California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Apr 2012
    Posts
    2

    Default Settlement for a Knee Injury

    Fell at work 8/27/09. WC covered all costs. Knee Arthroscopy didn't help. Had total knee replacement 11/2010. Now WC wants to settle. QME doc said 40% apportionment 20% PD. Calif WC judge said apportionment not legal and 26% PD. WC deducted apportionment and rates 10% and already paid that amount. Ididn't sign or agree to anything.

    Employer offered $5,000 more than judge said 26% was worth. When it goes to judge for final approval can he approve a payout that is more than the standard formula he used?

    Can WC ignore what judge said about apportionment?

    Do I need a lawyer?

    Since settlement amount is not even close to cost of knee surgery is it better to keep the claim open and not take a payout?


    Thanks!

  2. #2
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    2,959

    Default Re: Settlement Questions for Knee Injury

    Do you need a lawyer? You do not know the answer to some basic questions about this, so yes, you clearly need some legal advice.
    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
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Settlement Questions for Knee Injury

    They are offering you the 5K for future medical in a C&R... that closes the claim completely.
    You are agreeing to assume all costs for medical after the settlement.
    If your Dr says a TKR/Total Knee Replacement is necessary in the future, you will be paying out of pocket, you should think carefully before accepting a cash settlement.
    Yes... judge can approve the settlement.

    Talk to an attorney before you do anything ... www. caaa.org for names in your zip code.

  4. #4
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Settlement Questions for Knee Injury

    was there a formal award issued by the judge?
    how do you know what the judge finally decided.?
    opinions are not decisions;especially those given verbally.
    decisions must be in writing.
    has the period for appealing the award expired?
    the insurance carrier is required by law to pay the uncontested portion of the permanent disability benefits without waiting for the worker obtain a court issued award.

    yes the judge can approve more then the case is worth; they can only disapprove if the compromise and release is "inadequate".

    a formal award from the court can't be ignored without filling a formal appeal.
    a informal verbal opinion from a judge given in an informal conference or in other settings is not binding or appeallable.
    Last edited by .SH; 04-02-2012 at 06:43 PM.

  5. #5
    Join Date
    Apr 2012
    Posts
    2

    Default Re: Settlement Questions for Knee Injury

    WC ins co. requested a QME and after I got the results of it, I got a Summary Rating Determination, in the mail, from Dept of Industrial Relations, Division of Workers Comp, Disability Evaluation Unit (State of CA). It said a WC judge determined that "apportionment is not consistent with the law", that PD rating is 26% equal to 106.75 weeks of disability payments. The weekly rate is $230 and should start within 14 days of the last temp disability "indemnity". It also said "the correctness and applicability of the rating can only be determined by a WC Admin law judge."

    Then WC determined the PD was 10%, 33wks at $230 and started sending me checks again (a surprise to me) till that was paid. I asked them why the QME rating was 20% and they changed it to 10%. They said they deducted the 40% apportionment that the QME doctor had in his findings.

    Now WC is saying the final benefits have been paid, 10% PD with the need for future medical care for the knee. Then another letter came offering a C&R payout or a Stipulations with Request for Award.

    I know nothing about this process and was happy to find this web site. I don't understand any of this and will look for a WC certified lawyer. Thank you so much for your interest! I hope I remembered all your questions!

  6. #6
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: Settlement Questions for Knee Injury

    correct.
    in order to resolve disputes and receive additional disability benefits you need to get a decision from a judge after a hearing on the issues not an opinion from the DWC.
    legal and court orders trump administrative opinions.

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