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  1. #1
    Join Date
    Apr 2011
    Posts
    1

    Default Settlement Opinion, Lumbar Fusion

    I spoke with my attorney the other day and am not really happy. I'm hoping anyone that reads this can offer me their opinion.

    In 2006 I suffered a back injury at work that stopped me from working. After a year of Physical Therapy and other treatment my doctor recommended an L5-S1 spinal fusion. The WC insurance company requested an IME which determined that I did not need a surgery and could return to work immediately, thus ending my WC benefits.

    I had the surgery in late 2007, followed by a few months of Physical Therapy. I was ultimately released from my doctors care with a "light-duty" designation for work.

    I applied for and received Social Security Disability in 2008 and still receive it now. I attempted to return to work through the SS Right-to-Work program in 2010, and was unable to work for more than 6 months.

    As of today, I am unemployed and receiving SS Disability payments.

    My attorney has given me the following details on the current settlement negotiations.

    1. Approximately $50,000 for injury to man as whole
    2. Backpay of TTD checks and unpaid medical bills from date of the IME to my doctor's release after the surgery (6 months)

    So, I'm looking at under $70,000 cash, minus attorney fees.

    Is that really low or am I unrealistic?
    Last edited by quick79; 04-20-2011 at 12:15 PM.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Settlement Opinion, Lumbar Fusion

    DO you have a final PPD rating?
    PD indemnity is based on the rating...
    You are not paid based on the type of injury or amount of treatment provided.

    As you are Medicare eligible, you should NOT be negotiating any settlement until a SWAG/Scientific Wild Ass Guess on the value of future medical care is determined. THEN, a WCMSA/medicare setaside arrangement is determined. That would depend on your current status, and the total amount of benefits you've been paid in the claim.

    So, I'm looking at under $70,000 cash, plus attorney fees.
    Uh... atty fees are not generally added to a cash settlement, but are a % deducted from the total amount you agree to. Of course the future medical money to fund the MSA cannot be reduced even to pay atty fees.

    You aren't going to see any cash offer as "realistic" in closing out this claim. There is no such thing. The benefits in WC are predetermined.
    In IL settlements are based on prior claims similar to yours, and other factors as determined by a WC judge.

    DO NOT close out this claim until you are fully familiar with and understand what a WCMSA/Workers Compensation Medicare Setaside Arrangement is, and how it applies to your situation.
    You should be asked to sign a release of information form to get your SSA and Medicare status before this moves forward.
    Your atty should be fully aware of the mandates under MSPA/Medicare Secondary Payor Act, and SCHIPP, with the new reporting requirement

    more on this is here www.ssa.gov, www.cms.gov.

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