Trying to end this nightmare, I need to settle

[Ilyn]

I left my job last year on the advice of Doctor because of stress. I had a prior workers comp case for carpool tunnel in 2007. I had a new case filed last year, for my shoulder which was accept by wc. Last month I had surgery on my hand which had been covered through my old case under future medical. They denied my new case because it was stress. Now they want to settle my case for as little as possible because wc knows I won't be going back to work and the qme doctor release me. Can I add what it would have cost wc for my carpool surgery to my claim? Also even though I haven't had my shoulder surgery it is being also schedule through my medical insurance? I live in CA, will the percent go up because of the surgery? What is a reasonable settlement to close this case ASAP so I wont have to deal with these people again?

[1171]

what claim are they wanting to settle?
there is no method for adding fictional $$ to a claim. You can make a claim for related costs documented by receipts but not for unrelated items.
theoretically surgery should improve your function and lessen your impairment percentage.
which case are you trying to close?
there is no "out of thin air number" that applies to every case. settlement values are based on many factors each specific to the worker and the particular claim. they involve unpaid/disputed costs, permanent disability, and future medical.

[Wink]

Ilyn Wrote:I left my job last year on the advice of Doctor because of stress. I had a prior workers comp case for carpool tunnel in 2007. I had a new case filed last year, for my shoulder which was accept by wc. Last month I had surgery on my hand which had been covered through my old case under future medical. They denied my new case because it was stress. Now they want to settle my case for as little as possible because wc knows I won't be going back to work and the qme doctor release me. Can I add what it would have cost wc for my carpool surgery to my claim? Also even though I haven't had my shoulder surgery it is being also schedule through my medical insurance? I live in CA, will the percent go up because of the surgery? What is a reasonable settlement to close this case ASAP so I wont have to deal with these people again?

It's a wonder that the Subrogation/Workers' Compensation Department of your Medical Insurance Department hasn't required you to fill out an ACCIDENT QUESTIONNAIRE FORM before you settle ANY claim. I would advise you to consult with an honest attorney about your insurance carrier's "right of subrogation". Beware.

DEFINITION OF SUBROGATION

An insurance carrier may reserve the "right of subrogation" in the event of a loss. This means that the company may choose to take action to recover the amount of a claim paid to a covered insured if the loss was caused by a third party. After expenses, the amount recovered must be divided proportionately with the insured to cover any deductible for which the insured was responsible.

[Ilyn]

I assuming wc trying to settle the new claim because it was accepted and I had a qme as requested by wc. The surgery was under my private insurance which I was hit hard in payment since leaving my job,I also paid all the deductible even though I had future medical from the old claim. I did notify wc before the surgery because I had to prove continue treatment for the new claim. Like I said my job of over 20 years had become a nightmare, so if they and I can come to some agreement I will be so happy. The same adjustor did this last time push to close the case when I had no ideal the case was still open. They were notified right from the beginning, I don't want it prolonged this I'm getting my shoulder surgery through my insurance also. What is reasonable to ask for to settle without me jumping through more hoops?

[Wink]

Ilyn Wrote:I assuming wc trying to settle the new claim because it was accepted and I had a qme as requested by wc. The surgery was under my private insurance which I was hit hard in payment since leaving my job,I also paid all the deductible even though I had future medical from the old claim. I did notify wc before the surgery because I had to prove continue treatment for the new claim. Like I said my job of over 20 years had become a nightmare, so if they and I can come to some agreement I will be so happy. The same adjustor did this last time push to close the case when I had no ideal the case was still open. They were notified right from the beginning, I don't want it prolonged this I'm getting my shoulder surgery through my insurance also. What is reasonable to ask for to settle without me jumping through more hoops?

Ilyn, if your shoulder injury is a Work Comp issue, then your private insurance carrier is NOT going to be too happy about paying for shoulder surgery. If you settle with Workers' Comp for any sum of money for your shoulder injury then your private insurance carrier is going to come after you for what another party should have paid, that is, if you go ahead and have the surgery through your private insurance, and if they find out. It is very possible that they will. You see?

Someone, correct me if I am wrong.

[1171]

you cannot settle until a doctor gives an opinion and rating on any permanent impairment or releases you to full work. without an impairment rating no one can judge whether the amount is fair.

[AQA]

Wink, you are correct.

Why would a third party pay for something that the second party should have??????

Thats like Ford doing warrenty work on an Chevy.

[Ilyn]

I made sure they were notified of who was going to do the surgery on my hand before and after. They wc cancelled my shoulder surgery once already, that why I will let them know as soon as the surgery is planned. I didn't know the surgery was cancelled until I called the doctor. I read that they can't cancel if it's your private insurance, which is why they didn't want my private insurance handling my case. Its a game, but it's not funny. From past experience they're only going to pay toward the bill what they want to anyway. The medical insurance and wc they can battle it out. I will not never get back everything that I loss in the process so again I'm trying to minamize my cost, battles, and the nightmares.

[AQA]

Great. It sounds like you are playing it right. It is an awfull game to play, and we didn't even ask to play it. As long as you are being up front and honest. Thats all you can do.

O yea, if WC denies coverage. Then the personal IC can cover it. If there are problems latter. It is between them. AS LONG AS YOU HAVE THE DENIAL FROM WC. To cover your back side.

Take Care

[inpainokla]

1171 Wrote:you cannot settle until a doctor gives an opinion and rating on any permanent impairment or releases you to full work. without an impairment rating no one can judge whether the amount is fair.

i settled without a rating...without any kind of an oppinion or anything bc the treating dr said it wouldnt be fair if he did any kind of rating and he was the only dr i had seen..so my lawyer threw a number the insurance companys way and they took it