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  1. #1
    anonymous Guest


    I've been offered two ways of settling my case 1) receive a check every two weeks and medical for the next forty years or 2)receive a lump sum for salery and medical. I'm seeking a lump sum but I have been told that if I don't take their offer (which will be a low figure) then by law they don't have to pay me a lump sum and can just sent a check every two weeks for the rest of my life. Then why offer me a lump sum settlement when they don't have too stick by their offer.
    I'm 100% disabled and have been rated twice by a AME doctor. I want to take control of MY LIFE again and get the proper treatment in a timely matter and not 6 months to a year from now. That's why I'm 100% disabled because of workers comp carelessness and lack of concern for speedy treatment.
    If anyone knows the laws or can direct me to the information on what I'm entitle to when I settle this case.
    Peace Be With You

  2. #2
    anonymous Guest


    California doesn't allow medical to be limited to a certain number of years; lifetime or not at all.
    Both sides and judge must agree on an amount in order to get your benefits in a lump sum.
    Either side can ask court to enforce an agreement; you can ask for penalties.

  3. #3
    san Guest


    But remember, if you do not use your "life time" medical over a period of time, the insurance co will more than likely deny your treatment. You must use your medical for follow up or whatever within a certain period of time. Its best to use it within a year of settlement to keep it open. Otherwise the insurance company can say that other circumstances led to your need for medical care and slide out of the obligation.

  4. #4
    gettum Guest


    Dear Anon. There are 2 ways to settle your case - one is called a Stipulation (that's the settlement where you leave your future medical care open and receive your permanent disability benefits in bi-weekly checks. The other is a 'Compromise & Release' (the lump sum settlement) in which you 'sell' your right to future medical. The insurance company probably knows you'd prefer a lump sum settlement and they're using this as a means of lowering the lump sum value of your case. You have a few options. (1) if you're unrepresented, the WCAB Judges are VERY careful about approving C&R settlements if they know the injured worker doesn't have an attorney - you can take a chance and hope the Judge will refuse to approve the settlement and set it for a conference to address adequacy (2) you can request a conference yourself and ask the Judge (or an I&A Officer) to review the settlement for adequacy (3) take the Stipulation settlement and then Petition for a Commutation of your benefits. A Commutation is taking the present day value of your settlement (you'll end up with a bit less than the actual value). On the flip side, you have to prove to the Judge that there's a need for your lump sum (ie: paying off bills, etc.).

    As a new insurance hater (and a former adjuster), I'll also throw in another option. Every adjuster HATES having an open file. If you take the Stipulation - guess what ... that's an 'open' file. You might take the Stipulation, wait a year and I'll lay you dollars to donuts they'll contact you later on and suggest a C&R. That's when you have the ball in your court. Good luck.

  5. #5
    praying Guest


    I am going to be faced with the same decision as anonymous above. Being 100% disabled which is better, lifetime benefits or lump sum payment? $980 every two weeks is fair amount of money at this time and place, not the $35,000.00 to $40,000.00 a year I was used to making. But in Twenty or thirty years what will it be worth. I am in my mid thirties and asked my parents and older friends could they survive on what they made twenty or thirty years ago? They all said no. My attorney said the insurance will probably offer around $500,000.00 to C&R my biweekly income, not including lifetime medical. Yes $500,000.00 sounds like alot but at $25,480.00 a year, which is what my weekly would add up to, that would only be nineteen and a half years of payments.

    Second question is how do they garantee lifetime medical benefits and biweekly payments?

    SAN what do you mean by use it or lose it? personally I can not go a week without seeing my chiropractor but there are those who have lifetime medical that may develope scar tissue or other problems a year or more later and need an opperation. I assume that if I need an opperation because of my injury or if they come up with a new medical procedure a year or more down the road that the lifetime medical insurance will pay.

    I am also curious what additional medical care will lifetime medical pay for? I am curently getting medical care by medical doctors which by the goodness of their hearts treat me on a green lein, with the hope that one day they might receive payment. It would be nice to have insurance pay for accupuncture and massage which I have been unable to obtain without paying out of pocket. Any input will be appreciated.

  6. #6
    san Guest


    What I mean is that if you don't need medical care after awhile they assume you are permanately cured. I tried to make that sentence more easy to understand the insurance company way of seeing things. Later, if you request the care they can say that it is because of your present job file a new claim or because of the yard work you did or because you have grown older etc. When you keep your medical care open, you must continue to use it periodically. So go to your doctor at least once a year to keep it current. Many people end up in court getting coverage after the claim settled due to this.

  7. #7
    anonymous Guest


    Wait a minute. If you are really a 100% disabled there isn't much you should be able to do on a physical level aside from something very, very sedentary, right? So yes the insurance company would or should be very careful in authorizing future treatment if you continue to work. If the insurance company has agreed you are 100% I'm really surprised they have not suggested a structured settlement. That would generally guarantee you a certain annual amount and compensate for cost of living adjustments as you age and as medical costs increase. On the other hand a compromise and release (lump settlement) buys everything out now. However, it allows you to control your own medical treatment

  8. #8
    anonymous Guest


    Not necessarily right. A blind person is a 100% (i.e. >20/200,) but can be very active.
    Whether your need in the future for medical was based on the original injury or some intervening event would be a medical decison, with the treating physcian's presumption of correctness. So while the future medical award is not a gateway for anything and everything, it's also not an illusion. The continuing test for necessity and resonableness is not superceded by the existence of an award.

  9. #9
    Join Date
    Jul 2011

    Default Re: Lump Sum Settlement

    hi i need HELP ok i got hurt on 7/14/2010 ( my shoulder) its been a year now and i just seen my doctor and he said my shoulder wont get any better!!!!!! But my problem is i asked him what he would rate my disability at and he told me he doesnt know. last time i seen the WC doc he rated my arm at only 65% and it hasnt changed since.... so now i think the IC is going to try and settle what should i accept....

    oh and i have another question when i first got hurt i was getting $960 every 2 weeks (almost 2 months after my injury company forgot to tell IC i was out of work) then the IC calls me and says oh we r dropping your payments down to $720 every 2 weeks i asked why and she said its normal is that legal?

    last thing is it going to be worth settling i have been on workmans comp for a year now will i come out ahead or will the payments they have already paid me equal out? PLEASE HELP ME!!!!!!!!!!!

  10. #10
    Join Date
    Feb 2007

    Default Re: Lump Sum Settlement

    TTD/temp disability is not deducted from any settlement.
    You are not rated until your PTP declares you MMI, and the final report issues, including a valid/final PD/WPI rating.
    Rating your arm at only 65% has little to do with the whole person impairment rating you'd receive.

    You cannot determine the value of any PPD indemnity due until the rating is and the carrier have the right to dispute a PTP rating, you go to PQME if you don't have an atty, AME if you do.

    Your TTD rate is 2/3's of your AWW/Average Weekly Wage, subject to the min/max rates it will support.
    The PDA/Permenant Disability Advance payments are based on the rating, and other factors... but not generally as high as $320/week... don't k now what the CA is referring to...but yes...your weekly rate would be adjusted, lower, based on the PD/WPI rating.

    WC is not about lump sum settlements, but paying benefits. You could be offered a C&R, but it's not mandatory. They can let the PD indemnity pay out, leaving the medical open. You cannot force a C&R.

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