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Settling Future Medical for PTSD
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.

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

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