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Workers Compensation Settlement Amount?




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8 replies to this topic

#1 Bob Ray

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Posted 07 August 2012 - 09:14 PM

While inspecting a roof at work, I made a really stupid mental error and stepped backwards off of a roof. I am now a T12 complete after landing on my head so hard that it bent my spine backwards and crushed the sc. I work for the UC system here in California which is self insured for workers comp.

I am trying to maintain a positive attitude and I realize that things could be so much worse. Thankfully my wife and kids and friends have really pulled together to help.

I know my circumstance is a bit unique but I was wondering what amount I can expect in the final settlement. I plan on retaining the lifetime medical but my understanding of the process is that once I am rehabilitated to the greatest extent possible and I am medically stable that they will then use my level of permanent disability along with my income to determine a compensation cash settlement. The amount goes up if you forgo future medical (which I will not) and if you hire an attorney and sue. I plan on not getting an attorney unless I feel they are trying to screw me. Thus far they have been ok and approved pretty much all of the equipment and remodel on my home.

For those of you injured on the job, what has been your experience with workers comp?

Thanks!

#2 KaterinaWit

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Posted 08 August 2012 - 04:20 AM

We live in British Columbia, Canada and my guy was injured on the job (T5 complete), and has other complications. Through compo, he receives salary continuance, all expenses for medical, prescriptions, supplies, devices, equipment, care, adaptions, etc. Once he gets to retirement age, he will continue receiving expenses and the salary will be converted to a pension. Not sure how it works in your State, but in our Province as the injury is clearly evident and we have been absolutely transparent in our dealings with them, it has been our experience that while one has to be patient with the "bureaucracy" part, they have not and will not try to screw us.

#3 edlee

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Posted 08 August 2012 - 09:43 PM

You will "probably" be better served by the self insurance than an insurance company. One can hope. I live in Pa. so am not knowledgeable of the laws in your state. Here,,, as a permanent injury,, I chose to forgo any settlement and continue with the stipend they have been paying me.

If yours has been diagnosed as a permanent and complete disability by a doctor,,, you should also be eligible to collect Social Security disability payments,, as well as Medicare disability coverage ( for the stuff not related to your injury. In addition,,, you may have had a life insurance policy at work. Many of which are actually "death or dismemberment" policies. If so,, the complete loss of use of you lower limbs qualifies for a payout.

I mention all the above because nobody told me any of it. I had to figure it out on my own,,, and it took a while.

An attorney who specializes in workers comp would certainly be valuable. ( BUT DON"T SIGN A CONTRACT WITH HIM ) At least,, not till you've gotten the insurers best offer. He won't be able to take any of that, at least. Make a list of questions and take advantage of one of those "First visit is free" deals. Also,, remember this,,, the lawyers fees are ALWAYS negotiable,,, and don't sign anything he offers till you've read and understand EVERY WORD.

I guess you've noticed that I trust lawyers less than insurance companies,, and them, not at all.

#4 jscott92064

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Posted 12 August 2012 - 10:45 PM

While inspecting a roof at work, I made a really stupid mental error and stepped backwards off of a roof. I am now a T12 complete after landing on my head so hard that it bent my spine backwards and crushed the sc. I work for the UC system here in California which is self insured for workers comp.

I am trying to maintain a positive attitude and I realize that things could be so much worse. Thankfully my wife and kids and friends have really pulled together to help.

I know my circumstance is a bit unique but I was wondering what amount I can expect in the final settlement. I plan on retaining the lifetime medical but my understanding of the process is that once I am rehabilitated to the greatest extent possible and I am medically stable that they will then use my level of permanent disability along with my income to determine a compensation cash settlement. The amount goes up if you forgo future medical (which I will not) and if you hire an attorney and sue. I plan on not getting an attorney unless I feel they are trying to screw me. Thus far they have been ok and approved pretty much all of the equipment and remodel on my home.

For those of you injured on the job, what has been your experience with workers comp?

Thanks!


I have experience with worker's compensation in CA and I'm glad to share with you what I can.

First of all, I recommend an attorney as they know the "in's and out's" and you don't. The attorney will take (I think) about 12% of your award. Unfortunately, you could be getting "screwed" by the insurance company and not know it. It's not totally intentional, but why tell you of what you have a right to if you don't ask. So essentially, you may be leaving money on the table. Getting an attorney is not much money, their compensation is regulated by CA law and it's not like filing a lawsuit and having a jury.


About:

but my understanding of the process is that once I am rehabilitated to the greatest extent possible and I am medically stable that they will then use my level of permanent disability along with my income to determine a compensation cash settlement.


I believe your permanent & stationary award is based on a CA rating. Your income has little, if anything, to do with it. If it is, then there's a cap to the amount you can get. That is why if you work more in a white collar industry, say selling software, worker's comp really won't cover your daily expenses.

Also you should know the sum of your temporary payments will be deducted from your final permanent & stationary payment. Your attorney's fees get deducted out of each payment, but it's nominal and very much worth it.

You'll want an attorney to help you negotiate the highest amount. I believe you are looking at close to $100K, but realize your work life has drastically changed. You're going to want to invest that money well.

You should receive some vocational retraining - and under the changes from 2004, you can get up to $10,000. But try to have your own plan otherwise a vocational expert will be assigned and they end up biting into this amount.


Once you get your permanent & stationary settlement, you will have the lifetime care, but make sure to keep all your records. And here's the not-so-fun part ---the insurance company will do everything and anything to deny medications or care. There's no method of an attorney to be compensated to make sure you get the care you are entitled to. (Your attorney was compensated out of your temporary payments and then finally from your permanent and stationary payments.) It's not that your attorney is a bad person, but even they cannot be expected to work for free.

Most adjusters and case managers are overworked and I imagine get constant complaints from patients like you (or me on behalf of my husband.) So I do my best to try to befriend them first and be as reasonable as possible. I try to pick my battles. Lately there's this new adjuster who's been arbitrarily (it seems) denying my husband's medications. I've written her a nice letter in late July, today she received a frustrated (still nice) voicemail and email. But if his medications are not approved this week, then I need to take other steps. I'm looking into either filing a complaint with the DWC. There's this local seminar on how to file a worker's compensation lien and I plan to take that too. Not that I plan on fling a lien, but it's good to know all the legal ways to get the insurance company to fulfill their obligations.

Overall, worker's compensation does take care of your injuries, much more than regular insurance companies. My husband has received very good care, and that's part of luck of having had good case managers and then there's my being his medical advocate and keeping really good records.

You need to know Worker's Compensation is not like regular health care where you know for sure how much they cover. Rather it is based on medical necessity and that is not the same as getting your life back. For example, they can decide to purchase a vehicle for you so you can go to medical appointments or they can get medical transporation for you each time. They can offer to retrofit your current vehicle or if our case, they did purchase a van for us. (We had a great case manager who became a friend and she would recommend things even before we knew we needed them!)

By the way, is the carrier State Fund Compensation Insurance Fund?

Let me know if you have any other questions. Hope all this helps.

#5 jscott92064

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Posted 13 August 2012 - 02:50 AM

On the vocational rehab, you may want to see if your employer will accomodate your disability and let you return to work. Under CA Law, they have to try to reasonably accomodate your needs, depending upon your skill level and capabilities. (Maybe that's a federal law, not sure, but I do know they have to try.)

I read what Edlee said about attorneys fees. Atleast in CA, the fees are already set. It saves the injured worker the headache and I can tell you from experience, it was worth it.

Good luck!

#6 Bob Ray

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Posted 13 August 2012 - 03:23 AM

Thanks to everyone for your replies. The info on California is quite helpful jscott92064. It seems each state is very unique. I am only 3 months out from my injury and am learning as much as I can. You were correct in that I carried a separate AD&D policy similar to Aflac which I hope will pay out enough to pay off my house. I applied two months ago but as of last week, th hospital had not yet provided them records and without records, they will do nothing.

I have been living for the last month in a hotel with my wife as I cannot get into my bathroom at home until my home is remodelled. The entire process is so much slower than I am used to. I am learning patience. Not patiently learning, but I am learning it.

My workers comp is through the university of California system which is self insured. Thus far, I don't believe that state fund is a player. My remodel is routed and approved through the UC Office of the President. I believe they pay first through last dollar and only hire Sedgick as an administrator. Sedgewick in turn hired Paradigm as their catestropic case manager. It seems there is a host of other agencies that they contract with that provides supplies, equipment, contracting, etc.. It is a huge buearacracy.

I'm currently receiving temporary disability and workers comp. Together it is close to what my take home was previously. The temporary disability is supplimented by my sick time accrual. At the rate I am burning it, I have enough for over a year.

I appreciate the advice on an attorney. I will look into that a little further down the road prior to discussion on any proposed settlement.

#7 munkypoop

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Posted 13 August 2012 - 03:32 AM

While inspecting a roof at work, I made a really stupid mental error and stepped backwards off of a roof. I am now a T12 complete after landing on my head so hard that it bent my spine backwards and crushed the sc. I work for the UC system here in California which is self insured for workers comp.

I am trying to maintain a positive attitude and I realize that things could be so much worse. Thankfully my wife and kids and friends have really pulled together to help.

I know my circumstance is a bit unique but I was wondering what amount I can expect in the final settlement. I plan on retaining the lifetime medical but my understanding of the process is that once I am rehabilitated to the greatest extent possible and I am medically stable that they will then use my level of permanent disability along with my income to determine a compensation cash settlement. The amount goes up if you forgo future medical (which I will not) and if you hire an attorney and sue. I plan on not getting an attorney unless I feel they are trying to screw me. Thus far they have been ok and approved pretty much all of the equipment and remodel on my home.

For those of you injured on the job, what has been your experience with workers comp?

Thanks!

in my lawsuit at the time of my accident. The major factor in the settlement was if I was going to be like this for the rest of my life. If I wasn't I wasn't going to make much at all according to my attorney. Also, factors like future working and what not are looked at. With things like this. Attorneys are really a great idea, not only for the cash settlement but for insurance to pay your medical bills and more. Because they will only pay a minimal amount where an attorney will get them to pay a lot more. They will also make the cash settlement larger if you feel like they are ripping you off
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#8 Bob Ray

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Posted 13 August 2012 - 03:47 AM

Jscott92064.....My employer has been great and already said they want me back. I am a manager who was pretty hands on. It looks like I will need to modify the way I do things.

Edlee...Good advice on the lawyer and seeing the best offer 1st before talking to an attorney. You were right about the AD&D insurance. I hope it works out.

Munkypoop...thanks for the advice. I will talk with an attorney before making any decision on a settlement. I am too slow reading these and when I hit post there was yours waiting.

#9 Rick Macdonald

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Posted 27 August 2012 - 10:32 PM

My injurie was at work (industrial ) 2002 , had a very good solicitor luckily !

Here in the uk courts etc are diff from yours , but a good lawyer in the industrial injuries is your best bet if possible research !

In the uk there is a fund that companies pay into , Industrial injuries benefit .you get this for the rest of your life , an the amount payed to you monthly depends on the injurie .

When the company was taken to court ,there was 17 charges against them for breach of health an safety !


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