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  1. #1
    Join Date
    May 2008
    Posts
    12

    Default Settlement Amount

    Hi All new member here,,,I was hurt on the job a few years back now,Here is what happen to my shoulder/neck

    Date of injury 5/26/06

    Slap 2 tear of the glenoid labrum,rotor cuff interal closure.

    Had surgery to the shoulder went through th PT and released to go back to work. Still a lot of pain in the shoulder numbness in the hand.

    To the neck,,the ins. company denied the dr. request for surgery on the neck.Here is what was found.
    c5-c6 small disc bulg with fibrocartilaginous ridge that impinges upon the anterior aspect of the thecal sac.
    c6-c7theres a large disc herniation which is central and extends towards the left side impinging upon the spinal cord and compressing the left neural foramen.

    whit that said this is the demands from my lawyer to workman comp.
    45% cervical and 45% shoulder. 47 1/2% of partial total.

    So what kind of settlement im i looking at???

    Thanks

  2. #2
    Join Date
    Apr 2008
    Location
    In A House
    Posts
    308

    Default Re: Settlement Amout

    Waterman,

    I don' know about settlement amounts, but did anyone explain to you that c6-7 is why your hand is numb? And if C5-6 gets bad that will be your arm and let me tell you that is no walk in the park. Mine felt like someone was constantly stabbing me and then digging in it! I would see about fighting to get the herniations allowed and if they are allowed keep fighting for treatment to take care of that other wise you may regret it!
    I hope what ever you decide it works for you.
    D

  3. #3
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    659

    Default Re: Settlement Amout

    Hello Waterman it is the Bugmann and I am here to help you understand some about the NJ WC system. First is when it comes to ratings this is the measurable amount of permanent total disability as a body in whole. This figure is where your settlement amount comes from when your case moves to the final stage which is comp 4 the measurable amount of permanent disability, or settlement.

    It is unclear from your post if the neck injury was completely denied by the insurance co?? In either case your neck has DDD. This may be due to the natural aging of the body or the injury to the shoulder?? I'm sure I can take a good guess at which the insurance carrier claims is the case??

    I could not figure out what you where detailing with the 3 ratings you or your lawyer are referring to; 45% cervical and 45% shoulder. 47 1/2% of partial total.

    You can not be found more than 100% disabled as a body in whole.

    It is a standard practice for a lawyer to ask for a high % as the ins. carrier will come in lower. Usually your award/rating will fall in between the two. I imagine you are still employable, which weighs in as does the recovery you had from surgery. A poor recovery can add 2--5% more in rating. Your medical file will be reviewed by the JUDGE as he has the final word on this.

    Without more medical information and knowledge of your recovery and if the neck DDD is part of this work injury claim this is a very difficult question to answer and I would say this is a guesstimation of what you will receive. From past experiences a shoulder injury providing its functions are reasonably intact (but painful) will get you about 7%. If the neck is included as the reason for the numbness the neck may be slightly higher to 10%. At best you are looking at 15-17%.

    NJ has a chart that they use which I dont have access to. I am pretty sure that my estimate(s) are high and you may be expecting much more. I tell everyone to the one who has been permanently injured that there is no real fair comp for the loss of ones health however the State must have some way to compensate you for the injury and this is it. Certainly it is best to avoid injury at all cost when possible as the results are usually not what one would want.

    I wish you well.

    BUG

  4. #4
    Join Date
    May 2008
    Posts
    12

    Default Re: Settlement Amout

    This is an update to this,,,was told I'm getting 37 1/2% that was the last offer from the opposing lawyer,,,thats a combined neck&shoulder. I cant wait to come to a close on this

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Settlement Amout

    If your rating of 37 1/2% is the WPI the ER/IC is agreeing to, and this is a 'scheduled disability', you can find the potential value of your PPD indemnity here...http://lwd.dol.state.nj.us/labor/for...8_schedule.pdf
    In a C&R settlement, you would have to add the estimated value of any future medical treatment as indicated by your PTP final reports.

    If yours is an 'unscheduled' body part then a number of weeks is assigned to each 1% of your WPI rating...

    In either case, the value of a C&R is whatever amount the parties agree to in order to close the file on this claim.
    Only you and your AA can come to a figure you are comfortable with in accepting a cash lump sum for your injury....

  6. #6
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    659

    Default Re: Settlement Amout

    Hey Waterman,

    OK I see now the 47 1/2 was a "partial" permanent disability rating. From the medical notes in your first post
    "c5-c6 small disc bulg with fibrocartilaginous ridge that impinges upon the anterior aspect of the thecal sac.
    c6-c7theres a large disc herniation which is central and extends towards the left side impinging upon the spinal cord and compressing the left neural foramen." Sounds to me if the pain was bad, and/or you were having severe numbing and tingles this would warrant surgery also???

    I believe there are no medical, benefits once the treating Dr rates you at MMI.

    Rest assure your lawyer is working to get you the highest rating as his fees are a %.But in the first post you wrote the neck was denied, but this 37 1/2 rating includes the neck injury???

    BUG

  7. #7
    Join Date
    May 2008
    Posts
    12

    Default Re: Settlement Amout

    Yes this does cover the neck. once they settle this im pushing to have my neck checked out again...based on what my lawyer has told me it will be easyer to get my neck attened to now that they have put a % on my neck

  8. #8
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    659

    Default Re: Settlement Amout

    Hey Waterman, OK but something sounds fishy here, I agree with the lawyer in that it will be easier to get your neck corrected with WC giving a rating, as the rating establishes this as a pre existing condition, as far as private insurance is concerned.. So if you went to your own Dr and they say surgery there is no red tape with WC.

    Normally the rating comes after the corrective care has been rendered?????? Make sure you and your lawyer understand this. It appears to me that you are assuming with this rating that WC will now address the neck issue, but if they denied the neck condition in the beginning, is your lawyer planning to file an action or motion to compel treatment, as earlier suggested by the treating WC DR??? This case cant settle or even be given proper rating until all the corrective care has been performed, in consideration for a rating how one recovers from the treatment does weigh in on ratings. This is what I am having a difficult time understanding? If the treating Dr says surgery,the ins is obligated to do this, the law is on your side with this treating Drs suggestion. Why your lawyer let the neck denial go unchallenged only to wait for a rating to say it will be easier to get corrective care makes no sense. I'm no Dr but the one study to me indicated surgery would be appropriate, then the treating Dr says surgery but the ins denies this, did they give any reason for this denial?? Maybe that is the plan, but I dont recall the reason for the denial for the neck surgery in the 1st place.

    I only bring up points that seem out of place, in hopes that your lawyer will explain to you better his plan, you never want to assume something will be done because it is the right thing to do, as these ins co. will do just about anything to save a buck to show better profits for the year!!!!

    I hope that your pain is somewhat better today?? I know just thinking about this all can give one a headache to match the neck ache!!!

    Thanks for sharing this very interesting case..

    BUG

  9. #9
    Join Date
    May 2008
    Posts
    12

    Default Re: Settlement Amout

    Bug,,,they being the ins.co. have denied all along that the neck injury was not part of the accident.So now that they have put a rating on my neck as part of the settlement they have admitted to it being part of the accident.I have major trust in my lawyer she came highly recommended and has really done an awesome job.
    I hope this put a little more light on it.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Settlement Amout

    I believe there are no medical, benefits once the treating Dr rates you at MMI.
    MMI/Maximum Medical Improvement only means you have reached at state that a change in you condition is not expected in the next 12 months with or with out active treatment...it does NOT mean you are not entitled to additional treatment...eg. pain management. Anything past the 90 day point the injury is considered to be "chronic''...

    Normally the rating comes after the corrective care has been rendered??????
    That's true, you can't have a PD/WPI rating until you reach a MMI status, and the PTP can't evaluatate you until the treatment is complete...

    If the treating Dr says surgery,the ins is obligated to do this, the law is on your side with this treating Drs suggestion.
    Not necessarily.... IF the law allows for the PTP ''presumption of correctness'' then the IC would be held to the recommendation of the PTP...
    On the other hand, if the laws provide for treatment that is ''medically necessary'' and ''reasonable'' on an industrial basis, then not any and all treatment is provided...anything the PTP thinks is necessary would have to be backed up by EBM/Evidence Based Medicine...peer reviewed, published studies that warrant the treatment..usually ACOEM/American College of Occupational and Enviromental Medicine...

    Of course you have to understand the ACOEM guidlines are compiled by physicians amassed by the IC's....(picture becoming clearer here)

    bug, you're still thinking of WC as you would ''regular health coverage'' it's not.
    For one, the IW is not the 'insured party', the ER is.
    The IW is not paying the premium, nor the co-pays/deductibles for the care provided...as would be the case in 'regular health coverage', and you'd be afforded pretty much ''any and all'' treatment your doctor could back up the need for, or you were willing to pay the cost.

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