Oklahoma Worker's Compensation - Help For Injured Oklahoma Workers

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  1. #1
    Join Date
    Aug 2011
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    5

    Default Closing Out Medical Offers

    How do you know if they are making a reasonable offer to close out medical? I understand their incentive to do so, but I understand how they calculate the risk.

    My worker's comp claim has involved 2 shoulder surgeries with the second being reconstruction, >$100k in total medical bills, will be over 6 months off work, I'm know I'll be rated with some kind of PPD. That's an easy given. I'll hopefully be released to light duty next month and but with have therapy for several more months. I'm over the hill, but this thing will probably drag out until the end of summer. Other than the PPD rating that is a flat calculation, I know there will be some discussion of them closing medical so they can get away from all of this. With what I've been through and the level I'll be at when I'm done, I believe there is a decent risk for them in the future from their point of view to possibly pay out more and they may/should be somewhat motivated to close out and run away from me. Is there any typical rules of thumb or guide or basis of how much a reasonable close out settlement should be? Any examples?

    So far I've been extremely lucky in that the WC carrier/adjuster has done nothing to steer me to any doctors or deny coverage. I've seen every primary doctor and surgeon of my choice. They've been slow to approve many things, sometimes being extremely slow and have caused additional pain and suffering in my opinion from their delays, but they've always paid and never really questioned treatment (not that anything was in question as my incident & injuries were very clear). Everything I've needed, they've paid.... eventually.

  2. #2
    Join Date
    Feb 2007
    Location
    Charlotte, NC
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    3,030

    Default Re: Closing Out Medical Offers

    You have to do your homework. Figure out what medical treatment you may need and then figure out what it costs today if you have no insurance. People with no insurance get charged full retail prices by medical providers, rather than the discounted rates insurance companies and Medicare get. Go into the settlement negotiation knowing what your worst case future medical expense scenario will possibly cost. Then negotiate downward from that point.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  3. #3
    Join Date
    Aug 2011
    Posts
    5

    Default Re: Closing Out Medical Offers

    And typically settle for 75%, 50%, 25%, whatever you can get (obviously)??? If they offer up front about 50% of what I could feel I may have to pay out in the future, is that a fair gamble for everyone or would they tend to gamble more and offer less or pay more to get away? That makes perfect sense to me but is there any rule of thumb about what percentage range is typical or is it just all over the place?

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
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    18,017

    Default Re: Closing Out Medical Offers

    There is no rule of thumb. The goal is closure of a claim. You will not be paid money for future medical you may or may not seek post settlement. There is also the bet you won't live long enough to seek the amount of anticipated care.

    In a C&R, that is exactly what it means...you "compromise" on the outstanding issues....you take less than the medical is worth, the carrier doesn't pay what they think it's worth... and you "release" the ER/IC from all future liability.

    Money for future medical is not an entitlement in any settlement of a claim... it's completely negotiated. You could also see them wait a couple years post MMI/rating and see just what medical you will seek.

    Don't count on "big bucks" in a cash buyout of your medical coverage. And do not count on the money to cover even one surgery, one, you'll be paid in "todays dollars", and two, rising costs of care, inflation etc will far surpass the amount you receive.

  5. #5
    Join Date
    Aug 2011
    Posts
    5

    Default Re: Closing Out Medical Offers

    Thanks for the replies. I'm definately not counting on "big bucks". I just don't want to be the person that finds out later I was lowballed and accepted an insulting offer from my lack of knowledge. Of course, that will probably still be the case.

  6. #6
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    3,030

    Default Re: Closing Out Medical Offers

    Unless you are represented by a competent workers' comp lawyer, you will almost certainly be lowballed.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  7. #7
    Join Date
    Aug 2011
    Posts
    5

    Default Re: Closing Out Medical Offers

    I would really like to hire an attorney for this portion of my accident. My problem here is my on the job injury was part of an auto collision. I've spoken to 2 attorneys on the phone and attempted to make it clear I was interested in hiring an attorney or the workers comp portion only and did not want them involved in the 3rd party liability claim. It seems that is all they are interested in though and the workers comp portion is just "extra" to them. My claim is large enough to easily exceed liability limits so I fully expect to simply receive full policy limits and a small UM policy claim too. There is no lottery ticket to cash in. There are no huge limits for them to go after and negotiate on my behalf. My medical bills alone will surpass liability limits. But since it's pretty much guaranteed to get policy limits without effort, I see them as just trying to get in on an easy 1/3 of what I'll be offered (liability + UM) with no assistance. I do understand if I allowed them in on the liability side, I could also get them to negotiate down the workers comp lien placed on my settlement, but I don't feel it would be enough to offset the portion they are going to take. In my state I know WC can only place a lien on the 3rd party settlement and can't touch my UM. I just plan on letting them place their lien and pocketing the UM.

    How does an attorney get paid for just a workers comp claim? Aren't there statues or something that limits or says what they get so it's kind of like a fee? I thought I read something about that somewhere. How do they base their pay?

    Is it reasonable for me to ask for an attorney to only represent me for the workers comp portion and not be involved in the liability portion? If it appears I'm only doing so to cut them out of a good chunk of money, sorry, but that's exactly what I'm trying to do. I honestly feel there will be no negotiation on the settlement portion only a possible negotiation on the WC lien. And I'd gladly give up that portion of the negotiation to keep my other 1/3. But I have yet to find an attorney willing to do anything other than all or nothing.
    Last edited by FullAuto; 03-20-2012 at 01:07 PM.

  8. #8
    Join Date
    Feb 2007
    Location
    Charlotte, NC
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    3,030

    Default Re: Closing Out Medical Offers

    What makes you think that "it's pretty much guaranteed to get policy limits without effort?"

    So far as the lien is concerned, doesn't the work comp carrier have to pay its portion of your lawyer's fees for collecting that third party money for the comp carrier? That's the way it works in most states.

    If you want the best outcomes, hire the best lawyer(s) you can now before you screw everything up so badly trying to do it yourself that a lawyer can't clean it up for you later. Contingent fees are not set in stone. Try to negotiate a legal fee you can live with.

    In Oklahoma, your Republican legislature screwed up your work comp laws recently. I don't know how hard it is to find a work comp lawyer there now. I suspect a work comp lawyer will be willing to represent you on the comp case. But if you are calling "personal injury" lawyers who do car wreck cases and only do comp cases on the side, then you are calling the wrong lawyers to handle the comp case. You need to call a workers' comp lawyer to help you with the comp case.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  9. #9
    Join Date
    Aug 2011
    Posts
    5

    Default Re: Closing Out Medical Offers

    Quote Quoting complwyr View Post
    What makes you think that "it's pretty much guaranteed to get policy limits without effort?"
    With simply using my medical bills that the 3rd party insurance carrier has already received, I've surpassed their policy limits. My treatment is still ongoing. By the time I'm finished with this, the medical bill alone will likely pass both the 3rd party liability & UM policy limits. Now, I'm not actually being billed this medical stuff as it's all a WC claim, but that's of no concern to them. Any claim value as it relates to missed work (which as of today is approaching 7 months), misc. associated costs like mileage, and pain & suffering for all I've been through is still well above and beyond anything available. But I can assure you if I provide them $125k in medical bills, over half a year off work, my pain and suffering and get offered $60k of their $100k liabiliy limits to settle, I won't.
    Quote Quoting complwyr View Post
    So far as the lien is concerned, doesn't the work comp carrier have to pay its portion of your lawyer's fees for collecting that third party money for the comp carrier? That's the way it works in most states.
    I'm not really sure how that works. If I don't have a personal injury lawyer, then the 3rd party money isn't being "collected". If I would sign their forms, they'd mail me a check today. I just can't mess with the 3rd party right now because I can't waive any subrogation rights for my UM carrier. The UM carrier won't value the claim and settle until it's all over with. As far as I know, the WC carrier would simply send me a bill when it's all over.

    If you want the best outcomes, hire the best lawyer(s) you can now before you screw everything up so badly trying to do it yourself that a lawyer can't clean it up for you later. Contingent fees are not set in stone. Try to negotiate a legal fee you can live with.

    In Oklahoma, your Republican legislature screwed up your work comp laws recently. I don't know how hard it is to find a work comp lawyer there now. I suspect a work comp lawyer will be willing to represent you on the comp case. But if you are calling "personal injury" lawyers who do car wreck cases and only do comp cases on the side, then you are calling the wrong lawyers to handle the comp case. You need to call a workers' comp lawyer to help you with the comp case. [/QUOTE]Then the search shall continue. I'll push a little harder to find a WC lawyer.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Closing Out Medical Offers

    I'm not really sure how that works
    You are admittedly over your head here... using a message board to navigate a legal system...you are potentially going to leave valuable bucks on the table...attys are entited to a fee based on the work performed, just like you were when working.
    Just like a gardner mowing your lawn....
    Trying to save a few bucks in atty fees while leaving yourself open to reduced recovery...well...you currently have a fool for an ''attorney''.

    If you don't have a PI atty, and WC atty, the ER/IC will be entitled to full recovery of benefits they have paid out. You will be required to cooperate in that recovery.....with NO compensation from the PI case. Did you know that? You must bring the PI case to fruition...

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