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  1. #1
    Join Date
    Apr 2011
    Posts
    1

    Default After Settlement Can You Reopen a Workers Comp Case for More Treatment

    hello all
    i have been on a long , lonely road...."short version"...
    slip and fall at work, jan 09..meniscus repair....may 09 patella femoral dis.patella release surgery {wayyyy painfull by the way)...feb 2010..Acl reconstruction.....my main issue now is that my quad muscle and surounding muscles never recovered from the the 3 surgeries fully...my fce came back that my left leg is 67% disabled...my attys doc put a 82%rating on it...and the good doc from the ins. co. put a whopping 15%( that shows how corrupt they are....)anyway 6 weeks before the ins co. doc was to evaluate me i couldnt take the pain anymore...i went to my surgen and he took xrays and with my history he sugested another mri.
    but here is the kicker....no matter what the mri says...and i would bet the farm that i have another meniscus tear.....i am not a candidate for another surgery , because my muscles would not be able to endure anther surgery..
    so anyway, my atty went to wc court last week...they settled on 38% rating...about $25000....now heres my ? , i know i will need some future surgeries ....by me taking the settlement, does this mean future issues will not be addressed?????
    fyi...i did not settle yet because my atty needs to go back in a month and fight for $10000 more for back pay etc.

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

    Default Re: So Wait, After WC Settlement.i Can Not Open the Case for More Treatment

    my atty went to wc court last week...they settled on 38% rating...about $25000....now heres my ? , i know i will need some future surgeries ....by me taking the settlement, does this mean future issues will not be addressed?????
    Depends on the nature of your settlement.

    The medical benefits would be
    The entitlement to these services may continue indefinitely or for whatever period is required by the nature of the accidental injury, compensable hernia or occupational disease if there is evidence to establish that the need for these services is reasonable, necessary and causally related to the accidental injury or occupational disease.
    However... IF you are setteling the claim by C&R/Compromise and Release, you are closing the medical too.
    You are also agreeing to accept full liability for any further treatment to your injury. You cannot use your own health coverage to pay for a work injury. You cannot go back later and reopen the claim.
    ...i did not settle yet because my atty needs to go back in a month and fight for $10000 more for back pay etc.
    If successful in getting retro TTD, you would be paid that in lump sum.
    If you then take the indemnity in weekly benefits, that would leave the medical open for you based on necessity.
    my fce came back that my left leg is 67% disabled...my attys doc put a 82%rating on it...and the good doc from the ins. co. put a whopping 15%
    That's not unusual. And, the FCE is not a "disability" rating for calculating indemnity purposes.
    Permanent Partial Disability BenefitsInjuries that are not so serious as to leave a worker permanently, totally disabled may nonetheless result in some permanent impairment. This is called permanent partial disability.

    Benefit payments for permanent partial disability continue for a period of weeks established by the statute; a period that varies according to the body part injured and the severity of the injury. For example, the total loss of a thumb or the use of the thumb results in payments for 100 weeks. The total loss or loss of use of the 4th finger (also called the little finger) results in payments for 25 weeks. When the period allowed by a Workers' Compensation Commission finding and prescribed by the law has run, the compensation payments cease.
    http://www.wcc.state.md.us/Gen_Info/WCC_Benefits.html
    You'll have to find out the max weeks of indemnity due for scheduled loss of knee. If you take that, times your rating/38% X your weekly rate, you'd have a pretty close estimate of the indemnity due.

    You may also be eligible for VR benefits if you cannot return to your pre injury job.

  3. #3
    Join Date
    Jun 2011
    Posts
    15

    Default Re: After Settlement Can You Reopen a Workers Comp Case for More Treatment

    Quote Quoting mollyreese View Post
    hello all
    i have been on a long , lonely road...."short version"...
    slip and fall at work, jan 09..meniscus repair....may 09 patella femoral dis.patella release surgery {wayyyy painfull by the way)...feb 2010..Acl reconstruction.....my main issue now is that my quad muscle and surounding muscles never recovered from the the 3 surgeries fully...my fce came back that my left leg is 67% disabled...my attys doc put a 82%rating on it...and the good doc from the ins. co. put a whopping 15%( that shows how corrupt they are....)anyway 6 weeks before the ins co. doc was to evaluate me i couldnt take the pain anymore...i went to my surgen and he took xrays and with my history he sugested another mri.
    but here is the kicker....no matter what the mri says...and i would bet the farm that i have another meniscus tear.....i am not a candidate for another surgery , because my muscles would not be able to endure anther surgery..
    so anyway, my atty went to wc court last week...they settled on 38% rating...about $25000....now heres my ? , i know i will need some future surgeries ....by me taking the settlement, does this mean future issues will not be addressed?????
    fyi...i did not settle yet because my atty needs to go back in a month and fight for $10000 more for back pay etc.
    i know this thread is old, but in the state of new jersey you have 2 years from the date of your settlement to reopen your case and you can get additional medical treatment and then back to court to get a new disability rating and settle again.

  4. #4
    Join Date
    Mar 2007
    Location
    Georgia
    Posts
    1,928

    Default Re: After Settlement Can You Reopen a Workers Comp Case for More Treatment

    Quote Quoting bigjoey View Post
    i know this thread is old, but in the state of new jersey you have 2 years from the date of your settlement to reopen your case and you can get additional medical treatment and then back to court to get a new disability rating and settle again.
    Well hopefully the OP/mollyreese will return and get this information. Feel lucky in NJ as in most all states once a claim is settled that is the end of it. I am in Georgia and I settled indemnity only as the IC did NOT want to cough up the 3/4 million $ WCMSA necessary to close out my medical. Have a good day Bigjoey.
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln


    Take Care and Be Well.

  5. #5
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    668

    Default Re: After Settlement Can You Reopen a Workers Comp Case for More Treatment

    Hi Mollyreese,

    Yes, WC in NJ can be a long lonely road, I believe I can answer your question with regards to future medical care after MMI/you settle your claim. How this will work out is you have 2 yrs from the receipt of your last WC benefit, for your lawyer to file a motion, with the court, requesting additional "corrective" medical care, which a "meniscus tear" may require. I am no Dr but I think your muscles "at this time" may not be able to endure a surgery, but modern medical advances in this kind of injury may afford you some "type" of corrective care maybe when your muscles have healed more, or there maybe a new surgery which you are a candidate for. I dont know where this info came from that your muscles will not handle a surgery, but it sounds like something a WC Dr would tell a patient?

    Ok so you settle your case for all that your lawyer claims you are owed. This kind of settlement will pay you a set amount per week for a pre determined amount of time. There is a work sheet where you can see this for injuries in 2009 @ http://lwd.dol.state.nj.us/labor/for...9_schedule.pdf

    just look under the rating you settled on, under leg.

    Like I wrote you have 2 yrs to reopen your case from the time you received your last WC benefit, and I believe your clock begins to tick when you have received your last weekly payment for the 38% impairment for your knee. When you file to reopen your claim the carrier will direct you to a Dr for exam and this Dr makes the determination if you have an injury that requires "corrective medical" care. Palliative care is not a benefit afforded in NJWC.

    When you settle your case you will need to be present in court as the JUDGE must be sure that you understand your award. This would be a good time to ask if you have not discussed with your lawyer to your satisfaction?

    Good luck with the back pay issue. It appears that you were under corrective medical care but did not receive your TTD?? That should not be a difficult one, but in NJ anything is possible?????

    I hope this helps, and if you need more info please ask as that's what we are here for.

    BUG

  6. #6
    Join Date
    Oct 2011
    Location
    north dakota
    Posts
    43

    Default Re: After Settlement Can You Reopen a Workers Comp Case for More Treatment

    I apologize to any one this offends .But this post is the same injury that i have and is actually dated in 2011 .
    I am trying to find anyone that can share there journey with surgery and recovery and how they fought workers comp .
    Mollyreese if you still use this site please le me know? or any one with knee injury , I HAVE TO have surgery but still waiting for approval.. Have many issues i wish to discuss
    Thank you

  7. #7
    Join Date
    Oct 2011
    Posts
    30

    Default Re: After Settlement Can You Reopen a Workers Comp Case for More Treatment

    hopenprayer...check your in box. We are both SOMEWHAT in the same boat.

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