I'm confused a little bit, but I need some help. I am newbie, but have reading posts for a long time and trying to research. I was hurt at work 2 years ago, followed thru with all of the workers comp drs who diagnosed me with a RSD. My endurance has involved sympathetic blocks, a trial SCS, numerous medications, PT, MRI, Bone Scans, etc, etc,etc. I was able to get SSDI with 4 months of applying. Personally, this was a shock! I expected a fight for three years since others tried numerous times. Workers Comp was able to classify me as Perm Disable, but that was a fight. Now here is the thing, Workers Comp wants to settle with me. I am under no obligation to do it, but my case is worth lots of $$$. They are going to offer me just a little $ according to them and my attorney. I have never gone thru this before, but what can I expect from the mediation? My attorney states that I have to do all the talking he'll just sit there and listen. My concerns are about my medical. What % do they normally put aside for Medicare? I am so scared that I might be placing myself into a deeper hole because my attorney isn't going to keep what is in the best interest for me. What to do? What to do?
Morning Redswan..I'll try to clear some things up for you as best I can. Keep in mind all states are different so what I tell you might seem cut and dry but maybe isn't in your state.
Mediation: This is to see is both sides CAN agree to a $$$$ amount. If both can't there will be no settlement at that time. Case will remain open and games will continue. As far as open medical or a medicare set aside( which is the best way to go) it depends on your medical bills on a yearly basis. Let's say you spend $5000 on your injuries. They will times that by the years left in your expected lifespan and that's how they come up with the set aside. The money goes into an account in your name and you can name a beneficiary. you will begin to pay for your own medical from this money for anything pertaining to your WC injuries. I personally would not settle for anything less with having RSD. I am sorry you have this. I don't, but hear it's very painful .
Since WC has accepted your RSD you're on better footing. As far as what your case is worth no one can answer that. Just make sure your attorney has YOUR best interest in mind and doesn't just want to get paid. I found with my husband's case that the $$$$ mentioned by his attorney in medication was almost what they settled at 2 years later. Keep me posted.
My husband is in your situation exactly. He got RSD from an auto accident on company time. He applied for and is receiving SSDI and Medicare. We are negotiating now for a settlement. The Medicare set aside account is a certain sum of money that they think you will need for your future WC medical care. When it is gone, then Medicare will pick up the tab. It is actually a requirement of Medicare for anyone who receives Medicare as a result of a WC injury. Medicare wants to make sure that the employer is paying out money so that they don't have to. I figured out the future costs of his medications and they are astronomical.
In my husband's case, the amount for his injury is set by a table according to the degree of disability and date of injury. I don't understand how yours is negotiable. Since his injury was many years ago, the dollar amount is very low, which really irritates my husband, since RSD has ruined his career.
Thank you for your personal input. Wow he has RSD too! What I have found is that there really isn't too many people out there on WC with RSD. Most of them who have developed this has had it happen to them outside the workplace. All of this so new to me and I wish there was a book titled "Settlements of WC for Dummies"! LOl I feel like when I ask a question I am truly stupid and naive. I am a highly educated person who has been taken away from a great life of fun, family and work. In actuality, I have been told a figure, but then it comes down 8% from everything else being taken away. Thus leaving me a figure of about 1/3 of the price. Now I know you are going to start asking me more detailed questions, but I preferred not to give any figures out. Once we add the figures with what medical portion is allowed I am not walking away with much. This is what is so bothersome. I still have 50 years of my life expectancy and this is not going away soon. I could be destined to be in wheelchair or use other kinds of walking aids. Who knows what my future holds! WC is playing a game now and they want me to go to another dr to be examined. I have seen 7 drs so far and they all agree as to my condition. What is WC looking for? For someone to say I don't have this? I am lieing? When I go to the mediation I have been told that I need to brace myself for a personal beating. Great!! I do wonder if this is some kind of conspiracy to make me just settle for anythning and get away quickly. Uhm? I guess I have to wait and see.
I appreciate all who can give me insight and thank you so much.
Of course I don't mean to pry and I don't want to know any figures. I was just wondering if you were told yours was negotiable, as opposed to a certain rating formula, the way it is in California. It never will be what a person could make in their lifetime. I guess we have been lucky in that we have only been told to go to an IME once. WC seems to accept the RSD diagnosis without a problem. They are having trouble realizing that it is lifelong and doesn't get better so that you can decrease medications and see doctors less frequently. They put together a life care plan that decreases everything over time so that they have to pay out less money. That is the part we are negotiating. We have not been to mediation yet. What state are you in? I know there are several people on the RSD board who have had problems with worker's comp, but they haven't posted in awhile. You can do a search on the RSD board for WC and look at the old posts. We have not had trouble with WC denying treatment, but a lot of other people have.
Red , I also have RSD and wonder how wc negiotiate their settlements. i have done my research and yes, it is hard to find info. What I am trying to figure out is what the percentage of money is placed in the Medicare portion. Just a little FYI, SSDI will offer you Medicare aftere 24 months of being on it. Now what I just found out is that they will offer you Med part A for free and Med part B you will have to pay a premium and it could runyou big bucks every month. I am not too sure if you are aware of this or not. Oh, are you on SSDI?
Also, they are ready to settle with you after only 2 years, but I thought you said they were sending you to another dr. I am confused. If they wanted to settle so fast then why make you go to someone. Is your appt with the dr before you mediation? Sorry, but I am always curious cause i am always on the defensive when it comes to them. What is their motive? Well, whatever it is I hope you come out ahead. Ben
Last edited by Scrufysdad; 08-19-2007 at 05:49 AM.
Hi all....Redswan, WC is a game playing system. they will stop at nothing to not pay an IW. I do visit another site that is strictly WC. There are many there with RSD. Do you have an attorney? I'm sorry I don't remember. If you don't please get one. WC will slight you, send you for IME's until they find one who will go against you. I'm sorry to be so negative but I know too many people who have gotten shafted and lived to regret it by believing anything anyone from the WC IC has to say.
Scrufysdad....The money for medical is put into what's called a medicare set aside. As long as you are on medicare it is the best way to go. If the money is left in the hands of the IC you could/will probably lose it all someday. Once it's put into an account in your name no one else can touch it but you to pay any medical on your WC injuries. Once you have spent it all medicare will then pay for all medical including your WC injury. NO INSURANCE will pay for a WC injury that has already been paid/settled on. Did that make sense?
ICC, I have a question. You said that insurance will not pay for medical bills after a settlement. I checked with my Blue Cross last year (my husband is on it as a dependent) and they said that they would not pay for anything before a settlement, but that they didn't have a problem paying afterwards, as long as I paid attention to the lifetime maximum. So we were thinking about using the MSA to pay the co-pays for Blue Cross.
To arrive at the Medicare Set Aside amount, the WC insurance company figures out how much they think your future medical care will cost, based on your current treatments, meds, etc. and your life expectancy (an actuarial table--not anything they cook up). Then they can either put a lump sum in the account right away, or put a smaller lump sum in first and then payments each year from an annuity they buy. You have to do an accounting each year to say how much you have spent out of the fund on your WC related medical care. It is not really a percentage of your award, it is separate.
Hi Sunnycal....I am really surprised. I'm wondering if as in WC cases that states have different laws if private insurance does also. In my state since my claim was denied my private health insurance which is also a BC affiliate paid all of my medical until the Judge decided in my favor. Now the WC IC will pay all medical. When my husband settled his case the Judge made it perfectly clear numerous times that no insurnace would ever be responsible for his back injury except the WC IC and that's why they agreed to open medical for life. So I guess all cases/states are different. I am really surprised that BC would pay for something AFTER the patient was paid for it.
What you are saying makes sense to me. Hopefully the person I spoke with was knowledgeable. We will just wait and see after we settle.
I figured out why there would be a difference in what you are being offered--your life expectancy. You are much younger than my husband, and would therefore be entitled to much more over your lifetime. So, good luck.
Scrufysdad, I going to see another dr after my mediation. Personally, my husband believes that they are trying to push me into a settlement to get rid of me. WC has been trying to get rid of me. I wonder if it has anything to do with my office. It seems that my coworkers and even my boss have accused me of lying. WC have paid for most of all of my bills, but some times I have had to fight them.
ICC, I just recently got an attorney. Not sure if it was the right choice or not. Although, he did inform me that WC would start sending me to different drs just for the reason you stated.
Sunny, I don't understand why there would be a difference in what was being offered due to my age. No matter how I look at it, even though I have 50years left of life. According to my attorney WC will only cover me for the next 35 years only. How we get to this number? I donno!!
I just went to the book store this pm and found a book with a very interesting website listed. I realize I can not post, but it is in regards to mediation. So I am going to look up the site and hopefully I can gain more info there. I will give you all my thoughts later. Thanks red
Redswan (I love your screen name)
There is a table where they rate you by the degree of disability, come up with a dollar figure for indemnity and then multiply that by your life expectancy. I just meant that since my husband is a lot older than you, the total would be smaller because they are multiplying by a smaller number of years. I am going to try to go to the book store, too. Good idea. We have a book about WC in California. I wonder if it is the same one. Is yours specifically about mediation or settlement in general? As much knowledge as we can have going in won't hurt.
Redswan...I went through the same thing with my employer and co-workers. Haven't heard from one of them since my injuries. Supervisor lied in his depo and him and the IC attorney must have either lied to or payed another co-worker to lie about me. It was so bad they couldn't keep their lies straight. The Judge ended up deciding in my favor but not before 14 months. I was hurt by my co-workers but after being on this WC site that I visit I have found that 99% of people go through this. It is everyone's job NOT to pay you, be nice to you, get rid of you in the end. I also have an IME coming up. The IC changed Dr.s because their first one agreed with what I had said, my injuries being work related and all my Dr. said. Of course they won't use him again. At some point I believe we all need an experienced WC attorney.
The calculations they use for settlement numbers are different in all cases and all states. They sometimes give you an impairment rating which is different from another calculation they use. I don't understand it well enough to explain. Sorry. Each case is worth so much. No matter how much we turn it around it never changes. Sometimes people hurt themselves by wating and waiting for a higher offer and end up with a lower one. I don't recommend settling until you are ready and you are sure what will happen with your medical. It's more important than any amount of money.
Sunny, that used to be my CB handle (name) when I was a kid. Okay, I just dated myself! LOL But anyway, the book I found is about personal injuries in general. Although, it does goes into a summary of mediation and negotiations plus settlement. The only problem is that they only figure up to about a $10,000 settlement. I look at it as if it was more and try to figure out the best laid plans for myself. I did look up the website listed and found that it was strictly for mediators. They did have some interesting facts, but nothing else.
ICC, Gee, I hope that they aren't going to get depos from my coworkers and employer! WC is the one calling for this not me. I am completely satisfied with my medical being paid for rest of my life. Once again I will have to wait and see what happens, but my fingers will be crossed for my mediation.
Oher than that I will wait. Thanks for the great responses. Red
Hi Red....Did you ever have to give a depo? In time the IW, the employer, the treating Dr., the IME hired by the IC and sometimes co-workers have to give depositions. In my case the co-worker was told I named him as a witness but i did not and it is written nowhere that I did. It's a tactic that's very dishonest BUT done all the time. There is no one in the WC sytem that you can trust. Those that are nice to you at first eventually turn on you at some point. Of course there is always an exception to every rule.