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  1. #1
    Join Date
    Jun 2011
    Posts
    3

    Default Settlement of Workers Comp Cases

    My workers compensation claim was made in the State of: New York. First time poster who is NOT computer savy. Abbreviations(all) such as MMI and PPD I need to know what they mean since I'm new. I'd like to thank you all in advance for your help.

    I've had 2 attorneys. Originally I had one for my WC claim. I switched attorneys after hiring my 2nd one for SSD and he agreed to take over my WC claim (which had already been settled). I was injured in Jan 2007 so I do know I'm under the old law. Mine was a neck injury but in the end they ruled it occupational disease. I was ruled 75% disabled. I also suffer from spinal stenosis and degenerative disc disease so I do get SSD.

    Attorney #1 was all about making deals. My benefits for WC (before I filed for SSD) were for $233.34 per week. In one of my doctors reports, they released info that I was HIV positive. The NY State Insurance Fund got hold of that and wanted me to release all my medical records and I refused. They started making threats and subsequently I signed an agreement for the Special Funds Conservation Committee and an agreement was reached where my benefits were cut in half to $116.67 per week. To this day I do not understand this.

    In the meantime I had to appeal my denial of SSD and since I wasn't pleased with attorney #1, I hired attorney #2. He agreed to take my WC case because attorney #1 wasn't happy because I hired attorney #2. I won my appeal and was very pleased with attorney #2. I eventually received a settlement offer from NYS Insurance Fund which I contacted my attorney on. I briefly spoke to him and he advised against settlement. He actually sends out a generic letter. Being that I now also received Medicare I wanted to know how it would affect that. I tried to schedule an appt w/him but kept getting denied by his receptionist to speak with him even by phone. I'd have to submit a question and the receptionist would get back to me.
    I found this unacceptable and was uncomfortable about it. Since this was a so called lifetime decision I felt I was entitled (for $5,000.00) to have a sit down discussion with him so I could have an explanation and understanding of the case, especially WRT how it would affect my Medicare and future medical treatment. I spoke with my social worker from Workman's Comp (who's an absolute doll by the way) and she advised me to submit 2 offers. One that was a one time settlement with medical treatment and one without. I submitted that to the secretary and she called me back and said my attorney said no. I then proceeded to insist on an appointment(which she told me he was unavailable at the time. This was my 3rd request) I asked what was I paying $5,000 for and she said it was to represent me. I asked her, "don't you think I should have a right then to sit down and discuss it with him and I was informed this was not their procedure. I even offered to pay for an appointment and was denied by this "Matlock" wanna be. I asked her 3 times if she had a law degree since she kept advising me on what to do. She said no. Needless to say I boiled over and told her I hired an attorney and not a F'ng receptionist. My attorney quickly called and resigned from my case. I know I was wrong but I lashed out because I was so frustrated with her.

    I sent this man alot of business. I told him I felt I was entitled to an appointment since this would affect the rest of my life. He appologized because he was busy with other cases. I said in all due respect, you agreed to represent me and you stand to gain another $5,000. So, needless to say, I'm without an attorney. When I try to get another one they say my case is too far along.

    So if anyone out there has been through accepting a settlement, with continuing medical benefits, I would appreciate any advice WRT to any deceptions by the Insurance Co. Does it affect my Medicare? I understand that all medical issues WRT my neck have to go through WC, but is there anyway if I should need another surgery that they try to pawn it off on Medicare and I'm left hanging in the cold?

    Thanks everyone for your help and advice. Abe.
    Last edited by Abraham; 06-21-2011 at 09:07 AM.

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

    Default Re: Settlement Questions(Thanks)

    If you accept an offer that changes/closes the medical benefits in your comp claim, you would have to take Medicare interests to heart, and that would include a WCMSA/setaside arrangement. A estimate of future medical costs, based on what you have been provided in the past 2 years, would be calculated in a proposal sent to CMS/Medicare for review. May or may not affect any SSI or Medicade benefits, as a setaside can at times be counted as an asset.
    Your SSDI could be affected by offset depending on your specific numbers.

    AA/Applicant Attorneys do take an inordinate number of claims....the fees are limited, with no guarantee of any fee at all in some claims.
    Needless to say I boiled over and told her I hired an attorney and not a F'ng receptionist. My attorney quickly called and resigned from my case.
    Your frustration is understandable... surely you can appreciate the AA/paralegal side of things.
    Does it affect my Medicare? I understand that all medical issues WRT have to go through WC but is there anyway if I should need another surgery that they try to pawn it off on Medicare and I'm left hanging in the cold?
    Don' t know what 'WRT" is...but if you do have a cash buyout, and a WCMSA in place, you'd use that money to pay for any services Medicare would normally be responsible for, when the money is exhausted, you go to regular Medicare, and you pay the copays/deductibles out of pocket.

    There are lots of threads regarding WCMSA/Workers Compensation Medicare Setaside Arrangements on the disability forum...or at www.cms.gov.

  3. #3
    Join Date
    Jun 2011
    Posts
    3

    Default Re: Settlement Questions(Thanks)

    Thanks for the response. WRT means with regards to(at least that's how I use it) They're NYSIF are offering me a 4 year settlement and keeping my medical open. I want to finish my food concession business and go back to work. I just got info on a new program from SSD. It's called the BOND program. You can work without losing your benefits. I've got to re-read it. My understanding is that you can earn upto $12,000 and then for every $2 earned they deduct a $1 from your SSD and people don't lose their benefits. I actually think it'll be a ggod program. I don't know if it's open to anyone but I would imagine it would be. For those who may want to inquire the number is 1-877-726-6309.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Settlement Questions(Thanks)

    They're NYSIF are offering me a 4 year settlement and keeping my medical open.
    That could affect your SSDI...depends on your specific numbers...
    That settlement however is NOT relative to your BOND program...

  5. #5
    Join Date
    Jun 2011
    Posts
    3

    Default Re: Settlement Questions(Thanks)

    My workman's comp was already figured into my disability. Yeah, I understand my setttlement is not relative to the bond program. I was just stating the sttlement so I could go back to work and wanted to share about the bond program for those who are on SSD.

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