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Unsure what to do
#1
NYS-I’m not at MMI yet and I just had a SCS implanted in March. The carrier has appealed the judges decision that they have to pay for the medical bills associated with the SCS. My case is established for low back, left leg, neck and right arm. They appealed because the paddles were placed in the thoracic region and it’s not an established body part. My lawyer and doctors both say they’ve been through this before with comp and they’re almost positive the appeal will be denied and be in my favor. The carriers attorney has offered me a section 32 settlement for $118,000 and $13,000 going to my attorney. My attorney said they will more than likely withdraw the appeal and pay the medical bills if I except their offer. My doctor has me at 85% and comp has me at 100% TTD. My lawyer feels that $118,000 is a fair offer but I feel it’s low. I’ve been out of work for 9 years and have had 6 surgeries. I’ve stayed attached to the labor market and have done close to 200 job applications with only 3-4 reaching out to me. I’m wondering if I should go back at them with a higher number or just wait till I’m at MMI and get a loss of wage earning capacity %. Even at 50% loss of wage earning capacity it would be close to $210,000. My private insurance will cover existing injuries as soon as they receive a letter that my case is closed as long as there is no medical set aside. If I was to seek another attorneys opinion and they help me do I have to pay both attorneys 15% ? Any thoughts or help appreciated thank you
 
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#2
seems like a very high price to pay to drop a "sham" appeal; especially when you have no guarentee they will drop it or won't file another on something else. I hesitate to reward such tactics.

if you can hold out under the pressure they are applying, it would seem that time favors you.
getting to MMI and to a reasonable loss of earning capacity rating would not seem that far off; especially since you put so much time in on the claim already.
be aware that sometimes an atty will often evaluate a settlement in terms how much more the fee will be when compared to the work he will have to do (and/or miss other cases that may be more lucrative)--rather then how fair you feel the offer is.
I believe there will be a single atty fee that will be split if there are more then one atty.
will you have reasonable costing private insurance for your lifetime? it would be a shame to see prohibitive premiums forced on you in 4 or 5 yrs so you have coverage for expensive maintenance medical for your neurological problems.

also frivolous appeals can be grounds for sanctions or penalties if the court sees them as an abuse of the system--but your atty would have to be willing to pursue it.
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
Thank you 1171 I have decided to let the appeals process play out. My lawyer is going to write a rebuttal to the carriers appeal and submit it to the board. Couple questions, are most settlements (whether section 32 or open medical) a lump sum or are they paid out biweekly? Also how will a settlement affect my SSDI ? My lawyer briefly stated in an email “that a settlement works out better in the sense that we include language in the paperwork that allocates over a long period so that it looks like your getting less at once”
Thanks for the help
 
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#4
I haven’t seen statistics on how NY cases are finalized.
I would guess it depends on the type of case -I suspect that more litigated high cost cases tend to get lump sum 32s as that’s the trend in other jurisdictions. (Lawyers want their fee to include your future medical $$)
There is an 80% earnings threshold for SSDI.
Language that describes the lump sum settlement as an accumulated value over many weeks minimizes that effect on the earnings cap.
https://www.disabilitysecrets.com/resour...fset-socia
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
1171 thanks for your help. I have one more question. I know the carrier has 30 days to appeal the boards decision but once the board receives the appeal does my lawyer have a time frame to submit a rebuttal? Or will the board automatically go through the appeals process?
 
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#6
You/your atty have 30 days to submit the rebuttal.
http://www.wcb.ny.gov/content/main/wclaw...3_text.jsp
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
 
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