I am writing on behalf of my husband.
He was injured in September 2010, driving a limo at work. He had injury to his neck and lower back.
We did not have a lawyer and missed a lot of things from the beginning, which is choosing a proper QME doctor, and a PTP. So, now, by the end of this case, we have "bad" reports from both of them. QME calls his injury a "lumbar disk DECEASE", PTP did not even think to have MRI of the neck at all, only lower back.
Now, QME gave 12% WPI and released to work full duty with no significant restrictions. BUT, he also commented on the apportionment, which he believes, that my husband had 25% preexisting condition, which the last car accident he had back in 1987 and never had PD before. And the other 25% QME said was because of the latest "hit and run" rear end car accident we had in April 2011.
So, the claim adjuster of worker's comp said in one of her letters, that she has requested the DEU rating for the QME report. Which we were waiting, and waiting, and then asking her to send us a copy of that rating, but she simply ignored request, as by e-mail, and also by phone and by mail.
So we found out through the I&A officer that QME report was never rated and the case was not even in the system. So we requested the DEU rating and it came to 17% PD.
She disagreed with it and asked the rater to comment on the apportionment, which he said was a legal issue and can be resolved only in court by the judge, who is going to decide, if it is inconsistent with the law.
Now, WC claim adjuster made an offer of 15000 (minus PD already paid for 7% apportionment). We did not take it. Since then, we had hard time communicating with her, she was out of town for a months and then would not talk to us at all. We were directed to legal assistant on their behalf. He tried to bargain, said that in his 20 years work experience there, he has seen judge over rule apportionment in VERY FEW cases, so we had no chance in court, he said. Therefore, he offered us 10% PD, and 18000 settlement "out the door".
So the QUESTION regarding WC case.
Labor Code 4658 Section (c), do I understand it correct, that settlement should be calculated this way:
17%PD*5(weeks)*585(2/3 of ave weekly earnings) = 49725.
Am I correct or not in this calculation? Please help me understand.
There is a third party involved in my husband's case. The woman was at fault, but was not cited. We were expecting to get a significant amount for pain and suffering from her insurance. Her insurance Claim adjuster took his time to decide how much money they are going to release on her policy. And came out with a very disapointing decision. They released 15000 for pain and suffering .....BUT WC had a lien for medical bills, TTD, PD, which exceeded 20000. So the third party claim adjuster suggested we divide 15000 with WC. Which of course, WC said, they will keep the whole 15000 for their lien. So now, we are basically at 0 for pain and suffering.
We went recently to an atty. He said that this particular insurance company is know for giving a hard time in releasing insurance money. So he said there is a slight possibility they lied about actual maximum coverage for bodily injury on the insurance. They claim adjuster said he will send a declaration page to us to see the conditions of the policy. But since then he had hard time doing it, due to the system problem, he said. So tomorrow we are going to receive declaration page by fax hopefully.
So a question.
How else can we check the TRUE maximum bodily injury coverage on that lady policy?
Thanks a lot for all the answer in advance, I appreciate your time to help me out.