PD has started....

[jddancy]

Calif~
The two year mark was 2 days ago for my husband's injury. I have received so many letters in the last 2 days and have a few questions. We received a letter stating his $230 will start as of the 22nd of July (The day after the 104 days). There was also an amount quoted, which will equal 100 weeks of payments. I know I have read on here that WC has a rating that they kind of go off of until the final reports come in. On the letter it said that they agree with all of the Dr. findings, sounds good, I think. Anyways, my husbands WC Dr. is really not a very good Dr. He had a great one in the beginning of his injury and they took him aways saying "He was getting too personally involved". Anyways, he really doesn't do anything when he sees him. He may spend 5 min with him. He has seen 5 AME's and is seeing his last one on Tues, a neurologist. His injury is brain related and complicated. Anyways, when they say they agree with the Dr's findings, is that the AME Dr.'s or the regular Dr he sees once a month? The AME's he has seen all have written 28-37 page reports in his favor and have done very extensive tests. We have a WC attorney helping us and he is also not very informative. He had told us that in Ca., they don't do lump sum settlements anymore and in the letter I got today, there were 3 different options available and lump sum was one of them. Maybe someone out there can give me first hand account of that. I don't know how anyone can survive financially, on WC!! This is SCARY!! $230 a week!! I have also filed for SSI and SDI for my husband and hope he gets that too, but we are really scared now that it is over. He used to make great money! Anyways, sorry to ramble, but just curious on the Dr.'s findings AND the lump sum. Also, how do they figure that too? From the AME's? Thanks in advance for any info and hopefully someone out there has personally gone thru this all and can tell me what to expect now.

[Bad Boy Bad Boy]

(((He had a great one in the beginning of his injury and they took him aways saying "He was getting too personally involved". Anyways, this doctor really doesn't do anything when he sees him.))))

Took good doctor away, and you didn't have attorney fight against that?

1171 has explained to you on your older Threads about the settlement process.

Too much still is waiting, as he needs a rating first.

Attorney's are limited to certain information, they can inform you on the legal issues of the case though.

Lump Sum settlement may require a Medical Set-Aside Fund which lowers the amount of money he gets, as a portion of the settlement gets applied to his medical for the future. When medical is left open for life by the Insurance carrier, a medical set-aside isn't needed.

You have said on 3 Threads the case is complicated, yet never said why that is. You think you can explain that?

[1171]

yes, compromise & Release of all benefits still happens in california.
AME opinions are controlling about all benefits.

[jddancy]

1171, what do you mean by "AME opinions are controlling about all benefits"?

Bad Boy.... Yes, 1171 has explained to me, in the past, about the settlement process, but when I got the letter, I was a bit confused. This has been a very hard and tough time through this past 2 years, and I am sure most of you can agree. Why would someone want to go through this if they didn't have to. The case is complicated because my husband was electrocuted with 700 volts and it mostly effected his brain. So the only physical aspect that is visual is his shoulder, which he had surgery on and is better. The majority of the damage has been brain injury which they have had so AME's to evaluate him. I can't remember all of them but off the top of my head, he has an ortho, a psychologist, psychiatrist, neuro psychologist, and a few others and on Tues is his last and it is a neurologist. They usually spend 8-10 hours with him in each time. Testing and questioning. My husband has gone from a 45 old very active and one of the most funny outgoing persons you would ever know to the first year, he would not leave the house and lost all desire to do anything except watch TV and sleep. Very sad to see him like this. This last year, he has gotten a little bit better, but he has severe people anxiety, and no short term memory and can be very argumentative and reminds me of someone that has Alzheimer's and even Dimensia. He doesn't know when he is tired, hungry, has NO concept of any time, and has no sex drive. These are the most frustrating for me that we constantly fight about, trying to tell him to just eat, even if he is not hungry, he should just eat. Telling him it took him hours to do something, when he will argue and say it didn't. He resents me for trying to tell him what to do, when he doesn't realize I am just trying to help him. He was also left with little seizures and he is on seizure meds that help. They are like being electrocuted again. Anyways, that is why it is complicated, the brain, it has to have extensive testing and they said he was faking at first until the testing began. I don't know why our atty did not fight for the Dr, I guess I didn't think of it. Our atty is 1/2 retired and is tired, I think. I got a thing in the mail, with a note saying our atty may get $2,300 of my husbands $23,000, the $230/wk for the next 100 wks, PD. That is not much for All he has done.

You said too much still needs to be done, on the letter I got yesterday, they said they will know by Sept 23rd, 2010. So the amount of $23,000 isn't that on a rating that they already have? I have read through ALOT of stuff on the site that explains all about PD payments and it says if you are 69% or lower ratings, you will get the $230/wk, so they must have some sort of rating. They are going to go for medical for life but in my husbands case, how they have taken Dr.s away, I would rather be in charge of that. I read a post that 1171 posted regarding settlement amounts for body parts but I do know every case is different. I am just so afraid of the future and am waiting to hear from both state and fed disability. My husband used to make over $100,000 a year and we were comfortable in our living and have now lost all we ever had and it is very scary. It is hard for him to know he can't work like he used to but he just gets so confused on basic things, even driving so he will probably never work again, at least at what he did before. Thanks for your response. I have read alot of stuff on PD but my main question was when they make their FINAL decision, is it from the AME reports or the MAIN Dr.? Thanks!

[1171]

as I said The AME opinion controls.
the other doctor's opinons are all zero'd out.
for treatment;
for TTD;
for PD
all determined by AME.
(actually by the comp court -but AME evidence has the presumption of correctness --so basiclly no other doctor's opinon counts with the comp court).

[jddancy]

Thank you so much! That is a huge relief!! Sorry, I know you worked in the system for awhile and sometimes I can't understand your 'lingo'. I would consider myself an intelligent person but "opinion controls" didn't make sense, but now it does, thanks!!

[Bad Boy Bad Boy]

jddancy

Now pay attention to me. I know this is about your husband. But, as his injury takes an affect on the others around him, family, friends, co-workers, and so on. We only have the pleasure of speaking to you. I ask you to explain. Because you have sounded like you need to talk to people, outside your normal area. Yes, we are here for that too. I know what your going through trust me. Right now you read that and your eyes rolled, thinking how can I even know what your going through, am I correct? Then you need to sit down, relax, and understand, he has been in this ONLY 2 years. I myself been in this work comp system for going on 10 years. Yep, you think you have been through hell in 2 years, I would switch seats then any day, trust me. Now look, he went through something, I know what's it is like. I've been electrocuted thrown across a room and such. But, not like your husband has. Kind of gives me a idea of what he went through, only all I have to do is think in my mind of what he had gone through and then multiply it in my mind. I know when it happened to me, I didn't remember much of how it all took place, I wonder if he remembers much about it? Hopefully he doesn't.

When you talk about arguing with him, I can understand that. What many people can't do, is put themselves in another's shoe. Meaning your going to have to work things out for now, on his level, not yours. He has to make major adjustments in his life now, and that goes for you also. I hope your prepared to make those adjustments for a long time to come, are you ready to do that? You need to talk with people, talk about this stuff, clear you mind. So, you might as well do it here. Better then having a friend, or family member feel burden with things you like to talk about. We are use to these things. We all have different injuries, we all here been through hell, not just you, or your husband. You and him, aren't the only ones out there ever gone through this, yet I know you at times feel you's are, that is okay, and that is normal. You right, his income of $100,000.00 a year is gone. Gone forever, and you will need to adjust to that being that way now, can you do it? Are you really willing to do it?

Calm yourself, relax, get this stuff of your mind, we will listen, and be here for you. All you have to do, is give us that chance. And remember we don't have a crystal balls, so guessing at things isn't that easy....

[jddancy]

Bad Boy.... Thank you. Yes, I really wish I would have had a crystal ball 2 years ago and I think I would have been more relaxed. I had no idea it was going to be like this! WOW! 10 years!! Our atty has told us stories like that. I am not sure you are in Ca. but if you are, our atty told us when the law changed, you can't stay in the system that long anymore. They changed that. That is good and bad in some ways. I feel so bad for you, I can't imagine!! What were your injuries? You were electrocuted? Was that your injury or was there more? I am learning to deal with it but we have separated more than once since then but that is funny you would say that about "work things out for now, on his level, not yours", that is where I have gone now. It was hard because I have to choose not to argue, he doesn't get it. IT is very hard because it does feel one sided at times and we have a 16 and 12 yr old that get very frustrated too. We just started seeing a neuro psychologist for our marriage and I think this will help. It has been hard how little WC wants to help. I was 19 when I married him and am now 39 so I have learned to try to work it out through the good and bad. Sometimes he gets mad and says " I had an injury to my brain and you know I can't remember" but other times when he thinks he is right or is not making sense, he forgets that. It has been a tough road and you are right, I don't vent to friends or family because that is not my way and I have always been the one that people come to tell me their problems and I don't want to burden them and they say "Here she goes again". Thanks again for the encouragement. What state are you in? Are you still getting medical help or are you actually still dealing with the entire system? How do you do it?? I will look to see your posts, it may answer some of my basic questions I have for you, but I feel bad for you. Thanks again, It is very appreciated!!!!

[Bad Boy Bad Boy]

I'm from Illinois. I was once electrocuted, not my injury though. I had broke my neck twice, so to speak. Had a 3 level fusion the 1st time, and 2nd time a 6 level fusion. Don't feel bad for me, as see that doesn't change much. I am really fine, will be as good as it will get also. I have ajusted my life, so has my family and wife. So we are really good there also. Oh, it wasn't easy, never is. Just have to learn it is what it is, and it's not going to change things. My case yes 10 years. I was cut-off from the IC in Feb 2005, if I remember correctly. Been trying to settle my case ever since. It'll get done some day LOL. I'm okay though, can walk and talk, and I'm alive, can't ask for more then that. Medical I have been done with since 2005 also. How do I deal with the work comp system, simple I hired an attorney, and made sure the burden and headaches are on him not me. That's why I searched for the best first, then even then, I sat with him, and told him what I expected, and he in turn told me what he will be able to do, and not do. We put our cards on the table, dealt with all the question first, not later in the case. And then I signed the attorney contract. In genearl, I felt the attorney, as he felt me out. Since that day, I have treated my attorney as if they were and are my best friend, and in return, they treat me the same way. We are always on the same page, all the time, to most the time. That's how I deal with work comp. Then I went to work comp forums. One was for work comp, and I had dealt with attorney's there. Those attorney's taught me well, and still to this day, they find me, and call me on the phone. So, I stuck with it. maybe sometimes helping another, or learning from others. And simply just sharing it all as we go along this long road. So when I'm not doing things, I come to the work comp forums, while the wife is at work. Kind of keeps one busy and keeps the mind off things. LOL.

[1171]

not a problem.
it shouldn't be this complicated for workers to get benefits but.....

then attys would go hungry and their buddies in the legislature wouldn't want that so we are all left with layers upon layers of complexity to deal with.
the legal system has become a great game with the $$ pay off

justice long forgotten......

sorry about the soap box
it creeps in from time to time.