something that could be sold out too?

Or, could I sale out the future medical/non medical, but leave the TTD and life time pension open?

I'm hoping someone on here that has done a msa will way in, and answer some of these questions.

I appreciate your responses, and hope I can help you if and when you need it.
Hi Dolphines,

I have heard about an injured workers who only closed out the medical portion of their claim, and still receive TTD but it is rare. Usually they close out the entire claim for a lump sum.

I think it would be worth talking to a few attorney's at this time because you have described some serious injuries and you have questions about settling your claim. There is a big difference between receiving a 100% PD rating vs a 99% PD rating. The amount of difference is a huge amount of money. An attorney can review your case and see if there is anything that is being missed and if hiring an attorney would be beneficial to you at this time to both you and the attorney. I have no idea, but it would be worth getting a few consults (JMO).

As you are aware I am not an expert and I only know bits and pieces of your case from what you have written.There are different ways to rate a person and they can sometimes go outside of the guidelines for those who can no longer return to work due to their injury.

Sometimes the AME/QME needs to be deposed if there are things that were not properly rated. Both the defense and applicant side can do this. I do not think everyone needs an attorney, but I do think those who have serious complex injuries should consult with a few and may benefit from an attorney to help structure and negotiate a settlement. If you keep your medical open and your PD rating comes back 100% and your defense agrees with it, then I would not worry so much about hiring an attorney.

I was also hoping someone who has settled with a MSA would chime in. Maybe if you start another string and ask about your MSA it will get a response. This long string may be intimidating lol.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
i talked with an att. yesterday, he explained that when it comes to the msa, it is medical interest that need to be protected, and not mine, therefore they have their own people that set the determined amount to be set aside. They will only approve, if they feel they are fully protected, and this is something that I do not need to worry about. I need to only concern myself with the non-medical, and according to the I@A officer, this can be done by deu.

As far as the rating goes, I am still waiting for the pqme report, and I spoke with the I@A officer about the rsd in back/spine, and both knees, she said It is preferred that my ptp do a rating for all body parts, if the da/ca object, I will be sent back to pqme to resolve the knees/rsd.

According to her, and everyone I spoken with, the deu/cms will use my ptp reports as the primary reference, and the pqme/ame/ime reports as a secondary reference.

I wish I could find an attorney that would go through all my records along with the projected settlement from all fm and non-med. and see if everything is covered, but pay him/her a cash price, instead of a percentage.
It's day 32, and I still haven't gotten the pqme report. I believe he has 30 calendar day's to copy me, or I can request a new pqme. He had to notify me of any request for an extension, 5 day's before the 30 calendar day's expired. He failed to do that. if I don't agree with his report. do you think this is grounds for requesting a new pqme?
You have to object now to untimely if you want another PQME, and cannot wait until you get the report to see if it is favorable to you.

If you wait until you receive the report, it will be too late to request another PQME.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
Thank you.
California_Help gave me a web page about workers comp by an attorney, I was reading one of his posts and found it interesting enough to post on here. I hope it will help some of us out.

And thank you California_Help for the web page.


The $120 million “Return to Work” fund (to compensate workers whose permanent disability payments were disproportionately low in relation to their wage losses) was enacted in 2012 but not designed and instituted by the DWC until 2015.

Questions have swirled around how the fund would be designed, administered, and funded.

Among those was the question about whether $120 million would be put in the fund for 2013, another $120 million for 2014, and $120 million for 2015.

The DWC does not interpret the statute that way. Many applicant attorneys disagree.

This may be a moot argument given how the $120 million fund is designed. Workers must present evidence of receipt of a voucher (technically known as a job displacement voucher). The voucher itself is worth $6,000 and the DWC has designed the $120 million fund to pay $5,000 to workers who present the SJDB voucher in a timely fashion with their application to the fund.

But there are obstacles. Many workers, particularly pro pers, will not be aware of the entitlement to the $120 million fund money.

And in my experience many workers who may be eligible for SJDB vouchers don’t follow up to actually receive the voucher.

And time limits for applying may ensnare some workers.

Also, the DWC rules don’t allow a paper application. Non-computer savvy workers may have trouble navigating the DWC website to apply. Attorneys will not be compensated for helping with this project, a project that may occur in many instances after the comp case has settled.

The other option for workers who can’t or won’t apply via computer is to go to a WCAB office. I may be wrong, but am not convinced that this will be a path taken by many folks.

So at the end of the day I will not be surprised if the $120 million fund is underutilized in any particular year.

But back to the question of how to interpret the requirement to fund the program.

I’ve attached a pdf of that opinion dated May 15, 2015, prepared by Amy E. Schweitzer, Deputy Legislative Counsel.

Schweitzer writes that “…it is our opinion that the Director of Industrial Relations is required to annually derive $120 million from non-General Funds of the Workers’ Compensation Administration Revolving Fund for purposes of the return-to-work program. It is further our opinion that a court is likely to uphold the department’s construction of section 139.48, which requires that the funds derived for the return-to-work program in any particular year and that are not necessary to fund the program for that year or the previous years be credited toward the subsequent year’s surcharge on the employers.”

This could be tested in court, but the Legislative Counsel sides with the DWC that $120 million need not be aggregated from year to year.

I suspect that this was not the intention of some of the proponents of the $120 million fund, but three years later this is where things sit.

Here is the Legislative Counsel Bureau opinion:


Stay tuned.

Julius Young



Now if someone will tell us how this works, we'll be good to go
The fund he is discussing is for dates of injury after 1/1/2013 that have a permanent disability rating and for those who are not offered a position from their employer. They are entitled to a $6,000. voucher to a city or state college or vocational college on the states webpage list ($1,000. can be used for a computer or computer equipment and $500. can be used for whatever you want). After they receive/qualify for this voucher they can then apply for an additional $5,000. check to be used for whatever they want so total benefit is $11,000. This info is on the states web page or they can apply at a kiosk at their WCAB.


 I would contact an I&A officer to discuss if you are eligible for vocational benefits for your date of injury. The list of vocational colleges can also be found on this link as well as info for older dates of injury.

I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
So injuries from 2004 don't apply? I seen a pqme recently, he said in his report I am unable to return to any type of work. And said I was eligible for vocational voucher. I asked the CA about this, He said we would discuss it after the msa was complete.

Should I be following up on this now?

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