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  1. #11
    Join Date
    Apr 2007
    Posts
    55

    Default Re: 5 1/2 Yrs PTD or Settlement

    What do you all think a fair settlement would be for the following injured worker:

    - injured worker is male, 42 years old
    - has 9 allowed conditions including herniated discs, degen disc disease, etc
    - has had 3 back surgeries with fusion and rods/screws
    - between indemnity and medical over $200,000 paid out
    - reserves are at $175,000
    - 23% lumbar whole body impairment, 30% total whole body impairment

    So what do you all think this claim is worth in a settlement? Please advise.

  2. #12
    Join Date
    Sep 2007
    Posts
    189

    Default Re: 5 1/2 Yrs PTD or Settlement

    Truckdriver,

    I had an insurance adjuster tell me that there really is no set standard when it comes to settlements. Whatever it may be, the IW will feel it is too low; the IC will figure it to be too high.

    You have a high-dollar case, and I'm sure the IC would like to buy you out. The problem is, they (IC) do not like to part with large amounts of $$$. They figure they would rather pay you small sums, in the hope that you kick the bucket early, rather than paying you the true value of your claim.

    State laws regarding PTD have to be considered, as does SSD and WC PTD payments and set asides. If you are PTD and collecting SSD, will the IC's PTD payments be lowered (the %80 rule)?

    I have turned down a low six-figure C&R settlement. I am %11 whole body and am going to court for a PTD final hearing soon. My attorney told me my case is worth 165k indemnity, 75k future medical. Will the IC dole out 240k? I doubt it. Even if they would, I have to take Medicare's interest into consideration with a MSA. That is a whole other post. Plus, the IC will figure the future medical part of the settlement in "today's dollars" which will lower it significantly.

    I am almost 50 and have four herniated/ruptured discs. Future medical will be expensive, according to my PTP and IC IME doctor. Surgery most likely.
    Would 75k cover fusion surgery in the year 2012-13? I doubt it. That is why future medical is, according to Charles, a SWAG (scientific, wild-ass guess.)
    So, to make a long story short, there is no "formula" to figure out settlements.

    You have (hopefully) quite a long time left on this planet. Life expectancy tables for you is age 70, give or take a few. That's 28 more years. At 10k per, that would be 280k. At 20k per year, 560k. You get my drift?

    I know the frustrations you are going through (financial, emotional, physical) but you have to try and CYA because no one else will do it for you.
    Good luck...

  3. #13
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: 5 1/2 Yrs PTD or Settlement

    There have been posts on the OH forum discussing the value to a %PP/% of Permenant Partial Award...
    The provisions are as follows...
    Percentage of Permanent Partial Award (%PP)
    A certain amount of permanent damage (called residual damage) may remain as a result of the injury. %PP is commonly referred to as C-92 awards and is compensation awarded for residual impairment resulting from an allowed injury or occupational disease according to ORC 4123.57. For example, if an injured worker sustains a broken arm and can no longer extend it to the full degree, he would be eligible for an award based upon the residual loss. The permanent impairment may be physical, psychological or psychiatric.

    %PP is not payable for any psychiatric condition(s) unless there is an allowed accompanying medical condition in the claim. C-92/C-92A awards are based on medical information and the findings of the exam/review. The C-92/C-92A determination is supported by an independent exam and the examining physician will not contact the injured worker’s doctor/provider of record for medical information.
    https://www.ohiobwc.com/basics/guide...eralinfo35.asp for more information on benefits available
    What do you all think a fair settlement would be for the following injured worker:

    - injured worker is male, 42 years old
    - has 9 allowed conditions including herniated discs, degen disc disease, etc
    - has had 3 back surgeries with fusion and rods/screws
    - between indemnity and medical over $200,000 paid out
    - reserves are at $175,000
    - 23% lumbar whole body impairment,
    The basic valuation of your award will be based on the WPI/Whole Person Impairment of 30%...the other factors have already been added into the calculations...
    "Reserves'' the IC may carry have nothing to do with a settlement.
    The only thing the past medical would have to do with this is for a SWAG on the potential value of the FMT/future medical treatment as determined in the stipulations/award.


    My attorney told me my case is worth 165k indemnity, 75k future medical. Will the IC dole out 240k? I doubt it. Even if they would, I have to take Medicare's interest into consideration with a MSA
    Your AA may be close on the indemnity...but has no idea what CMS/Medicare would determine on the WCMSA...and if there is a setaside, Medicare would step in once the funds are exhausted...of course you would continue with out of pocked costs...
    At any rate, you can NOT settle you claim until CMS weighs in on the WCMSA...and you need to consider the WCMCA/WC Medical Custodial Account.

    All things being equal..there are LOTS of settlements much higher than the 240K you are contemplating.
    I don't know how your state handles ratings...but I would doubt you will see a PTP/Permenant Total Disability award with an 11% WPI ...not without significant additional medical findings.

    Most of your post is correct dan...some just a bit skewed...

  4. #14
    Join Date
    Mar 2008
    Posts
    53

    Question Re: 5 1/2 Yrs PTD or Settlement?

    Quote Quoting hurtinggrandma View Post
    Thank you all for your input so far, to update my questions, I do have private insurance through my husband, I will not be eligible for Medicare for 4 more years and I do receive SSDI. My attorney has advised me to make a decision now whether to go for a settlement or PTD. He is asking for quite a large settlement if I go that way (six digit) and was just wondering if anyone has ever heard of or know of anyone who gets that large of a settlement or if it a waste of time to even try for that. My prayers are with everyone going down this road, which is definitely not a road we choose to travel, and the hardships and things we have to endure during this travel.
    my husband has tendonitis of the shoulder and was advised to c&r. Not too many people get more than 20 to 40 thousand for their injury even those who are severe. Good luck to you my husbands employer never paid one dime of benefits for 4 mnths. We were forced to live off of unemp. comp. and i am disabled and dont get much money. So think hard about what you do we now have no income til the check comes.
    hifisi, an injured worker that will do his best to answer your questions

  5. #15
    Join Date
    Apr 2007
    Posts
    55

    Default Re: 5 1/2 Yrs PTD or Settlement

    So what does everyone think a good settlement amount would be for my claim? From what I am reading 30% whole body impairment is a decent number. This percentage was from a BWC hired doctor. So what's a figure that I can feel that they are not taking advantage of me? Please give me dollar figures. Thanks in advance.

  6. #16
    Join Date
    Mar 2008
    Posts
    53

    Default Re: 5 1/2 Yrs PTD or Settlement

    there is no true answer to your question; it all depends if you want to have medical open or go through c&r in which everything will be settles and whatever you figure is best for you.
    If you settle by c&r it will release the er and ic from treating you any further.
    so if you need further treatment (ex. surgeries, constant need for medical care) do not settle for c&r.
    the check,if you settle, you receive is 1 that you live day by day till to you are able to work or to receive ssdi or other money you have squared away which is very little because wc screws around and puts you in the poor house.
    I am happy with what I settled for and hopefully you will come to a happy agreement with yours.
    also it is up to the ic to give you a figure and don't be surprised it will be a very low figure. as they are the ones that will get you out the door and to settle all in 1 day.
    if they say its a good figure always go for more because the ic will usually have a cap and the first figure is always low (ex 1st figure 2500 and your lawyer might get a hint on how high the ic is willing to go)
    don't expect to get your job back either.
    hifisi, an injured worker that will do his best to answer your questions

  7. #17
    Join Date
    Apr 2007
    Posts
    55

    Default Re: 5 1/2 Yrs PTD or Settlement

    Is there any injured workers who have actuallly settled their claim on this forum? Would be interesting to see what their impairment rating is compared to settlement amount they got. Nobody has to give an exact figure just a ballpark figure. I am just starting to get the settlement process going. Thanks in advance.

  8. #18
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: 5 1/2 Yrs PTD or Settlement

    What you are asking for carries too many variables..
    There is more than one way for a claim to be settled..
    Settled – medical and indemnity – the claim has been closed out in its entirety in exchange for a sum of money. No additional medical treatment or compensation can be paid out in a claim once it has been settled.

    Settled medical - the medical portion of the claim has been closed out in its entirety in exchange for a sum of money. No additional medical treatment can be paid out in a claim once it has been settled.

    Settled indemnity - the indemnity (compensation) portion of the claim has been closed out in its entirety in exchange for a sum of money. No additional compensation can be paid out in a claim once it has been settled.
    Each of those options would carry a different dollar amount.

    For the indemnity portion, take your weekly amount and multiply by the number of weeks allowed for %PPD...if you take this over time, you would of course receive the whole amount...a lump sum will be reduced to ''todays dollars''...a discount per annum of a given % over the length of time the benefits are payable...eg 450/wks divided by 52 = 8.65/years....you'd reduce the award by say 3% per year to get todays dollar value...

    The amount of each 'award' would carry the same guidlines...
    A medical award is a "SWAG" at best..Scientific Wild Ass Guess...no one can pre determine how much your medical would cost 5 or 10 years from now, OR that you would even use the money for treatment to this injury...few IW's do.

    So...the PD indemnity you can figure out, the amount is set by statue...
    The medical is dependant upon your anticipated needs..

    What other IW's may have received is not really relevant to determining what would be a ''fair'' offer to you...neither side is ever happy with a C&R...you didn't get enough...the ER/IC paid too much...
    When you receive a figure YOU are happy with...take it.

    You can read about lump sum settlements here...http://www.ohiobwc.com/basics/guided...ORC4123.65.asp
    Any C&R you enter into must be reviewed for adequacy...if the agreement is determined to be unfair...it will be denied...

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