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Thread: SI Joint Injury

  1. #1
    Join Date
    Sep 2007
    Posts
    7

    Default SI Joint Injury

    I forgot to mention 2 years ago this month I injured my lower back while working in 36 inch coal pulling on a mining cable. I was off work for about 9 months and was told by my Dr. I would always have arthritis in my SI joint. I was released to go back to work but was never offered a settlement by my comp. I now have a lawyer who is filing on that injury this month. I reinjured it during this latest injury also. What kind of settlement if any am I looking at. Any thoughts please? Thanks again for listening.

  2. #2
    Join Date
    Mar 2007
    Location
    Georgia
    Posts
    1,928

    Default Re: SI joint injury

    Hey again RKV. It might be a good idea for you to post a continuation to another thread in that same thread. Just go to the original thread and press the post reply key. It will give you a new window to type in. I say this as when I first seen this post it didn't make a lot of sense as a stand alone post. I had to go hunt down your first one in order to makes sense out of this one. No biggy for sure just something that might be helpful in the future.

    As far as a dollar amount for your injuries. It is likely way too early to project such a thing. With your multiple injuries, back, shoulder, arm, etc., it is likely going to end up being a percent of a whole body impairment for your PPD settlement. I am not sure just how your doctors will go about doing a PPD impairment rating. You might be able to get a better idea of and how the procedure works by going to the KY WC web site at

    http://www.labor.ky.gov/workersclaims/

    You need to make sure you educate yourself as to your rights and responsibilities where WC is concerned. No better way than to dive right in at that web site. Many here are very knowledgeable and will help you any way they can as well. If ever in doubt about any of the information offered here just go to the web site and look it up. Where you are already represented you should be able to depend on your attorney for information as well. If he/she is a typical WC attorney they simply do not have time to answer a lot of questions you may have that are general information and not something specific to what is taking place with your claim at any given time. So use that web site to your advantage that is what it is for.

    Most states web sites have a section for PPD settlements and list any scheduled injuries. Usually expressed as a number of weeks for each body part or the body as a whole. You would then take the disability percentage and multiply the number of weeks by the PPD percentage. Then multiply that answer by your weekly TTD rate for a total settlement amount.

    You will also have to make a decision about continued medical care often referred to as future medical or FM. If you dare risk letting the IC buy out your entitlement to FM then they also include a dollar figure for that. If you do that kind of settlement usually called a "compromise and release" or C&R, the IC is forever off the hook for paying for any FM including any complications from the injuries.

    Another consideration you will have is a WC Medicare Set Aside. This is used when you have applied for SSDI, are already approved for SSDI, or anticipate filing for SSDI within 30 after you enter into the settlement agreement. The reason Medicare requires a WCMSA is for years the WC IC's were cost shifting, in other words Medicare was picking up the bill for WC injuries that the WC IC should have been paying for. The rules for Medicare is very clear IF the medical treatment is for a previous WC injury. The money delegated for the WCMSA has to be used up before Medicare will start paying for treatment for a previous WC injury.

    Go here for more information on WCMSA's:

    http://www.cms.hhs.gov/WorkersCompAg...wcsetaside.asp

    or here:

    http://www.jjcelderlaw.com/SSDIOffsetMSABull.htm

    You can also google WC Medicare Set Aside for additional information.

    The guidelines are if the PPD settlement is equal to or more than $250,000.00 then a MSA is mandatory. Don't be fooled by thinking if the settlement is less than the $250K that they will automatically pay for treatment, they will not and can require that you use every penny of the PPD settlement for medical expenses before they will start paying. The way around that is two fold. You can keep FM open and WC has to continue to pay for the medical treatments for the WC injury. This is known as a stipulated agreement. In essence you are stipulating that on a life time basis or for a set number of years WC will continue to pay for your work injury related medical care.

    Or you can settle with C&R and be paid up front by WC IC for FM as described earlier. A couple of things to be very careful of here is making sure that the amount delegated for FM is enough to actually cover your FM. The other important point is to make sure any money intended for FM is specified as such in the settlement and placed into a separate account to be used for FM care only. Most states do not allow attorney's fees to be taken from the amount specified for FM. Bear in mind that is most not necessarily all. Check at that web site I gave you for KY. It should say in the regulations.

    Take care and Be Well,

    Steel
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln


    Take Care and Be Well.

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