Settlement Worksheet

Sunday, July 31, 2005 | 0

The following worksheet for making a basic determination of the value of a settlement of your workers' compensation claim was posted in our Injured Workers' Forum. It is reproduced here with some minor editing.

SETTLEMENT WORKSHEET:
Value of Workers' Compensation Claim

1. Permanent disability (determined by rating) _______weeks X $_____________ per week

2. Life Pension (available if rating is between 70 and 99.75)

3. Past due temporary disability

4. Past due Vocational Rehabilitation Maintenance Allowance (VRMA)

5. Reimbursement for mileage (includes driving to Dr. appointments, Physical Therapy, even to the drug store to pick up your prescriptions, etc.)

6. Reimbursement for medical (includes unpaid Dr's appointments, hospital bills, etc.)

7. Future medical expenses, calculated at __________% of actual costs:
a. medical examinations and hospital bills (including surgery, physical therapy, etc.)
b. temporary disability (at __weeks X $____per week)
c. medical costs (including prescriptions, tests, wheelchairs, hearing aids, braces, etc.)
d. discount subtotal to present value.

8. Right to reopen case (five years from date of injury)

9. Penalties Total (specify): Such as delays in response to medical requests and delay in payments. They can be fined 10% for delay up to $10,000 max

10. Other (specify):
a.. Vocational Rehabilitation: You can settle this for a lump sum up to 10K or 16K in a few instances (does not apply to Supplemental Job Displacement Benefit).
b. Home Health Care Reimbursement: This can also be #of hours a day that your spouse, family members take care of you. They can get paid for their time- as long as you have a Dr's note stating that assistance is needed.

11. Total value of claim (sum 1-10 above)

12. Minus Attorney fees: 12-15%

13. Minus Permanent disability advances

14. Total you will receive

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