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Settling at 100%
#1
Hi,
I am in CA. I was injured at work in 2017, and started seeing doctors through my job's WC insurance a few days after.

Fast forward to now and my doctors have all declared me P&S. Between all of their ratings, my PDR would have been 73 (After adjustments). A Vocational Rehab expert tested me and declared me 100% unemployable (With 100% apportionment and not amenable for rehabilitation). My lawyer sent the VR report to my treating doctors and they all responded in agreement with it. One of my doctors ordered a home care assessment, the request was denied, and my lawyer paid for one out of pocket. The RN determined I need a companion or homemaker for 4-6 hours a day. The lawyer told me last week that once my doctor sends a request for the home care in and it is approved, we can reach out to settle. He says if they don't approve it, he will appeal it through IMR.

I'm seeking to settle with closed future medical. Is it unreasonable for me to hope that the settlement will be at 100% PDR and that they will have to pay for the 4-6 hours a day of Home Care? Am I right in understanding that the lawyer will get %18 of the settlement and %3 of the SAWW?

Thank you for reading and sorry for a long post.
 
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#2
yes.
You can’t have closed medical and also regular home health care. home health care is not considered a disability payment but rather a medical expense.
Either all the future medical is cashed out or its left open.

There is a dispute as to your PDR. unless you have a trial a settlement would have to be negotiated. A negotiation means both sides give a little and get a little. There is no reason for either party to give all and get nothing.

No. Atty fees have to be approved by the comp court. The 15%-18% is just a guide. In most high cost cases your attorney will likely be required to provide additional justification of their services and the set accordingly.
There is no additional fee based on the states average weekly wage.
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
(01-13-2020, 12:44 PM)1171 Wrote: yes.
You can’t have closed medical and also regular home health care. home health care is not considered a disability payment but rather a medical expense.
Either all the future medical is cashed out or its left open.

There is a dispute as to your PDR. unless you have a trial a settlement would have to be negotiated. A negotiation means both sides give a little and get a little. There is no reason for either party to give all and get nothing.

No. Atty fees have to be approved by the comp court. The 15%-18% is just a guide. In most high cost cases your attorney will likely be required to provide additional justification of their services and the set accordingly.
There is no additional fee based on the states average weekly wage.

Thank you very much for responding! I worded the part about the Home Care poorly. I was trying to figure out if the lump sum agreement that comes about could reasonably include a decent percentage of the projected cost of the Home Care, and how high that percentage could be.

Would they go back and forth about the PDR in the negotiations, or would they focus more on things like the payout for the future medical and the COLA?
 
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#4
https://www.centurylink.com/aboutus/comm...eline.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.
 
Reply
#5
Yes i see. Home care is considered a medical expense and would be included in any lump sum Compromise &Release amount.
Generally C&R negotiations are not done piece meal on individual benefits or items. Just one bottom line amount that you can break out into any sub Categories you want.

As the duration of lifetime payments as well as the inflation factor are, by definition unknown, there is little certainty in predicting an amount. consideration of the claimants overall health also could factor into such discussions. Atty fees are required to reflect the value of the services.
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.
 
Reply
#6
(01-14-2020, 12:19 AM)1171 Wrote: Yes i see. Home care is considered a medical expense and would be included in any lump sum Compromise &Release amount.
Generally C&R negotiations are not done piece meal on individual benefits or items. Just one bottom line amount that you can break out into any sub Categories you want.

As the duration of lifetime payments as well as the inflation factor are, by definition unknown, there is little certainty in predicting an amount. consideration of the claimants overall health also could factor into such discussions. Atty fees are required to reflect the value of the services.

Thank you very much. I have a clearer understanding of how the next few months will play out.
 
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#7
(01-14-2020, 02:25 AM)IW2020 Wrote: [quote='1171' pid='170370' dateline='1578975542']
Yes i see. Home care is considered a medical expense and would be included in any lump sum Compromise &Release amount.
Generally C&R negotiations are not done piece meal on individual benefits or items. Just one bottom line amount that you can break out into any sub Categories you want.

As the duration of lifetime payments as well as the inflation factor are, by definition unknown, there is little certainty in predicting an amount. consideration of the claimants overall health also could factor into such discussions. Atty fees are required to reflect the value of the services.

Thank you very much. I have a clearer understanding of how the next few months will play out.
[/quote
https://www.dir.ca.gov/wcab/WCAB_Policy_...Manual.pdf

Make sure you are afforded an opportunity to object to any fee requested.
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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