Settlement Amount for Herniated Disc

**xroadsgrad** · 05-07-2009, 04:46 PM

i just had surgery on my l4-l5 which had a huge herniation/protrusion; I was offered 78k to c&r before the surgery which we refused; it has been 11 months since doi;

although i am pretty sure i'm going for lifetime medical or stip as they call it, I am sure they will make another c&r offer before this is over;

do you think the offer will be more than pre surgery or do they offer less now?

thanks again guys!

be nice bvia!

**.SH** · 05-07-2009, 08:14 PM

without knowing what the original offer was based on and what your future medical needs are it's difficult to guess.
if all things being equal they would offer less since they already paid for the surgery.

**BvIA** · 05-08-2009, 04:29 AM

SH hit it... you already had the surgery... there would be no reason to up the offer... Unless, your PTP determined/s you may need additional treatment/surgery as a part of your FMC/future medical care.

But if that happens... don't expect to get enough money to pay for another operation...they don't pay for ''maybe's'', and there is no guarantee you would have a second surgery.

I was offered 78k to c&r before the surgery which we refused; it has been 11 months since doi;

You get an offer prior/during treatment, particularly prior to a surgery because IF you accept it, the IC is relieved of the liability of the cost... usually pretty expensive.
There was no PD rating to base PD indemnity on... so it would stand to reason the 78K was primarily for FMC. And we KNOW that money would not cover addtional treatment you may need.

C&R money is actually ''new money''... it may appear, and could be at times, to be based on PD indemnity, and a SWAG to future medical... but it's actually just money offered for your consideration to 'go away' and drop the claim.

People get all worked up about how C&R money will compensate them for the injury, and pay for additional medical... it's not really intended to be either. As we see in the offer you received prior to an expensive treatment.

Can't be nicer than that... sorry.

**xroadsgrad** · 05-08-2009, 06:02 AM

thanks bvia! My attorney told me that he turned down the first c&r due to the offer being to low, and that they will offer more; I sure hope I just understood him wrong, because what you and .sh said is making sense to me, and now that i've spent over $100,000 of their money on surgery i don't see how they'd offer me anything higher.. i am confused! guess I always have been

thanks guys! ( and gals! )

they should at least offer me a stip with future medical for the same amount right? ( like monthly payments or whatever plus medical?)

**BvIA** · 05-08-2009, 08:08 AM

i am confused! guess I always have been
....they should at least offer me a stip with future medical for the same amount right? ( like monthly payments or whatever plus medical?)

It would appear so... confusion at times can be difficult to rid yourself of.

It usually helps to take in the information you receive from your attorney, and a message board if it helps.

Your PD indemnity will be based on the PD/WPI rating when you have reached MMI. With out the rating there is no way to determine IF there is any PD due.

If there is a stipulated award... it will not contain a specified dollar amount for future medical treatment... that is still subject to ACOEM/MTUS treatment guides..and the UR process. (haven't we been over this...?)
The % of PD will be ''stipulated'', or agree to between the parties... and ''presto'' you have a settlement.

IF you can the IC cannot come to an agreement by stipulations, or C&R...your claim will go to trial. Then a judge will issue a Finding & Award/Order basically a 'forced stipulation'.. same terms...PD paid out over time... medical open.
You can C&R later if the parties agree.

So, those are your choices... no 'big' money here... hopefully this helps clear some of your confusion...(?)

and now that i've spent over $100,000 of their money on surgery i don't see how they'd offer me anything higher..

Not sure how 'you' spent the money... but ?

With the new CMS rules regarding reporting of claims under the MSPA/Medicare Secondary Payor Act, this claim will be reported to CMS...and any money you receive for 'future medical' probably will need to be deposited in an interest bearing account and not used for anything but this injury.
You should go to www.cms.gov and read up on the new rules on this. If you receive a lump sum payment... you are not likely to see all of that money in your own bank account....

**.SH** · 05-08-2009, 08:23 AM

the default finalization (if lumpsum cannot be agreed upon) is bi-monthly payments of the PD awarded with future medical continuing with the carrier.

**xroadsgrad** · 05-08-2009, 08:43 AM

Not sure how 'you' spent the money... but ?

by that I meant the first surgery I already had was over $120k.. so that money is spent right?

sorry , but "big" money to me is $50k, so when my lawyer turned down the $78k i was flabbergasted.. for most people in this area of california, $30k is more than most people make in a year..

"big" money to you guys must be in the milliions.. but i already took a 2nd on my house to pay bills for the last year and I have no more 2nds to take.. so I'm starting to freak out... It must be easy for others like you guys who have enough money to survive and support your spouse and 3 kids and being able to work or do whatever in the meantime..

thanks!