California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Sep 2008
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    10

    Question What is 'A Reasonable Settlement'?

    I was injured in July 06, swapping trailers as a truck driver. The injury was a pinched nerve (C6-7). After several bouts with PT that were unsuccessful I had a three level fusion (C4-6) in January 08.

    I was listed as Permanent and Stationary in June. Had QME in August. I got the QME report from the Dr. today. It says I have 48% whole body impairment. Also have apportionment of 20% due to previous conditions, age, etc. So my permanent disability is about 38%.

    I know there is a chart that lists what % is worth what $.
    That sounds cold but as a result of this injury and subsequent surgery I will never drive truck again. It has been my career for more than 17 years. In order to make the kind of money I was making before the injury I will need to get a 4 year degree. I started school, through the Department of Rehabilitation at the end of August.

    I have some $25,000 in my SDI account, or so EDD told me in June. That won't last thru 4 years of schooling.

    My first question is this: Is it reasonable to want to get 3 years of pay as settlement before the medical comes into play? I have learned to be quite frugle since they pulled me off the road completely in May of last year but $25K will still work for only about a year.

    I think that the IC rep said something about $30K for 30% (or something similar) and that isn't going to help me get thru 4 years of school.

    Also, the QME Dr. said that I will likely develop "adjacent segment disease and therefore reservation for future surgery should be given." What does that mean?

    I don't want to get 'lifetime medical' because this company has already changed hands 3 times in the 2 years since I was injured. I feel it would be too easy for them to say 'that isn't our case' and deny a claim if I were required to have future surgery.

    I am sorry this is so long, but I would appreciate ANY information I can get.

    I do not have an atty at this time. The adjuster I have dealt with so far has been great, no delay with treatment, PT, MRI's, pain mgmt referrals, even when we realized that surgery was necessary there was no problem getting it authorized. I just want to know what is reasonable to expect.

    I have a friend who suggested that I ask for '4 years pay (apx $165,000 then double that number for pain, suffering, the scar that looks like I had my throat cut, depression at the loss of my career, etc.'. That seem extreme to me. I was hoping for the $150-160K so I wouldn't have to worry about rent and food while I go thru college.

    Can anyone tell me if that is reasonable or not?
    Thank you in advance for your help,
    TruckNMom

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: What is 'A Reasonable Settlement'?

    you have made many mistaken assumptions.
    an impairment rating from the doctor is not the same as a disability rating from the state's Disability Evaluation Unit. all impairment ratings have to be modified (up or down)for age, occupation, and Future Earning capacity.
    you will not be entitled to SDI benefits as your restrictions are permanent not temporary.
    workers comp does not pay for pain and suffering - only disability in the form of your rating.
    not reasonable at all.
    as far as future training you are eligible for a few thousand from the voucher system:
    http://www.dir.ca.gov/dwc/rehab.html

    if you can negotiate a lump sum C&R buyout (optional) you'll be offered a choice of your PD and few thousand for future medical or weekly payments of PD and open medical.
    you need to start reading about california comp system and deal with facts
    you can start here
    http://www.dir.ca.gov/CHSWC/Reports/...book-3rdEd.pdf

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
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    18,017

    Default Re: What is 'A Reasonable Settlement'?

    I got the QME report from the Dr. today. It says I have 48% whole body impairment. Also have apportionment of 20% due to previous conditions, age, etc. So my permanent disability is about 38%.
    How do you get 38% by subtracting 20% from 48% ? If the 48% is the final WPI, the 'apportionment' would/should have already been taken into consideration...
    So...there would be ONE of two numbers here...28% WPI, or the 48% as a final rating.

    For the 28%, the potential value is based on 6 weeks for each 1% or 168 weeks of PPD at a max of $260/wk. +/- depending.
    For a 48% it would be 7 weeks or 336 weeks, same $ max/week.

    I have some $25,000 in my SDI account, or so EDD told me in June. That won't last thru 4 years of schooling.
    Doesn't matter how much money there might be... SDI benefits are good for 12 months...max.

    My first question is this: Is it reasonable to want to get 3 years of pay as settlement before the medical comes into play? I have learned to be quite frugle since they pulled me off the road completely in May of last year but $25K will still work for only about a year.
    There is no 'reasonable' issue in WC. You aren't going to negotiate for 3 years of pay/wages for the time you intend to go to school. IF you are entitled to any VR it would be a SJDV..voucher, and the amount would be based on your rating..up to 10K to be used at a accepted facility. You won't see a 4 year degree out of a voucher.

    I don't want to get 'lifetime medical' because this company has already changed hands 3 times in the 2 years since I was injured. I feel it would be too easy for them to say 'that isn't our case' and deny a claim if I were required to have future surgery.
    There is no such thing as 'life time medical'... you would receive treatment that is determined through the UR process to that which is 'medically necessary, and reasonable' on an industrial basis. Only for the time it would take to cure and/or relieve from the effects of your injury. The ER/IC will use the UR process to control your future medical.
    I feel it would be too easy for them to say 'that isn't our case' and deny a claim if I were required to have future surgery
    Liability for any future medical you may require would remain with THIS IC ...a change by your ER would have no affect on your benefits.

    I have a friend who suggested that I ask for '4 years pay (apx $165,000 then double that number for pain, suffering, the scar that looks like I had my throat cut, depression at the loss of my career, etc.'. That seem extreme to me. I was hoping for the $150-160K so I wouldn't have to worry about rent and food while I go thru college.
    Tell your friend to read the labor codes that pertain to WC.
    There is no provision for 'lost wages', or 'pain and suffering' in WC.
    The PD indemnity is set by statue. Any future medical would be a SWAG/Scientific Wild Ass Guess at best...even at that, the number would be reduced to 'todays dollars', not likely to cover any additional treatment you may need as per the final report of your PTP/PQME.

    IF you take a C&R to your claim...ALL additional treatment will be out of your pocket. No other IC or Medicare will pay for treatment where you have already been compensated.

    Once you get a handle on your ''final'' rating, you claim is potentially valued at between 44K and 85K give or take.
    In a C&R those numbers don't really paint a clear picture... you would be asked to accept a amount of money to release the ER/IC from all future liability...a much lessor amount of money than if you were to let this pay out over time.

    an impairment rating from the doctor is not the same as a disability rating from the state's Disability Evaluation Unit.
    The PD rating your PTP calculates is based on the AMA 5th edition for disability ratings... then converted to a WPI per the PDRS the DWC has adopted.
    The PTP/PQME rating IS acceptable for negotiations..and a DEU rating is NOT always necessary. If either party disagrees with the rating, a supplemental can be requested, or an informal rating by the DEU.

  4. #4
    Join Date
    Sep 2008
    Posts
    10

    Thumbs up Re: What is 'A Reasonable Settlement'?

    BvIA:
    Thank you so much for your input. I can't tell you how much I appreciate it!! It answered the question for me. What I was hoping for IS unreasonable. It was a nice dream while it lasted
    BTW: the way that I came up with 38% was subtracting 20% OF the 48% (that would be 48% - 9.6%= 38.4%).
    I could write out how he put it in the QME but that would be WAY too long. Basically what I understood (and I am/was a truck driver NOT a doctor) was that my rateing was 48% and the apportionment would be minus 20% of that.
    If you're really bored I could PM you with the specific language and you could 'slog' thru it. But really, my question was answered so for my part that is unnecessary. And I thank you for that!

  5. #5
    Join Date
    Sep 2008
    Posts
    10

    Default Re: What is 'A Reasonable Settlement'?

    Quote Quoting .SH View Post
    you will not be entitled to SDI benefits as your restrictions are permanent not temporary.
    I AM getting disability payments from the state, as well as 'permanent disability advances' from the IC. My understanding of why is that EDD says the weekly amount should be x and IC says it should be z so EDD is paying out the difference.
    I may have mislabeled it as SDI but I have been paying into this since I started working when I was 16. Having a few years off work to have children puts the amount that I have paid in at around $25,000 (or so EDD told me in June).
    From what I gather they will continue to pay out that money as long as I am not working, until the money is gone. Of course if I get a job instead of going to school that will cease.

    Quote Quoting .SH View Post
    workers comp does not pay for pain and suffering - only disability in the form of your rating.
    not reasonable at all.
    that was the question, thank you for your input

    Quote Quoting .SH View Post
    as far as future training you are eligible for a few thousand from the voucher system:
    http://www.dir.ca.gov/dwc/rehab.html
    I am aware of the voucher system. Since my rating will not be above 49% and is already above 26% the voucher I will receive will be for $8,000.

    I already have started, that is how I got to this site. Again, I am/was a truck driver NOT a doctor or attorney. Therefore since nobody else in my world speaks in such a way as to make the listener feel they have an IQ hovering around 30, I thought it prudent to ASK, as I was taught that there were no stupid questions except those that remain unasked.
    As I said, thank you for the input, my question was answered.
    Have a good day.

  6. #6
    Join Date
    Dec 2006
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    2,165

    Default Re: What is 'A Reasonable Settlement'?

    Truck, just to clarify, are you are receiving "STATE DISABILITY INSURANCE" (SDI) as opposed to SSDI (Social Security Disability Income), or SDI (SUPPLEMENTAL DISABILITY INCOME through Social Security)?

    Also, how long have you been off work, what are your work restrictions, what are the Doctors saying about FUTURE medical treatment/surgery, etc, and do YOU feel that you are currently UNABLE to perform any "substantial gainful employment---the ability to earn approximately $930 per month), now, and in the foreseeable future, on a CONSISTENT and SUSTAINED BASIS as a reult of your medical conditions?

    I'll respond when you provide the answers!

    Charlie

  7. #7
    Join Date
    Sep 2008
    Posts
    10

    Smile Re: What is 'A Reasonable Settlement'?

    Quote Quoting Charles Stevens View Post
    Truck, just to clarify, are you are receiving "STATE DISABILITY INSURANCE" (SDI) as opposed to SSDI (Social Security Disability Income), or SDI (SUPPLEMENTAL DISABILITY INCOME through Social Security)?
    Hi Charlie,
    I will answer to the best of my ability -
    1- The check stub says for: State Disability (it comes from EDD)

    Quote Quoting Charles Stevens View Post
    Also, how long have you been off work,
    2- I have been off work since May 07...from then until June 08 I was receiving WC, when the doc said I was P&S I went from WC to PDA (Permanent Disability Advances) from WCIC and partial from EDD. Again, as I understand it, IC says I should get x/wk and EDD says I should get z/wk (which is higher) so FOR NOW EDD is paying the difference (x+EDD pmt=Z).

    Quote Quoting Charles Stevens View Post
    what are your work restrictions,
    3- Specifically it says: 'Work preclusions...repetitive neck movements, heavy work,and work at or above the shoulder level...'
    I am a truck driver by profession, 'repetitive neck movements' is most definitely part of the job description!

    Quote Quoting Charles Stevens View Post
    what are the Doctors saying about FUTURE medical treatment/surgery, etc,
    4- In the QME the doc said I am at risk to develop 'adjacent segment disease' so 'reservation for future surgery should be given'. Beyond that it says I require PT and periodic muscle relaxants and anti-inflammatory medications. There is nothing else about future surgery beyond the aforementioned


    Quote Quoting Charles Stevens View Post
    and do YOU feel that you are currently UNABLE to perform any "substantial gainful employment---the ability to earn approximately $930 per month), now, and in the foreseeable future, on a CONSISTENT and SUSTAINED BASIS as a reult of your medical conditions?
    5- It isn't as if I can't work at all, I can't do the job I have been doing for 17 years. Under 'Vocational Rehabilitation' it says "Clearly with her restricted range of motion, the patient cannot return to usual and customary work and is considered a qualified injured worker."
    So-I am going back to school because there is no entry level position I could take, without higher education, that would earn me the type of paycheck I am accustomed to. This is why I wanted 3 years pay for the settlement. The amount in my EDD account will get me through the first year but there will be a minimum of 3 more years after that.
    Could I make $930/mo?... probably, but my WC was more than twice that AFTER I got injured. Could I LIVE on $930/mo. No.

    Quote Quoting Charles Stevens View Post
    I'll respond when you provide the answers!
    Charlie
    I hope those are the answers you needed. Again, as I understand it I was given a WBI of 48% with an apportionment of 20% for preexisting, age, etc. I believe that means the WBI will be right around 38% (the 20% is OF 48%).
    I was really just looking for what is a 'Reasonable Settlement'.
    thanks for your help and interest,
    TruckNMom

  8. #8
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: What is 'A Reasonable Settlement'?

    TrucknMom, thanks for the information. The only reason I asked those questions, is because IF you are unable to work for at least one year because of your medical condition, then you should consider applying for SSDI benefits. If you have dependent children under the age of 18, and you are approved, then you kids would receive an additional 50% of your SSDI. Your SSDI benefits are roughly 80% of your highest earnings quarters prior to you being off work due to your disability.....

    Good luck, and keep us posted!

    Charlie

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: What is 'A Reasonable Settlement'?

    mom... It would be doubtful for you to qualify for SSA/SSDI benefits at this time.
    At any rate, there is a max SSA retirement benefit, now set @ $2185/mo. Whether that amounts to about 80% of your pre injury earnings or not would be another matter.
    You can find more information about SSA/SSDI benefits here...www.ssa.gov

    2- I have been off work since May 07...from then until June 08 I was receiving WC, when the doc said I was P&S I went from WC to PDA (Permanent Disability Advances) from WCIC and partial from EDD. Again, as I understand it, IC says I should get x/wk and EDD says I should get z/wk (which is higher) so FOR NOW EDD is paying the difference (x+EDD pmt=Z).
    Your SDI benefits are being offset due to your receipt of PDA's... and your PTP certifies that you cannot RTW. More information on SDI/EDD is here http://www.edd.ca.gov/disability/

    5- It isn't as if I can't work at all, I can't do the job I have been doing for 17 years. Under 'Vocational Rehabilitation' it says "Clearly with her restricted range of motion, the patient cannot return to usual and customary work and is considered a qualified injured worker."
    "QIW"/Qualified Injured Worker isn't really a term used any longer...regardless, your PTP has determined you cannot return to your preinjury job, so you would be entitled to a SJDV/voucher to use to hone your exsisting job skills, and/or obtain new ones to help you compete in the open labor market. The dollar amount of the non transferable voucher is determined by your PD/WPI rating and is set by statute.

    So-I am going back to school because there is no entry level position I could take, without higher education, that would earn me the type of paycheck I am accustomed to. This is why I wanted 3 years pay for the settlement. The amount in my EDD account will get me through the first year but there will be a minimum of 3 more years after that.
    Could I make $930/mo?... probably, but my WC was more than twice that AFTER I got injured. Could I LIVE on $930/mo. No
    The amount in your EDD account is based on the premium you have paid over time...not that you have 'deposited' 25K and you can draw from that 'til it's exhausted... the SDI benfits are good for 12 months, or 'til exhausted, which ever is sooner...not past the 12 months.

    A 'settlement' to your claim, by lump sum payment, would be based on the amount of your PD indemnity as calculated by the rating... and the potential value of any future medical.
    You don't get 'wage replacement' in a settlement as in your thoughts of 3 years to complete a retraining program.
    A lump sum is basically a payment to you to 'walk away' and release the ER/IC from all liability to your claim. The numbers used to form the offer to C&R are simple guides as a starting off point...
    Again, as I understand it I was given a WBI of 48% with an apportionment of 20% for preexisting, age, etc. I believe that means the WBI will be right around 38% (the 20% is OF 48%).
    I was really just looking for what is a 'Reasonable Settlement'.
    Where you have a 20% apportionment to your WPI rating of 48% means your Final WPI will be 28%...(possibly the '3' there is a typo?)..48-20 =28%

    "Reasonable'' settlement.... the value of your PD indemnity would be claculated, and reduced to ''todays dollars'', the value of the future medical would be a SWAG/Scientific Wild Ass Guess... and reduced to ''todays dollars''...while a commutation to todays dollars is provided at 3% per annum, you could see as much as a 40/50% reduction in the full value of your potential 'award'.

  10. #10
    Join Date
    Sep 2008
    Posts
    10

    Lightbulb Re: What is 'A Reasonable Settlement'?

    Ok, thanks guys for the 411. I will keep you posted...
    One more thing...I am going to try again to explain my 38% figure (it wasn't a typo).

    The QME said that apportionment should be 80% due to injury and 20%...we'll call them 'other factors', instead of say 50%/50%. Now...the 20% would be 20% of 48%. Because if it was 20% OFF of 48% that would be 28%. However if he had said it should be 50%/50% then the settlement would have been nothing because 48% - 50% would be me OWING them. Therefore, when he says 80% due to injury and 20%...it would be 20% of 48% which would be 48% - 9.6% = 38.4%
    I hope that makes sense.
    The IC-A said, when I talked to her earlier, she may have some #'s for me late next week. I will let you all know how that goes. Maybe this is closer to being 'Done' that I had hoped? We'll see.
    Thanks again for the clarification
    TM

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