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Thread: C&R

  1. #1
    Join Date
    Nov 2009

    Question C&R

    I want to settle my medical, on the C&R form in paragraph 9 there is a list of disputes that I and the insurance company have/should initial to settle these disputes, do all apply? The main disputes that I am concerned about are: employment, serious and willful misconduct, and self-procured medical treatment. I understand what the other issues are, but these ones i am not sure if I should initial. I do not have an attorney and have been representing myself for 5+ years.

  2. #2
    Join Date
    Oct 2006

    Default Re: C&R

    the issue of "employment" refers to whether at the time of the injury you were considered an employee of this employer. If that is in issue/dispute then it should be included in the settlement.
    the law provides an increase or a decrease in benefits if either party is guilty of serious and willful misconduct. if you or the employer have raised such an issue then it should be included.
    Self-procured medical treatment refers to treatment that the worker provided themselves and are seeking reimbursement from the carrier/employer. if that is being disputed it would also be inclulded.

  3. #3
    Join Date
    Feb 2007

    Default Re: C&R

    No 9 reads confusing.
    On one hand it says there are still disputed issues that have not been addressed and you should check those...on the other hand it says by checking those items, you and the ER/IC are agreeing to settle them by way of this C&R agreement.

    the law provides an increase or a decrease in benefits if either party is guilty of serious and willful misconduct.
    Not so quick on a reduction to the IW's award... IF either party are claiming serious and willful, its' not settled in a C&R, but must go to hearing/trial. Only a judge order an award or reduction for this.
    4551. Where the injury is caused by the serious and willful
    misconduct of the injured employee, the compensation otherwise
    recoverable therefor shall be reduced one-half, except:
    (a) Where the injury results in death.
    (b) Where the injury results in a permanent disability of 70
    percent or over.
    (c) Where the injury is caused by the failure of the employer to
    comply with any provision of law, or any safety order of the Division
    of Occupational Safety and Health, with reference to the safety of
    places of employment.
    (d) Where the injured employee is under 16 years of age at the
    time of injury.

    4552. The reduction of compensation because of the serious and
    willful misconduct of an employee is not enforceable, valid, or
    binding in any respect until the appeals board has so determined by
    its findings and award as provided in Chapter 6 of Part 4 of this
    Information on Chapter 6 part 4 is here, only by a finding by a WCAB judge can the IW settlement be reduced due to serious and willful.

    There shouldn't be a dispute to ''employment'', if the claim/injury was accepted as AOE/COE, you were/are an employee at the time of injury.
    "Employment'' relative to #6 and your 'wages at time of injury'' may be under dispute, as that may or may not affect your TTD rate.
    I want to settle my medical,...
    If medical is the ONLY outstanding issue... be sure the self procured items have been addressed, and that ALL medical bills, and liens if necessary, are to be paid by the ER/IC. This is on the bottom of page 5/9, and item 8 on 6/9.
    The items you are concerned about here, should be able to be initialed by both parties.
    Bottom line is, ANY/ALL of those items you and the carrier initial are INCLDUDED in the settlement, you cannot come back later and claim benefits/money for any item checked.

    As you are concerned with this item, and not represented, you should not sign off on the agreement until you have discussed your options with an I&A officer.
    Message board should not be a substitute for legal advise of an attorney or I&A at the WCAB.


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