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  1. #1
    Join Date
    Sep 2008
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    11

    Question "Offer" Made and Rejected - Now What?

    My attorney sent a "Demand Letter" approximately four months ago (of $84,000) and suggested a "25% compromise" amount between the two doctors involved - one giving a "30%" PPD - the other "20%".

    The third-party work. comp. insurance company countered with an "offer to settle" of $50,000 approximately two months ago. My attorney informed me about a month ago that this amount was "too low" considering that the surgeon has suggested at least one more surgery (hardware removal) from my leg - but that it is "elective". I do not want this surgery (or anymore surgeries actually), and have opted to not have it.

    The surgeon also mentioned almost a year ago in his MMI report ("30% PPD rating"), the potential or 'possibility' of a "fusion" or debridement/arthroscopic procedure in the future. He also tells me that he can't rule-out the possibility of nerve damage in the foot and or leg.

    The IME doctor I was sent to see (by the insurer) seven months ago gave me a lower PPD rating ("20%"), and said he didn't believe that I would need any further surgical intervention.

    Can anyone here say with any reasonable certainty where I (my case) stands? I feel confident in my attorney on the bottom-line of this case (he has been practicing work comp and disability law specifically - and only - for over 30 years - closer to 35 years, I think), but he is very slow, and takes two to three weeks just to return my calls often times.

    The case will be two years old (which is the maximum time limit for filing a claim in my state - VA) one month from today - in other words, the original date of injury, and when the claim was made, was in October of 2006.

    I am just wondering if the insurance carrier will make another (second) offer (is that "typical"?), or do they typically take it for a hearing after they have made their offer to an injured worker? Again, we are $34,000 apart after the first round of offer/counter-offer (about a 1/3 difference) - $50,000/$84,000.

    Thanks in advance.
    Last edited by 321_no_more_fun; 09-10-2008 at 10:15 AM.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    if they do make another settlement attempt it'll only be before any hearing date and to avoid the legal fees of an appearance.
    you need to get a court date if you want to increase the motivation to negotiate further.
    (that or ask them to authorize surgery- nothing like large medical bills coming in to stir their settlement juices....)
    Last edited by .SH; 09-10-2008 at 10:57 AM.

  3. #3
    Join Date
    Sep 2008
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    11

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    Quote Quoting .SH View Post
    if they do make another settlement attempt it'll only be before any hearing date and to avoid the legal fees of an appearance.
    you need to get a court date if you want to increase the motivation to negotiate further.
    (that or ask them to authorize surgery- nothing like large medical bills coming in to stir their settlement juices....)
    Thank you very much for your reply.

    As much as I had to admit it, it all sort of seems like some sort of a big "game". But I would think they would be anxious to "settle" it and be done with it (?). I don't think I've been unreasonable (at all?) through-out the process (I didn't retain counsel until a year after the injury, and they stopped paying weekly benefits).

    I suppose I'm thinking that if we (I/my attorney) "asked" (sent a "Demand Letter") for "an amount", and the insurance company countered with a lower amount, that the case would reasonably "settle" fairly close to the middle of the two amounts - and again, that they would be anxious to make it "go away". Am I way-off in my "logic"?

    Thanks again ...
    Last edited by 321_no_more_fun; 09-10-2008 at 11:39 AM.

  4. #4
    Join Date
    Oct 2006
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    9,109

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    come on, you can't have been doing this for 2 years and not realize both sides try to "game" the system.
    if you don't think settlement negotiations are a game you shouldn't be doing it yourself-let your atty handle it or let the state figure it for you.

    getting other people to do things you want them to do is the game of life.

    why would you think they want to spend money now when they can spend it later? the the value of money over time is huge (look at your mortgage!)
    you buy a car or house so you can pay later--same difference.

    no, you are not way off on your logic; I wouldn't be surprised if settled at the last minute just before the hearing for around $67K.
    I'm surprised your atty's first offer was already a split between the ratings. when you do that you are already signaling that'll you'll take another split (but then again you aren't really intending to spend the surgery money on a surgery so it probably washes out)
    Last edited by .SH; 09-10-2008 at 01:04 PM.

  5. #5
    Join Date
    Sep 2008
    Posts
    11

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    Quote Quoting .SH View Post
    come on, you can't have been doing this for 2 years and not realize both sides try to "game" the system.
    if you don't think settlement negotiations are a game you shouldn't be doing it yourself-let your atty handle it or let the state figure it for you.

    getting other people to do things you want them to do is the game of life.

    why would you think they want to spend money now when they can spend it later? the the value of money over time is huge (look at your mortgage!)
    you buy a car or house so you can pay later--same difference.

    no, you are not way off on your logic; I wouldn't be surprised if settled at the last minute just before the hearing for around $67K.
    I'm surprised your atty's first offer was already a split between the ratings. when you do that you are already signaling that'll you'll take another split (but then again you aren't really intending to spend the surgery money on a surgery so it probably washes out)
    Thanks again, and I am sure that I am somewhat naive in the matter - to a certain extent.

    A lot weighing on my mind (including an unrelated spine surgery a month ago - and the recovery therefrom) - but ultimately, "YES" - I am VERY concerned about "settling", and then needing a RELATED surgery in the future. The fact that I am 'opting-out' of a hardware removal surgery is that it is termed "elective" by my surgeon, as well as being based on the fact that the hardware doesn't much bother me WHEN I stick to his restrictions - and that it could easily be removed in the future if I were to need a fusion.

    I am not at all trying to "game" the system - I only want what is decent (read: what the law stipulates) - and I am not certain that I would get that if I "settled" - and I would like to bury this all behind me SOON, so as to open another chapter in my life - so to speak.

    Thanks again.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    You said you have a PD/WPI rating.. figure out what the statute provides for PPD and the number of weeks payable...if you take a lump sum for that amount, it would be paid in 'todays dollars', not the full amount...probably about a 25/30% reducation..maybe more depending on the number of weeks...

    Then the rest of the lump sum settlement would be for ''future medical''... IC"s know that IW's do not access the amout of FMT as may be indicated in the doctors final reports...so they assume you won't be having the hardware removed... IF it were even necessary down the line..so don't expect too much compensation for that item.

    I only want what is decent (read: what the law stipulates
    There is nothing 'decent' nor 'fair' in a settlement/lump sum payment.. .you will always feel you took too little, the IC will think they paid too much.. and there is nothing you can do to make them accept your demand, nor can they force you...the option is to let the PD indemnity pay out over the set number of weeks...and leave the medical open...for a time at least and see just what you might need in future medical... the medical can be settled at any time..

    Keep in mind though...the amount of money you receive should be deposited in a setaside account, and spent ONLY on the treatment to this injury.
    When you become Medicare eligible..no matter how many years from now...CMS/Medicare will want to see proof that you have exhausted that money, including any interest on treatment...and they can/will withold you Medicare entitlement until you can do this

    The Medicare Secondary Payor act is being inforced with a LOT more teeth...beginning in July 09, there can be up to $1000/day in penalties for not taking the steps to protect Medicare interests...yup...per DAY.

  7. #7
    Join Date
    Sep 2008
    Posts
    11

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    A lot to think about. It's a real shame on the "system", because I, not unlike many people I am sure, had my life completely "rearranged" by this "game" (all due to simply performing my job).

    When I was first injured, I was not paid a dime for two months + (more like two and-a-half). I know few people who can go that long without pay - especially with a 5 year-old (at the time) child to support (via child support!). There were a number of mistakes made along the way - by the employer - by the insurance company - and by me. And as I said, I was (am?) a bit naive I suppose.

    They then sent me back to work after a year, but the "new position" didn't work-out. The corporate office (detached, and on the other side of the country) had called me back ... the new local site manager where I worked admitted that he "didn't really have a position for me" (that was within the restrictions) - and within two weeks they had me doing DOUBLE of what the doctors restrictions were. I simply could not physically do it - so I put in my two-week notice (knowing that if I were fired, then I could really be screwed) - but really only lasted another week before I left.

    It really is a shame, that these companies can play their game - with the lives of real people at stake ... including my PERFECTLY innocent (now seven year-old) child.

    Thanks again.

  8. #8
    Join Date
    Sep 2008
    Posts
    168

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    I can relate ....I have a 7 year old as well..... He has noticed all the life changing evnts that went on since my injury. I keep all related issues away from him now and try my best to be his dad.....the age is tough... Thats when they really expect to do things with dad My injuries keep me from doing most of them.....he was starting to say things like .....Oh yeah! daddy you cant because your back is broken....it killed me!

    My pay from the system has been next to nothing....And I was fired from my job.....first time in my life Ive ever been told those words.

  9. #9
    Join Date
    Sep 2008
    Posts
    11

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    Quote Quoting Devon View Post
    I can relate ....I have a 7 year old as well..... He has noticed all the life changing evnts that went on since my injury. I keep all related issues away from him now and try my best to be his dad.....the age is tough... Thats when they really expect to do things with dad My injuries keep me from doing most of them.....he was starting to say things like .....Oh yeah! daddy you cant because your back is broken....it killed me!

    My pay from the system has been next to nothing....And I was fired from my job.....first time in my life Ive ever been told those words.
    I'm very sorry to hear about your situation - I mean I really am. It angers me - America, and the greed of certain people at the top is what's really "broken" the most.

    I was raised that there was Truth and Justice and Decency in our legal system - and make no mistake - work related accidents and injuries are legal matters now, and are more about the companies (and even more so - the BIG CORPORATIONS) protecting them-SELVES than it is about "doing the RIGHT thing", and doing ANYTHING for THEIR employees - the very people who make them successful in the first place. There is no loyalty with companies any longer - and they wonder why people job-hop (??).

    The companies really started this nonsense: it is an obvious fact of life that accidents are going to happen - human-beings are imperfect, are prone to error (hell even machines break-down, and can cause trouble) - the people who start businesses and run businesses KNOW this going-in - but then they want to deny it when push comes to shove, and fight the very backbone of their organizations (usually - much more often than not - the people in society who are paid the least to begin with). They then look at "THEIR" people (real live humans) as if they are nothing more than a number - a line on a balance sheet or ledger ... all in the name of THEIR ALMIGHTY god of profit - and greed.

    It's quite frankly sickening the way they lobby congress, with their lawyers and such to tilt laws in their favor. And frankly, I strongly believe (in fact I have no doubt), that one day in the not too distant future - based-on the course that has been set - and that we are on, we ARE going to see the likes of Ted Kaczynski again (recall - the unabomber) - only this time - en masse. This WILL happen again on a larger scale - because you can only push people so far - and they will become PRIMAL (I think there was a movie; "John Q." ??).

    The ONLY question is whether it's 50 years from now or 50 WEEKS from now, but it will occur, sadly ...

    Best to you and your son.
    Last edited by 321_no_more_fun; 09-10-2008 at 07:52 PM.

  10. #10
    Join Date
    Sep 2008
    Posts
    11

    Default Re: Demand Sent-Offer Made/Rejected - Now What?

    Wanted to thank you again for your help on this - and I just HAD to point-out: your "Join" date here (10/10/06) just happens to be the date of my work injury/accident. Ironic - and what are the odds of that I wonder??

    Thanks again.

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