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  1. #1
    Join Date
    Aug 2008

    Default Injured Worker Case in California

    Hi everyone,

    I'm new to this site and I've tried to search and search for information regarding settlement amounts and haven't found any particular amounts... I've read alot of people saying that when they ask this particular question, all they care about is the money, rather than improving their condition/disability, and that may be true for some people, but it's DEFINITELY not true for me and I really want to know because I have an attorney that doesn't return any of my phone calls or speak to me... I haven't seen him in 4 years- since I first settled my claim (with future medical, and at that time, I was rated 66% disabled and I was 22 at the time of injury, as a senior accountant and said I could do sedentary work.. now, I'm 29, almost 30 -- in a month, and my attorney has re-opened my case as I've had tons of other injuries related to my original one, and he has stated he's getting me 100% permanent disability. Oh, and all the AME's I've seen - I have seen a Neurologist AME, Psychologist AME and several Orthopedic AME's and all state I can't even do sedentary work, that I am ordered full-time bedrest, which I've maintained for 2 years, and I will never be able to return to my accountant sedentary job and my doctor's pulled me out of work in 2004, despite my arguments to continue working as I really wanted to for satisfaction and self-esteem issues, and they stated I could no longer work and pulled me out because it was causing alot of further injury.
    Anyways, here's a recap of what happened to me...
    I'm hoping you can please help me by answering a couple of questions I have regarding workers comp. in california, which is where I live. I was injured in 2001 at work, resulting originally in a ACL and meniscus tear in my right knee, and during the 1st open operation something went wrong as there are now several issues now and I've undergone 8 surgeries since...there are hundred metal fragments in my knee, I've been told it's similiar to people that stepped on a landmine, and no doctor has been able to get rid of all the metal fragments as they are inside the joint and now embedded and can't be removed...they cause constant inflammation and serious swelling all the time as i've been told it's a foreign body (my x-rays of my knee looks like polka dots everywhere), and after all the surgeries, years of physical therapy (which after 6 years my ortho. surgeon pulled me out of physical therapy, stating it was causing more damage... the more I do, the more damage, he compared it to polio) I've had 8 knee surgeries and a zillion problems with other body parts that are all listed as covered as well, however , no one will do back surgery or address my other problems because they stated they are focused on the severity of my knee for now.
    I NEVER was able to regain range of motion and was diagnosed with severe arthrofibrosis which is severe scar tissue and it's like cement now and they can never remove it all, there's still a ton in there, I was also diagnosed with patella baja, meaning my kneecap is so low now its sitting on my shin bone, and i've been diagnosed with grade 3-4 chondromyacia, and I've had alot of chondroplasties and microfractures to try to help this, but to no avail.. i also have been diagnosed with severe synovitis and have had alot of ' extensive synovectomies' but haven't helped as i've been told all of my synovial fluid in my knee is gone... I have been told my several dr's to just get knee replacements, but then I've been told that won't even fix my problems because the same thing will happen with the new knee, it will become frozen again with severe scar tissue, and my other problems will continue and I also now have a severe case of RSD/ CRPS so no one will touch my knee anymore... I recently had tests done and my bad knee is 20 degrees colder than my other knee and I've had an EMG, where they stick needles in your leg, and 2 of my major muscles in my leg are in *constant* contractions and muscle spasms, all are involuntary. Also, I've been diagnosed with Clonus, dystonia, and myclonia, movement disorders from the RSD/CRPS.
    I now have a 7 inch long scar and 9 holes all over my knee and thigh and my leg is deformed.
    I have permanently lost 30 degrees range of motion in extension, even on the operating table, no surgeon can get my leg to fully extend, and I also lost flexion, I think it was last measured at around 120 degrees, out of 140. I have also lost extensive muscle in my leg- the AME last measured a loss of 2 inches in my calf and 4 inches in my thigh (I know, it's alot of atrophy). My psychology AME reports state that I have a major "Severe depressive disorder, panic disorder with agoraphobia, related to a Pain Disorder", meaning, it's related to my disability and she stated I will be permanent and stationary, psychologically in 6 months (that was 3 months ago). I have undergone 5 AME's with a orthopedic surgeon and 1 AME with a neurologist, just a month ago the neurologist stated I have "marked complex regional pain syndrome with a secondary movement disorder, of a myclonic-dystonic type" from my 8 surgeries as a complication, and that I have "considerable objective evidence to support this diagnosis" as well as my other diagnoses. I have been told by my treating dr's, as well as my AME dr's that I can not even go back to my sedentary job as a senior accountant and I cannot work. I currently spend all my time in bed, about 90-100% bedridden.. due to severe pain, legs go numb ( i also have a herniated disc at L5-S1 and degenerative disc disorder related to my knee, from limping on a cane for several years and it has been listed as being covered under W/C... also covered is my right knee, left knee, right hip, low back,psychological related stuff, bowel and urine dysfunction, heart disease, a 78 lbs weight gain due to bedrest for 2 years, which now caused very high cholesterol, borderline diabetes, heart disease, no menses/ period for 2 years(... I'm only 29!) and alot of other medical problems for me.... severe insomnia, and a slew of other health problems. My treating dr. stated I will die in ten years if I do not get my heart disease under control, however, its extremely difficult because I am immobile, can't exercise, and was even told by my dr. to discontinue physical therapy 2 years ago, after going for 5 to 6 years, 5 days per week.. For now, I'm still receiving temporary disability payments every 2 weeks, have been for 4 years now... I get 1246.42 every 2 weeks, about $2500 per month.

    My question is, if I settled and tried to get a lump sum payment, rather than future medical, how much should I get or how much should I fight for?

    It isn't the money I care about, although I realize that's the primary question I'm asking. It's because I've already gone thru 7 years of doing EVERYTHING I've been asked to do to get better and I've been told I won't get better so now I'm focused on how much I should ask for, as I have alot of money to pay ahead of me--- several knee replacements, back surgeries, my medications cost $4,000 per month and this isn't considering alot of other costs I haven't factored into the equation. I tried to go to the California W/C website and there's a LONG adobe pdf file on how to calculate your permanent disability... I was a senior financial analyst/ accountant for 10 years and I STILL can't figure it out! LOL. I have heard SO many different numbers from reading other stories and hearing stories that I don't know what to expect... and it matters since I will never work again, so I need to ensure I get the most I can since I'm screwed up for life. NO money could EVER replace what has been taken away from me... I was a former athelete-- competed in gymnastics, horse competitions, soccer, ran everyday, worked out 6 days per week, 2 hours per day.. and I did EVERY sport you can imagine. I also was a workaholic, which is why I worked as long as I did after the injury, and had to have my doctors force me to stop... and now I'm depressed because I am the complete opposite of my former self... I am on bedrest, can't do any activities let alone any sports, I sold my horses years ago, I can't work anymore, even for my husband who owns his own company and he begs me to help do the accounting and I can't concentrate or do anything.... I want to help him so badly and can't... we have had to even put off having a child and I was pregnant 3 years ago and am still dealing with the fact I was told to have an abortion because either the fetus or I could have died because of my heart condition... had I knew that before, I would have never tried to get pregnant for 5 years. I don't know if even I could even care for one, given I can't even take care of myself. My poor husband has had to do everything for me, and I mean everything. He brings me all my meals in bed ( I bought a hospital bed), and he cleans, cooks,and quit his job 3 years ago to stay at home with me, so he now owns his own company and works in the other room from me. The only time I leave my house is for Dr. Appts, and even going to short Dr. appts, I pay for it for about a week afterwards with severe pain, alot of swelling, stiffness, and my legs go completely numb and my leg locks so often, alot of the time I can't manually unlock it.. it's so embarrassing but I've had accidents in our bed before because my leg has locked or gone completely numb that I couldn't make it to the bathroom.. I shower 1 time per week, if I'm lucky. I brush my teeth 3 times per week if i'm lucky. I used to model and now I am an unkept pig. Sorry, but that's how I feel. I feel totally worthless.

    Regarding W/C, if I do get 100%, how much would that equate to, and how much should I ask for if I get a lump sum? I would REALLY appreciate your help, as I feel completely lost and helpless...

  2. #2
    Join Date
    Oct 2006

    Default Re: New to This Site & Injured W/C Case in Cali

    you can't settle until your condition is Permanent & stationary and you have a rating.
    You can't place a value on your permanent disability until you have a rating.
    there is no guarentee they'll agree to a lump sum buyout
    Ratings can very tremendously: 100% permanent total = TD rate for life with COLAs. 99% or less drops the amount more then half and you don't even know your life expectancey.
    Future medical costs for the conditions you mention very tremendously and can't be estimated without detailed knowledge of your medical condition.
    the only settlement you should be considering is the regular periodic PD payments and open medical--too many chances to leave you short (besides Medicare will take the majority for their setaside trust acct.
    The fact that you have AME reports means you're represented.
    my opinion: your legal advice will be better then anonymous posters on a public message board.

  3. #3
    Join Date
    Aug 2008

    Default Re: New to This Site & Injured W/C Case in Cali


    Thanks so much for your reply. Yes, I'm represented... I have one of the best attorneys and he's represented me for the past 7 years, since the original injury in 2001. The original injury was I was playing soccer at a company-sponsered soccer game, against another company, when my right leg was planted in a hole and my body went one way, my knee went another and snapped. My co-workers immediately took me to the hospital and I was diagnosed with a torn ACL and meniscus in my right knee. I had an open surgery about a month later. That is when the metal blew up in my knee and there's now a bunch of metal fragments in my knee they can't remove. I have a TON of problems from that knee injury now. I've since had 8 surgeries, and have been diagnosed with a number of things, and ALL the AME's agree and have been very kind to me in their reports. I've seen Ortho AME's, Psych and Neuro AME's and all have been very kind and state that my disabilities are severe and I will never be able to return to any kind of work- even sedentary. Whether, before, when I settled my case in 2004-- I was declared P&S in 2004 and was given a 66% rating and future medical... then, about a 1 1/2 later, my attorney re-opened my case due to further injuries, and I got pulled out of work by my Dr's and AME dr's agreed I could no longer work.... I then developed severe major issues- severe RSD/CRPS from the 8 surgeries-- the AME neurologist stated in his report that I have "considerable objective evidence of RSD/CRPS with a secondary movement disorder of a dystonic-myclonic type, related to my severe knee injury". Also later developed major depression, panic disorder with agorophobia, and lots of other problems from 2 years of bedrest- Heart disease, L5/S1 disc herniation and degenerative disc disease, colon problems from the 20 meds I'm on, have had 2 colonoscopies, borderline diabetes, hypertension/ high blood pressure and very high cholesterol, all from a 78 lbs weight gain from 2 years of bedrest and all of my conditions have been stated by the AME's that they are compensable and related to my original knee injury. Also, like I previously said, my husband has to do everything now... cooks, cleans, brings me food in bed, etc. I can't take showers anymore or take care of myself. I'm only 29. I really feel like I also need some kind of home health care so my poor hubby isn't stuck with all of this stress.

    I was previously permanent and stationary in 2004, and given a 66% rating. Now, my attorney stated he is going to get me a 100% rating and is confident of that, given all my favorable AME reports. However, my issue is I can NEVER speak to him. I've read on this board that this is very common. I know that these particular attorneys (I was in a master's program before I was injured and actually was going for my J.D. degree to be an attorney myself... now that I've seen the horrible side of them, and also because I haven't been able to continue my education beyond my B.A. degree in Economics because of my disability (i'm immoble), I don't think I ever want to be an attorney!!!)

    Anyway, I have faxed my attorney and written him letters and lots of phone calls demanding he speak with me and answer my questions. My husband even called several times to tell him it was an emergency. We can't stop by his office because he works from home, for himself and has a "P.O" box " address and he doesnt have an assistant. I haven't seen him in 3 years and I haven't spoken to him in over 2 years because he refuses to return my phone calls, fax requests, and letter demands. He got $10k when we settled in 2004 and I'm sure he'll get alot more when we settle again soon. I have called several other atty's and they will NOT take on my case, as they stated that my atty already got his money and they wouldn't get much so they refuse to take it on. I don't know what to do. I have tried to call the W/C board, but they refuse to answer my questions because I'm represented.

    My reason for wanting to just settle and get a lump sum is to get rid of the W/C insurance company because since my atty stated I am going to get 100%, they have been horrible and causing severe stress on me. Last winter, they produced a tape claiming it was me, and sent it to all my dr's and my atty, without verifying the license plates on the car. My attorney called and wrote several letters stating the woman in the video, running on the beach, is NOT me and looks NOTHING like me and told them to stop harrassing us. My attorney even told me to retain another attorney and sue the W/C insurance co. and the Sub-Rosa person for Fraud and Defamation. I contacted ONE atty and he stated it would be difficult to prove they did this in malice and it was just probably a case of mistaken identity. Not so, because we kept writing them letters stating it WASN'T ME and to BACK OFF. They didn't. They kept harrassing us for months. They finally gave up months and months later, after they sent a letter to the Ortho AME, asking him if he believed it was me or not. The AME wrote a letter stating it was NOT ME in any way- facially, bodily, nor could I walk or do ANY of the activities the tall brunette woman was doing (at least the Sub-rosa should have gotten an actor that looked like me!! I have platinum blonde hair and am only 5'4, the woman in the video look almost 6' tall and pregnant!!!) Anyways, going thru all of this, I came down with the flu, then shingles... my Dr. said due to all the stress I was going thru at this time.

    So, that is the reason why I am contemplating just obtaining a lump sum and getting rid of them, as my atty stated since they know I'm going to get 100% , they are fighting like hell for that 1%...

    What is this about medicare? I have Kaiser insurance, so I would be covered medically under them, should I choose to get rid of my w/c medical. I have always had a secondary insurance. I am, however, also obtaining SS disability simultaneously (well, I have an attorney for that as well, and i'm going before a judge in a month and he will decide whether or not I receive it... this is my 3rd appeal... I was denied 2 prior times due to my young age... despite my serious W/C injuries/ disabilities stated above that are permanent, and my other disabilities that are non-work related, like my left eye that is congenital- I was born with it completely closed and have had several surgeries to raise the eyelid but they didnt' do it early enough, so my brain shut off the vision, so not only do I have an eye that is deformed and stays open all the time (even when I'm alseep, my eye is open all the way-- it scares the crap out of people that don't know me!), and my eye doesn't blink. and I'm completely blind in that eye. I have a slew of other problems as well... I'm always told over and over , "your way too young to have all of these disabilities"... I wish I didn't have them, trust me. I wish I could go back to my gymnastics and horseback riding competitions and all of the other sports I loved... and as much as I hate to admit it, I really miss working... alot. I was a workaholic when I worked. That's why it took my dr. forcing me to stop for me to finally throw in the towel. I still want to work in the future, even though my dr's, AME's and even voc. rehab stated I can't work (even sedentary). I'm trying to still hold out some hope.

    All I'm trying to figure out is, what a 99 or 100% disability rating equals to compensation so I can figure out if it's worth settling a lump sum or future medical, like I previously settled with them for...? I do have Kaiser ins. under my husband's company, and will always have medical insurance, and although Kaiser isn't great by any means, I feel its alot better than W/C!!! I'm just trying to find out SOMEWHERE (and I can't) how much money 100% actually is, if I opt to get a lump sum because I definately can't get my atty to respond to any of my questions... Thank you!!!!!!!

    I am eternally grateful for your replies and reponses!!

    Thank you!!!!!!!


  4. #4
    Join Date
    Aug 2008

    Default Re: New to This Site & Injured W/C Case in Cali

    Anyone out there??!! PLEASE HELP! I am sooo desperate for an answer... My husband and I have been worrying about this for years now and have never had an answer. I've heard of people settling & getting $656k, $700k, and I saw a couple of people that "said" they got $1,000,000 (one million) and they had a 'friend' that got almost $2 million.

    My question is if I get 99 or 100%, which my attorney is confident I will get, from the AME reports and he sent me a letter recently stating he is talking to the insurance company currently to get my 100% rating. He never said I was P&S though... like i said previously, I was at one point P&S, in 2004, when I settled and was rated 66%, with future medical. then, my attorney re-opened my case 1 1/2 years later due to my treating Dr. forcing me to stop working at my senior accountant sedentary job, and the AME agreed at the time, and all the current AME's agree that I am still totally disabled, and can not return to any type of work and I have already been denied by voc rehab as well.

    I've been told in the future, I will need very expensive medical treatment, probably the most expensive will be the several knee replacements and back surgeries...when they do a lump sum settlement, do they factor in all of that?

    I have Kaiser as a secondary medical insurance and I'm just wondering, if I settle for the lump sum and get rid of W/C completely (I explained above several reasons why my family & I want to get rid of w/c as they put us all thru sooo much stress for months and months of harrassing us...
    I have a walker and a cane and walk HORRIBLY and can't walk longer than 100 feet or sit more than 10 min, stand longer than 5 min. so I am quite disabled and I would LOVE for them to catch me on tape, it would only help my case extraordinarily. However, I've NEVER heard of any IC or Sub-rosa person taping the WRONG person to try to intimidate me?? Has anyone heard of this? They had to know it wasn't me. All they had to do was check the plates on the car and know it wasn't mine, or actually LOOK at her because she is literally my opposite. Anyway, has anyone heard of an IC doing this to try to intimidate the IW? I got soooo sick from being so stressed during that time and it's one of the main reasons why I want to just settle with them and get it over with. My attorney said they would love to settle with me and get rid of me, since my future medical he said, they've set aside millions. I used to work at a large insurance company, as a senior analyst, so I know about this. The claims adjusters or defense attorneys put aside a lot of money in each claim, to estimate how much you're going to cost them.

    Anyway, I'm hoping someone who's either previously settled with a similiar percentage that I'm rated (between 99-100% both my atty told me and the last AME told me, although I don't think he was allowed to give me that info).. I just want to know how much that equates to with respect to a lump sum payment in dollars.. I know no one can give me an exact figure b/c it's extremely complex. However, I have NO idea what I'm dealing with. I've heard that there's a cap in california and you cannot get more than $157,000, then I've heard of people- both online and in person, people I've spoken to during Dr. appt's, etc. and I've heard of a man getting a million, then another got 2 million, and they are both from california, and a few online people I've read received between $600,000-$700,000, but I have no idea if those last numbers from those I read online, are even from the same state as me, California. My DOI was in 2001. I just want to know what I'm dealing with, so I can make an informed decision, and since I can't get any answers from my non-responsive attorney, I'm hoping someone on this board could please respond by either giving me a ballpark figure, or someone who has already settled could give me an idea what to expect dollar wise, so I can make an informed decision. Since I've already been thru 7 years of surgery after surgery, 8 to be exact and they've wanted to do alot more but the severity of my other disabilities and the diagnosis of stage 3 RSD/CRPS stopped my surgeon from doing any further surgeries on my knee, and now they don't even want to touch my back and do back surgery.
    My attorney sent a letter to me saying he's currently speaking with the IC to get my rating (he said 100%), but I don't see in all my recent AME reports that I was declared P&S again (remember I was P&S in '04, and settled and was rated 66%, then attorney reopened case for add'l injuries, illnesses, and severe major depression w/ panic disorder and severe case of RSD/ CRPS- Stage 3 (my knee has been frozen bent for 7 years now, I can't get more thant 30 degrees of extension and flexion is at 90, also when I had neurological tests done, I had needles put in my leg, an EMG and was told 2 major muslce groups in my bad leg are in 'constant involuntary spasm', and during my last surgery, while I was unconscious under general anesthesia, my Ortho. Surgeon stated my leg kicked out, and " cogwheeled approximately 40 times and he could not move my leg during surgery and couldn't obtain any extension on the operating table, leading him to believe I had severe RSD and he said he couldn't do any more surgeries as it's "above his expertise and his head now" and he's the #2 knee surgeon in the nation and is at Stanford in CA. (Dr. Steadman in Vail, Colorado is rated #1 for knee surgeries)... so I was then told there was nothing more they could do and was switched from my Ortho surgeon being my primary treating doctor, to a pain management doctor being my treating dr. and was told that all they could do was just manage my pain and that's it.
    So, after 7 years of doing everything possible i could- both everything THEY (the insurance company) recommended and all the dr's, etc. recommended, and I even did a ton of extra stuff on my own to try to get better to no avail.. I paid myself for tons of extra opinions, did years of research on the best surgeons and saw them for 4 out of my 8 surgeries, but they said it was too late, that I should have seen them in the 'beginning'...however, the 1st surgeon I saw that blew up metal in my knee w/ his shaving instrument during surgery,(I never sued him for that... he also put my ACL in wrong but all of this was told to my by surgeons years later, when I saw the local surgeons they were trying to ' protect' him and didn't directly tell me that the 1st surgeon was the cause of all of this, so when I finally found out later, it was too late to sue him anyway- statues of limitations... but I don't know if I would have sued him anyway.. I know there's always a risk of any kind of surgery... but at that time, all I knew was I had a very screwed up knee that wasn't healing right and he blamed me- said I wasn't working hard enough in PT- even though I was attending five days per week 2 hours a day, and working my a$$ off.. come on, I was a former competitive athelete, like I could slack off in PT??!!! THe entire time I was thinking, or rather expected and KNEW I would heal and I would never EVER be a ' malingerer' and I would return to all my competitive sports in no time. I thought this way for 6 years. It wasnt until the surgeries stopped that I finally gave up hope... each surgery I had, I kept saying to myself and others, "this is the ONE, I'm going to be FIXED this time and I can't WAIT!!!!"... what a rollercoaster. Then, when the surgeon stated it was above him and he couldn't do anything further for fear of further damage to my already damaged nerves and nervous system, that's when I gave up. When he gave up, I gave up as well. I trust him b/c he is the BEST & the highest recommended surgeon in my city and in the US, besides Dr. Steadman (who did Kobe Bryant's knee).
    Anyway, I will of course still try alternative things and do everything I can on my own, but as far as W/C goes, I'm SO sick and tired of them and they are doing nothing for me but stressing the hell out of me and my husband and my entire family (who all have to take care of me... thats another question I have-- has anyone had W/C pay for some type of home health care, and if so, what do they provide? I also need someone to help me with cleaning my large home, cooking, etc. as my Husband owns his own company here at home and he works constantly and he is still left to take care of me and that is REALLY not fair to him as he is SO STRESSED right now I don't think he can handle anything more, so I really need some kind of help- home care and a housecleaner, cook, or someone that does it all. I just don't know how to go about it or who to ask. So, if anyone has had experience with this, please let me know!!! Thanks!

    Thank you all SO much for taking the time to read my awfully long posts and I really appreciate your thoughts and replies and PLEASE help me if you have had experience with settling, or know about any of the questions I've raised above about home health care, disabled car/suv, etc., relocating or purchasing a single story home with handicap options, and how much am I legally required to receive as a lump sum with my rating and disabilities? Right now, since i've already spent 7 years in agony day after day and trying my best and hardest to get better, all I want to know is how much money am I entitled to get as I am completely in the dark regarding this. PLEASE HELP! I'm seriously desperate.

    Oh- one more thing I forgot... Regarding my "Stage 3 RSD/ CRPS w/ a secondary movement disorder of a myclonic-dystonic type", I've had several 'thermagram' tests showing that my bad knee is a little over 20 degrees (Fahrenheit) COLDER than my other knee!!!


    Thanks again,

    Last edited by Injured_2001; 08-20-2008 at 01:55 AM.

  5. #5
    Join Date
    Feb 2007

    Default Re: Injured Worker Case in California

    I would first welcome you to the forum..

    I would also say that you aren't going to generate a whole lot of response here because your posts are difficult to read and are more like an 'novelette' that a real if you can in future posts, limit to only a few issues it would be better for you and the reader..

    From what I can acertain..and I did not read everything...

    IF, and this will be your biggest IF... IF you were to be rated at 100% for your WC injury...the PD indemnity would be your TTD rate paid at the time of your DOI...WITHOUT COLAS...only DOI's post 01/01/03 receive a COLA adjustment...

    The ''IF" here is that in order to get that 100% rating you'd have to be rated under the 'old' PDRS...and a reliance on case law. One of those decisions is that you must have been P&S and a report issue prior to 01/01/05 that indicates PD...
    There could also be an issue of apportionment as your org. claim settled by stipulation, under the new laws the ER/IC is entitled to apportionment...
    There have been a lot of posts regarding your type of issues...heres one you might follow...

    To be rated under the new schedule, there woudl be a huge fight with the IC, and there would be a tremendous amount of work on your AA...including expert testimony to your ability to compete in the open job market.
    A 100% PD/WPI under the new PDRS, based on objective leave you literally near death.

    A rating between 70 and 99% will be worth a set number of weeks for each 1% of your PD/WPI rating..a rating between 70/99% is 9 weeks for each 1% and payable at around $230/wk.
    As you have an attorney, the fees will be commuted off the far end...meaning your number of weeks PD indemnity would be reduced to satisfy the commutation.

    After the PD indemnity is paid...there will be a Life Pension paid for can calculate that amount here..
    4659. (a) If the permanent disability is at least 70 percent, but
    less than 100 percent, 1.5 percent of the average weekly earnings for
    each 1 percent of disability in excess of 60 percent is to be paid
    during the remainder of life, after payment for the maximum number of
    weeks specified in Section 4658 has been made. For the purposes of
    this subdivision only, average weekly earnings shall be taken at not
    more than one hundred seven dollars and sixty-nine cents ($107.69).
    For injuries occurring on or after July 1, 1994, average weekly wages
    shall not be taken at more than one hundred fifty-seven dollars and
    sixty-nine cents ($157.69). For injuries occurring on or after July
    1, 1995, average weekly wages shall not be taken at more than two
    hundred seven dollars and sixty-nine cents ($207.69). For injuries
    occurring on or after July 1, 1996, average weekly wages shall not be
    taken at more than two hundred fifty-seven dollars and sixty-nine
    cents ($257.69). For injuries occurring on or after January 1, 2006,
    average weekly wages shall not be taken at more than five hundred
    fifteen dollars and thirty-eight cents ($515.38).
    the only settlement you should be considering is the regular periodic PD payments and open medical--too many chances to leave you short (besides Medicare will take the majority for their setaside trust acct.
    Actually CMS/Medicare doesn't 'take' any of your money...they can require a setaside account, but it remains YOUR setaside...
    As I said, I haven't read this entirely, but IF you are receiving SSA/SSDI benefits, you CANNOT settle your claim by a lump sum until you have taken the steps to protect Medicare interests...that may require a WCMSA.
    Here is a guideline ''map'' to help determine IF you need to be concerned with a proposal for a setaside account...
    I have Kaiser as a secondary medical insurance and I'm just wondering, if I settle for the lump sum and get rid of W/C completely...
    I don't know the rest of that question..toooo much information...but if you are considering using Kaiser for your work injury, forget it. You cannot shift liability for a work injury from the ER/IC to another IC...and Kaiser is failry blunt in their language that they do not cover work related injuries regardless of whether or not the claim is open or closed.

    One, even IF you are determined to be 100% PD/WPI for your WC claim/injury...IMO..I would not be looking for the IC to lump sum your claim...there is far too much future medical involved..and you will NEVER receive enough money to pay for any additional treatment you will need...
    As I noticed you have a RSD diagnosis...that alone will preclude the IC from making ANY reasonable offer to settle thsi by a lump sum...

    Two...the SSA/SSDI issues..IF you have SSDI and are Medicare eligible you must address the WCMSA issue...
    If you are not receiving SSA/SSDI but would be Medicare eiligible within 30 months of a settlement that affects the medical portion of your must protect Medicare interests...
    The ruling is if you would be Medicare eligible within 30 months due to age, disability, or application...even if you haven't applied, but think you will..

    Now, if you can edit you post down, and bring a few questions at a time...I think we'll all be in a better position to help you figure out what you are asking for...

  6. #6
    Join Date
    Feb 2007

    Default Re: Injured Worker Case in California

    Ok, I've read through most of this ...

    Your 99% PD rating is as I said, 9 weeks for each 1%..=891 weeks, at $230/wk for an award of about $204, the life pension.

    As has been provided..a 100% PD would be the TTD rate on DOI for life, that would be the amount for the life pension.
    At 100% and a life expectancy of oh, 75 for you say...and the TTD rate of $890/wk...a lump sum there would be about 2340wks, @890 = $2,082,600 +/-...a commutation would reduce that amount by 3% per year...(45 years worth) are not going to see that money in this life time..

    Based on your information..
    One, you cannot use Kaiser for any treatment to this injury. cannot settle this claim until you submit a WCMSA proposal to CMS/Medicare for a determination

    Three..You can't force a C&R/lump sum no matter how much you'd like to get out of this system.

    Four...the value of your FMT..or a SWAG/Scientific Wild Ass Guess would put your medical costs WAY over what the IC will be willing to cash you out for.
    IF there was a commutation for the would NEVER be compensated enough for what treatment you will eventually need.
    Without considering a WCMSA, the IC will never come up with the kind of money you need...and IF there were to be discussion of a lump sum for the FMT... it would eventually come down to a figure in ''todays dollars''...and even lesser amount than you will eventually require.

    I know I have a ''' just can't remember right now...again, those posts are tooooo long to keep anyones attention.

    Question though.. IF this attorney is such a hot shot in WC...why doesn't he have a paralegal, or asst, or address, of could possibly be reached...?

    Sadly, the other AA's you have spoken to are right...there isn't much money left in your case to generate enough fee to elicit much interet.

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