settlement question

[highdesertguy]

Iam in CALIFORNIA, had a laminectomy discetomy L3-L4-L5 discs in 2009,doctor rated me at 25% disabled, went to a settlement back in april, carrier offered 60,000 we refused that so now we are going to trial in september,my question is this , on the trial will the judge make a desicion as of how much will I get for a settlement?or what can i expect on this day,last time we went to the hearing the judge said he wanted a letter from the carrier saying they were paying for this settlement and all medical expenses since the company I used to work for went bankrupt,the carrier accepted liability in 2008 for my injury and they paid me workers comp for 104 weeks, Iam now receiving a partial payment of 12,000 of my settlement from them.(in payments)I just have no Idea how this will go,Iam still in a lot of pain and taking pain meds all day-night..thanks for your info..

[1171]

judge cannot order a C&R lump sum amount.
court will award periodic PD payments according to a fixed % decided by the judge and based on the medical evidence, open medical as well as atty fees and any other issues (liens, TTD, etc.)
if you wish some of your PD in a lump sum you can ask at the hearing for a certain amount to be commuted from the end of the PD payments.

looks like you will need more future medical care then they were willing to include in the settlement.

the court's decision now does not preclude a latter C&R lumpsum settlement should you and the carrier come to an agreement later.

[newknee]

(06-12-2011 01:53 PM)1171 Wrote:  judge cannot order a C&R lump sum amount.
court will award periodic PD payments according to a fixed % decided by the judge and based on the medical evidence, open medical as well as atty fees and any other issues (liens, TTD, etc.)
if you wish some of your PD in a lump sum you can ask at the hearing for a certain amount to be commuted from the end of the PD payments.

looks like you will need more future medical care then they were willing to include in the settlement.

the court's decision now does not preclude a latter C&R lumpsum settlement should you and the carrier come to an agreement later.

---

Am hoping 1171 can help me. Had total knee replacement 2007 @ age of 53. IC wants to settle medical for $15K. Knowing knee replacements only last 10-15 yrs, I would need to have repair surgery later on and know that amount would not cover it (researching shows TKR costs are $45-$$60k plus cost of therapy, meds etc) Am considering the option of open medical. However, not seen very positive posts regarding ease of or ability to get approval for surgery this way. And what if IC goes backrupt ?? I am in California & my carrier has "changed hands" twice thruout this ordeal already...Can I request or stipulate a set amount ($55K for example) go into a trust fund just for the surgery for later date or any other opton available? I have already received TD /PD to equal the amount of rating so no other settlement there. I really don't want to get a lawyer since this isn"t about rating amount unless absolutely necessary. Thanks so much!

[1171]

you should start a new thread so as not to confuse other readers.
http://www.workerscompensation.com/forum....php?fid=4


UR can be a pain --especially for optional or non-traditional therapies.
the court still retains jurisdiction so you can go back to the judge for a medical decision if you have to.

but for serious clear-cut treatments it shouldn't be a problem. the key is a doctor that knows the carrier's process and how to justify their treatment requests.
there is also the QME/AME route to help with a difference in medical opinions.

Insurance Company's have to pay yearly assessment to support a Guarantee Fund that takes over claims of bankrupt carriers.

what do you mean your carrier has changed hands?
it's been bought/sold to other Insurance companies?
that's a bit rare....

as part of your settlement you can designate where you want it paid but you have no say over the amount--- it's totally up to what you can negotiate.

but a better option might be a structured settlement where the carrier buys an annuity that pays out as you direct it.
this way the annuity is not taxable as it'w owned by the carrier.
but it's usually used for much larger amounts.

i'm aware of recalls on implanted hardware and other unexpected problems that can develop if they are done incorrectly.
I would urge you to leave your medical open to cover all eventualities. it's most likely that costs will continue to escalate and $100K would be a more reasonable estimate.

make sure you use a doctor within the carrier's MPN ( you can change to any within the MPN until you find one you like)
that should help minimize the possible UR problems.

I'm not sure the carrier could even get a $15K C&R thru the WCAB on a total knee case--the judge would likely bounce it.
you have to remember that future medical is never paid out upfront at full value.
even in this bad economy money is worth a lot more in 10 or 15 years---they will only give you the present value
($15K @3% for 15 yrs = $23.3K which you know is still way too low!)

[newknee]

(11-02-2011 02:05 AM)1171 Wrote:  you should start a new thread so as not to confuse other readers.
http://www.workerscompensation.com/forum....php?fid=4


UR can be a pain --especially for optional or non-traditional therapies.
the court still retains jurisdiction so you can go back to the judge for a medical decision if you have to.

but for serious clear-cut treatments it shouldn't be a problem. the key is a doctor that knows the carrier's process and how to justify their treatment requests.
there is also the QME/AME route to help with a difference in medical opinions.

Insurance Company's have to pay yearly assessment to support a Guarantee Fund that takes over claims of bankrupt carriers.

what do you mean your carrier has changed hands?
it's been bought/sold to other Insurance companies?
that's a bit rare....

as part of your settlement you can designate where you want it paid but you have no say over the amount--- it's totally up to what you can negotiate.

but a better option might be a structured settlement where the carrier buys an annuity that pays out as you direct it.
this way the annuity is not taxable as it'w owned by the carrier.
but it's usually used for much larger amounts.

i'm aware of recalls on implanted hardware and other unexpected problems that can develop if they are done incorrectly.
I would urge you to leave your medical open to cover all eventualities. it's most likely that costs will continue to escalate and $100K would be a more reasonable estimate.

make sure you use a doctor within the carrier's MPN ( you can change to any within the MPN until you find one you like)
that should help minimize the possible UR problems.

I'm not sure the carrier could even get a $15K C&R thru the WCAB on a total knee case--the judge would likely bounce it.
you have to remember that future medical is never paid out upfront at full value.
even in this bad economy money is worth a lot more in 10 or 15 years---they will only give you the present value
($15K @3% for 15 yrs = $23.3K which you know is still way too low!)

---

1171, Thank you sooo much & bless you for helping so many people on this forum! The judge did bouce it & asked me how will I pay for knee replacement as they are not "lifetime" & no one can quarantee how long it will last. Mine is very successful ~ after 4 years, Dr says looks extremely well ~ I think would last til I am 65 & able to get Medicare. However judge explained that medicare will NOT cover as its a work related injury ( IC attorney told me it would!) ... especially since medicare $ getting tighter. IC attorney argued as to whether Iwould even need it later on. Due to my age and family history I am sure I will live 30+ years to be in my late 80's.. 90's. Judge pretty much agreed I will need another one & said he could set a trial date for us. If I go that route, do I have to have an attorney? Can I see an IA (?)
counselor without IC attorney present since i am pro per to have them answer my questions? And are MPNs usually state wide as I want to move 10 hours away? Thanks again!

[1171]

start a new thread please.