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  1. #1
    Join Date
    Aug 2009
    Posts
    1

    Default Over One-Time Settlement

    Hi, This is my first claim. I was diagnosed with right radial tunnel syndrom as well as right lateral epicondylitis. I was treated with medications and occupational therapy. The symptons improved slightly. Doc suggested cortisone injetion but i didnt want steroids so requested for more therapeutic sessions. I had worked 10-11 hour days every working day for the last employer for 3.5 years. I quit that job recently and now I got a notice "Permanent disabilty benefits denial form" and when I contacted the insurance adjustor, I was told that they will do a one time settle of $8500 to close the claim and any future issues will not be treated under workers comp.If I choose not to take that one-time settlement, they could keep the claim open for a finite period of time (6 - 12 months) . If I have to go in for surgery after the 6-12 month time frame, it will have to be under my own personal insurance. My question is - Should I take this ? If I do go for the one-time settlement, is this a fair amount ? How do I arrive at what is fair ?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,018

    Default Re: Over One-Time Settlement

    My question is - Should I take this ? If I do go for the one-time settlement, is this a fair amount ? How do I arrive at what is fair ?
    You are the only person who can make the decisions regarding your claim.

    That said however, whoever is telling you the claim will close in 6 months is lieing to you.
    Your ability to file to reopen the claim is there for FIVE YEARS from your orginial DOI/Date of Injury.

    You are capped at 24 visits each for PT/OT/Chiro..physical therapy, and occupational therapy. Requesting additional visits beyond the cap is wholly up to the ER/IC.

    Once your PTP/doctor has determined you have reached a stable condition, you will be declared MMI/max med improvement and your condition rated to disability/impairmenet. That does not mean treatment stops.
    An award in your claim is based on the PD/WPI rating, a predetermined number of weeks for each 1% of the rating. That rating plus an estimate of future medical would be the basis for a lump sum payment.

    IF you were to C&R/settle the claim by lump sum, the CA is right in that additional treatment would be out of your pocket. No other IC or Medicare will pick up the cost of your anticipated surgery. $8500 is no where near the potential cost of any surgery.

    As you dd not say what your status is...TTD, MMI, rated yet...can't tell you what the next steps might be.
    Contact an I&A officer at the WCAB for assistance, or a WC atty.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Over One-Time Settlement

    california awards medical care for life not 6-12 months. whether the carrier keeps their claim open or not it is the court that ultimately decides whether whether a future treatment issue is covered.
    based on this misinformation I'd be suspicious of their offer.
    a Compromise & Release is based on the value of future beneftis e.g. TTD, Medical & PD.
    without a permanent disability you can't evaluate your future PD or what they are worth in a lump sum buyout.
    You should appeal the denial.
    if you wan legal representation get a workers comp specialist
    www.caaa.org

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