Settlement with Sedgwick

[mtack88]

I injured my back in early 2005. I ruptured my L5/S1, L4/L5, and T1/C7 disks. I was off work for a couple of months then returned to work. I go to the doctor every month. I was sent for an IME several years ago and the doctor refused to give me a rating, saying he felt that they had not done enough to see if I had reached MMI. The only thing they ever did was send me to physical therapy. Until 2 months ago I had to pay for my own medication, even during a 3 year period with no insurance. Now they keep trying to settle with me and I`m not sure what to do. They will not change my diagnosis either, it is still listed as sprain and strain. What happens if I keep telling then no? I don`t know much about workers comp other than it is completely worthless. Any advice about my best course of action? Sorry for the the long post I just wanted to try to give all of the details. Thanks.

[.SH]

you should be discussing your options with an atty that specializes in workers compensation law.

[mtack88]

I might call around but I just wanted to know what happens if I turn down the settlement offer [which I have twice]. I have done a lot of searching on the internet and it seems like most people that did this have been cut off completely. Most of the attorneys around here would just want to settle so they could get a cut and that would be the end of it. The amount of the settlement I`ve been offered would not break even with my out of pocket expenses from paying my own prescription charges for 3 years. It seems I am in a no win situation with these people. I do not care about the money but I do not want to end up with nothing either. I still am shocked that they did NOTHING for years and now they have tried to get me to settle twice in a 2 month period. Sorry for the long post again I just needed to rant a little.

[BvIA]

Sedgwick is a TPA/Third Party Administrator that handles claims for employers, or in your case for the WV Ins Commissioner. It's not Sedgwick's money that is paying your claim benefits.

A C&R to a claim is money offered for your consideration to walk away w/o holding the ER for additonal benefits, or them addmitting liability. Even though this has gone on for a period of time, and they have paid for treatment or other benefits.

They have 'done nothing' because you haven't taken the opportunity to dispute the denials by taking them to the comp court. If you had an atty, or researched the process, that would have been a possibility to get a judge to order the reimbursement of your out of pocket costs, and provision of benefits as required by law. The dispute resolution request and process are here http://www.wvinsurance.gov/wc/pdf/no...on-process.pdf. If you feel your out of pocket costs should be reimbursed, you should ask for this hearing.
Info on claims process is here http://www.wvinsurance.gov/wc/index.htm

what happens if I turn down the settlement offer [which I have twice]. I have done a lot of searching on the internet and it seems like most people that did this have been cut off completely.

Benefits don't stop just because a settlement offer is declined. WC benefits only go for so long. There are also statutory caps on some benefits...eg the 104 weeks disability.

Your treating physican is the single most important participant in your injury claim... that is the one to provide all the reports and medical documentation as required to get you the benefits you are entitled to.

Most of the attorneys around here would just want to settle so they could get a cut and that would be the end of it.

That's because that's what attorneys do. The system is geared to informal settlements and closure to the parties. Usually your atty can't get you more treatment, or a higher rating, or more money that what the injury/rating or future medical may be worth.

Talk to a few attys, see about getting your out of pocket costs reimbursed. And get a realistic estimate of your future medical needs and potential value.

Have you received an impairment rating... there is info here http://www.wvinsurance.gov/rules/wc-...wc-rule-20.pdf on the medical management, and ratings /ranges of PD awards.

[mtack88]

I should have clarified, in WV if you refuse a settlement they don`t just cut you off. They send you for a new evaluation which always finds in favor of them, usually with a 0% rating. As far as the back pay for my out of pocket, I paid a lawyer $2300 only to be told it was a computer glitch. We [my wife and I, plus my doctors office] called every month when they refused to pay for my prescriptions. Still nothing until 2 months ago when they paid out of the blue. I called several attorneys this morning and when they hear I don`t want to settle that pretty much ends it. What I`m worried about the most is my doctor says I`ll need surgery but they won`t pay because I`m too young. So if my claim is closed what do I do when that day comes? One other thing, in my first post you will see that the independant medical examiner refused to give me a rating due to the lack of anything other than physical therapy.

Here is a link to show what sedgwick is doing http://www.wvgazette.com/News/200905160210

[nixonnic]

Get a attorney if you can find one that is the best way to go but they are hard to find there is none in are area the one i had stopped handling the cases because of getting screwed by them just like they do the injured worker but i have been on comp from wv since 2000 and they have never closed my claim yet but of course i am being activly treated still the only they will close the claim if you are no longer being treated but you may always file a reopening

[woman2real]

Get an attorney as soon as possible

[.SH]

don't try to resurrect zombie posts- let them die.
they have not been waiting around here 4 years for your insightful advice.