Taking Charge of Your Case is Essential

Saturday, June 7, 2003 | 0

The following dialogue (edited for brevity and clarity) appeared recently in the workcompcentral.com Injured Workers Forum. The editors felt this dialogue was an excellent example of some of the considerations that need to be taken into account when considering whether to settle a workers' compensation claim for a lump sum, foregoing the right to future medical care.

Q: "I am out of work on LTD; have carpal tunnel and back injury. The attorney for my employer has proposed a lump sum settlement of $95,000 - w/no supportive care. Of that $50,000 would be designated as future medical and $45,000 would be against compensation benefits? I am 62, so any money that is not medical will be taken by my employer's LTD carrier. They are putting the $45,000 at a monthly rate of $180.35 for 15 years. But out of this, my attorney gets 25% of the $45,000 and 25% of the $50,000. Which leaves me with a medical settlement of - $37,500. I cannot work due to the back injury and right and left hand carpal tunnel syndrome. I was a very high earner (low six figures) and this just seems like, after all this, I end up with practically nothing! I live in Phoenix, AZ. My attorney is telling me the offer is huge, in terms of what is usually offered, and I should jump at it. I don't know what to do?"

A: "I would not settle my future medical with a back injury! The attorneys will probably tell you that you are near Medicare eligibility age ￯﾿ﾢ￯ﾾﾀ￯ﾾﾓb.s.- Medicare has clamped down - rightfully so - they are tired and BROKE from having to pick up the WC insurance co obligations!! They are very sophisticated as are 3rd party insurance companies, and can track settlement electronically and see what your settlement covered. Coverage will be excluded for those body parts until that settlement money for care is finished and then the medical carrier will ask for proof that the money was used for medical treatment (i,e, medical bills). Of course the attorney wants you to settle - 25% is a large fee - CA is capped at 15%... Are you very familiar with your states rules and regulations for WC - if not I would do some fast reading - you don't have to accept the first offer while you read make them wait they make come higher - you may have to accept the $45 but don't settle for the medical."

Q: "Thank you for your reply to my question about the proposed lump sum settlement. I am 62 and I already am receiving Social Security Disability plus Long Term Disability from my companies insurance carrier - Prudential. How do I find out about the laws, rules, regulations for Arizona?"

A: " http://www.rmlibrary.com/db/lawwc.htm - check through the 2 sections listed for Arizona. Also you need to carefully read the papers you got for your LTD and social security disability disability-IN SOME cases- THEY have the right to get some of your award - there are a lot of factors to consider - you will have to discuss those particulars with your attorney after you read the law and get a fair understanding of Arizona law. And after you read and re-read the fine print on your LTD forms discuss with your attorney. Often the way the settlement papers are drawn determines whether the other third parties can get their hands on the money - sad but most aren't told about this before it's too late."

Q: "Your statements regarding my posting saved me from making a big mistake! I went to my HMO doctor at Cigna to get a referral for pain management because the WC insurance co. is saying I can only go so many times per year. My medication requires I show up monthly, in order to get the script. So, I figured while my lawyer tries to sort this out, I would go to Cigna. Guess what . . . they may refuse to treat me because it is a work comp case!!!! How's that for a wake-up! Also, on the settlement, my LTD carrier would take the part of the settlement not designated as medical BUT now, that means the entire medical would have to be paid by me (not a co-pay). Re: Social Security Disability - they would not take anything because I have made over a certain amount for the last 5 years. Re: back injury - I had a job function change but the top brass forgot to get my office ready so I was forced to carry around my laptop, files, everything - and try and find spots in the banking center branches to set up shop. This activity caused a synovial cyst on my spine. Finally decided to have surgery, but surgeon only took part of the cyst and left a part. So I'm actually in more pain than I was pre-surgery. That's the short form on the back --- For the SSD, I used an attorney who only did Social Security -- I was approved in under 2 weeks and it only cost me $360.00 which I feel was a bargain."

The upshot to the above dialogue: it is up to you, the injured worker, to ultimately take charge and ensure that YOUR interests are taken care of.