I have a question concerning workers comp and settlements. I have posted here before and actually taken a lot of the advice, so thank you for all of it. I got injured at work, L5-S1 herrinated dic, torn disc, DDD, and narrowing of the Nerve cannel. My claim got accepted and after many injections, numerous therapy sessions and MRI's they finally did a one level fusion as well as rotoruter my nerve cannels. I am 2 months post opt and do have a great lawyer. I have not yet been released, and am not expecting to be. They are talking about retraining due to the field that I was in or the job I had was physical demanding. I like many of you are in for a long haul. I am sure that I will have many problems in the future and will not be able to do many of the activities that I did. Which sucks, but life goes on. I kow that certain states have ways of determining a settlement, but how does one put a number on a injury that will affect the rest of your life. Does anyone have any advice on this. Does anyone know what type of money to expect. WOuld love to hear from you. Thank you for reading.
I can't tell you how it works in your state. You would have to do some research. But don't expect too much. Work comp does not pay you the way a regular lawsuit does. It is strictly regulated so as to keep employers insurance costs low. Therefore you will probably get very little. How it works is you go to a couple of medical exams that your lawyer will send you to and they will give you a disability rating of lets say 75% disabled just for arguments sake. Then you go to the insurance companies doctor and they always lowball it and would probably say you are only 25% disabled. Then you go in front of a comp judge and he decides on a number somewhere in the middle which might be 50% in this case. Then the amount of money can be determined by looking up the schedule of payments for your state. You should be able to find this info if you do enough research for your state. Mine even had the schedule of payments charts on the internet. Just don't plan on getting much and don't plan on getting it anytime soon.
I wouldn't be talking a settlement at this early date. You are just 2 months post-op. You need to be fused first and see what is going on at 6 months min. Things happen after fusion surgery and not always good things. I don't want to scare you, but you could have a failed surgery, nerve damage, scare tissue issues, or a non-union of the bone graft. If you take a settlement, even with a medical clause, you could be making a major mistake. In California there is a set amount of settlement. It is not enough to take you through life, unless you are 90 years old already. The medical they give is hard to get anything done. It is worse than the workman comp medical. Unless your company is going to rehab you for another job position that is guaranteed, watch that deal also. The insurance company will train you in a dead end occupation and you will have trouble finding a job. Don't sell yourself short. Your doctor shouldn't be releasing you this early anyways. Rotoruter, I like that. That's what they are going to do on my second surgery. Probably when I am 90 years old and the settlement looks good. LOL
I definitely concur with chris on the medical part. Once you've reached the point of maximum medical improvement and have settled your case it will be hard to get anything done medically relating to your back. You may be awarded future medical care covered by work comp for your back but good luck. I couldn't get them to run any more tests or take any of my back complaints seriously at all. It was so bad that I decided I was just going to pay for it out of my own pocket but I couldn't even get an appointment with any doctor once they have found out I had a prior back problem covered by work comp. I tried to get work comp to authorize another opinion from another work comp doctor but I was unable to do that even though the doctor I was seeing referred me to see another one. The only way I got that resolved was to go back to court and fight them for medical care. Good luck and stay healthy.
Let me start by telling you what I'm going through right now.
I injured my L4-L5 in 2003 ,been on comp since..My attorney want's me to settle..I told him it would take alot for me to settle cause I'm not sure I will ever be able to work again..He said what would it take , and I explained It would have to be atleast $350,000.00 so I would be able to pay for medical expenses plus pay my home and bill's off since I wouldn't have any income , he told me I would not get that much. After I told him to forget it he came back with how about $200,000.00 plus 2 years left on your medical , I said how about $250,000.00 plus 2 years on my medical or forget the whole settlement. He agree'd on it..I won't take less ! And I mean it.
Ok now after my spinalcord implant I realized how much I am disabled..I do have doubts that I won't be employable..So I checked on SSD on a website , they are telling me not to settle because of my medical treatments down the road and that I can collect w/c checks and SSD checks..It would be $500.00 more than I get a month now,,,BUT my wife is taken RN classes and she has to quit her daytime job to attend the nursing program which is an 8 hour class a day..We can't afford her to quit unless we take the settlement.
I'm in such a pickle it isn't funny..If she finishes her nursing program she will earn more than the both of us make now...If she can't finish her schooling were still in the poorhouse but earning a little more a month...What to do is a hard question..I have an interview with SSD and I'm going to get answer's fast because my lawyer is pushing for a settlement fast so I don't apply for SSD because he won't get any money because comp will not want to settle just the medical part of the claim they want it all gone..
I definatelly agree with Chris and others about settlement. You don't know what to expect in a future. Of course they will push you to settle, since your future treatments (in case you need any) will requiere them to pay you more... They don't care about you, they want to save money and that is it. Take care of yourself and try to get the best advice from your own lawyer.
Shawley, i understand your situation about your wife going to school: this is so honorable and good for both your futures.
But what if you go back to work and in a couple of month you realize that you can't really work or you can't work full time? Than what? Part time? Will this part time check covers you all your expences?
We have Monmouth University right next to me, they have an excellent nursing program and a lot of PC and those who want to become RN's go there after work (include my future daughter-in-law). Do you think iit's possible that she can take credits as many as she can in her situation and go to scholl at night? This is not easy for sure, but i am afraid what if you loose your SS benefits and will not be able to work? I know for a fact how hard to get them back. I understand how much you want to try, i felt the same until i tried...
Maybe they would give you a trial time to see how are you doing first?
4 month ago i asked my boss if I can come to the office and work for some time and see how i can handle my responsibilities(even though this is NO-NO without Doctor releasing me back to work note . Our company's rules a tough about it, but my boss is the best). I came and was able to be first day for 2 hours constantly changing positions since i can't seat or stand for long. Next day the same and i really pushed myself hard. A week later i realized without them telling me that at this point i am absolutely not able to perform my job. They could not understand why do i get on a floor in order to reach something from the lower drawer :-) Here is my "working" story...
It is so painful, i want to be like everybody else, but i have to agree with reality for now...
Moldova--Trust me I want to do the best thing..My attorney hwant's to set a side a medicare plan for me , whatever that means ? They do not offer a night class for her nursing program . I wish they did. If I got insurance for medical and a settlement of what I ask for we could pay off the house and other bill's and she could carry the bulk of the bill's . I know it's pretty low of me to let her do this but it's what she wants to do..We need cash NOW ,but I won't settle for less ..NO WAY ! I don't even know if I would be approved for SSD. I'm so confused about this whole ordeal.
I think you also have to think about -- what if? Not to say it would but what if your wife decided to walk out of the marriage after settling and getting her thru nursing school. Don't be mad at me buddy but then what? Also what if she hurt her back and was no longer able to work? Would you be able to survive financially? Will you have medical, the money for medical, etc. Just thinking of what if scenarios.
I only suggest this cause I care or maybe my meds are kicking in.
Pepper-- Who would ever want to hurt me ? My wife loves me and I know for sure she wouldn't leave over money..But what if she got hurt ? My attorney is starting a set a side Medicare for me so the medical will be taken care of . I do plan on working again. Even if it's part time I'll try my hardest to make it through the day. I really want to buy a backhoe and a small dump truck and do odd job's. I think I could do that if it's my own company. Pepper I'm not totally sure if I'm going to settle. I just have to be prepared for the upcomming question's I may face.. My ex-employer ask me about a full settlement month's ago , they haven't reacted to my demand I ask for so they probably won't anyway.
I told my attorney I was going to file for SSD and he flipped out , telling me not to that it will cause me to lose alot of money , of course he is the one who will lose by me not settling. I'm confused right now , the wife and I are going to sit down and discuss this in more detail with each other.
I wouldn't ever get mad at you because I know your only trying to help me.
This post has helped me so much. I am sort of in the same situation now. I have not been with my company that I got injured with for 2 years now, and they are trying to settle with me as well. I am in a position in which I do not know what do to. I am very young and have a long life to live, and don't know if I am going to have more problems down the road. Do I settle and take the chance, or do I keep getting my chump change of w/c bi-weekly and the security of w/c. I do not know. It is a lot of pressure and stress. I am only about 3 months out of a fusion, and I have begun fusion. Just starting, but it is starting, which is good. And I can honestly say, that my 26 year old body feels almost 26 again, unlike the past two years. I just wish I was a fortune teller and could know where my life would take me. I know people that have gotten a fusion at my age and now are in there 60 with no problems. Am I going to be that lucky?? I don't know. What to do???
Hey guy's I don't know if anyone has told any of you but you may be able to get SSD on top of your worker's comp checks , I didn't know this until recently and now I'm applying for SSD , I honestly don't think I'll ever be able to work again at anything , my wife and I sat down and had a long talk about this , she know's how I am , I can't do much of anything before I have to lie down on that couch because of pain..My attorney is going to be ****** but Oh-well better him than me right ? I'm filling out the paper work tonight we got from SS and I'll see if I qualify...I know it's hard to get on it but I do honestly think I can..A lump sum will only last for a little while you know.
You have to think of the long haul with back injuries.
Surgeries down the road , a new battery for my stimulator , ect..ect..
Anyone have any question I can try to help.
Hi Shawley: If you are talking about a Medicare Set-Aside Account, just remember it will only cover work related injuries, and can only be used after the bill is submitted to Medicare/or whoever your ins co will be, then the set aside kicks in after that. So if your primary medical will be Medicare, then they would pay 80% of the assigned amount (bill) then the set aside pays what MC doesn't cover. If you had any other medical problems, non back, of course the set aside acct doesn't pay for that. You can read about them at Medicare or at Medicare Set-Aside Accounts. I'm sure you knew that anyway... I hope the Set Aside amount is substantial, they aren't always unfortunately; when you consider the cost of surgeries these days, but the set aside only has to cover the difference between what your primary ins pays and the balance of the bill.
Last edited by DesertBloom; 06-30-2007 at 08:55 PM.
I have a secondary that covers the 20% and my part D (meds) 80% through a private insurance company. I have straight Medicare and not an HMO that you can get. (Like I say, HMO and W/C are on the same program, DENY!!!) It is sometimes hard to get a doctor on Medicare. I now get my primary to refer me to a specialist for Urinary problems from the surgery. W/C denies that they are responsible. I see this specialist on Medicare. They (W/C) pay for catheters but not the antibiotics for infection. Sometimes can't figure the logic that they use.
Hi Chris: It does seem so unessecarily confusing doesn't it. I have Medicare and Blue Cross ppo for my Medicare gap coverage. I also have a 3rd insurance for Medicare Part D. I fortunately am not dealing with WC, my husband did but I didn't, and he doesn't anymore. My injury was from a personal injury claim/suit/car accident, and have been on MC part A since the mid 80's and part B since the late 80's, part D since last year. I've had the option of choosing an HMO during open enrollment but am afraid to go that way since treatment is totally different. The way we're going with a medigap plan is more expensive, but we don't need referrals for anything, and have been able to go anywhere, see anyone, so far. I haven't been turned down once due to MC, but I don't have the additional problem of WC.
I hope you can finally get things straightened out. I'm heading out to see the fireworks on our lake, can you see them from where you live or just the ones from the fair grounds, I'm not sure when those will be-tonight-I dont' know?? Have a nice weekend...