Benefit Amount Dispute

[jwdwater]

I finally got my lawyer on the line today and he said that he hasn't received a date for a hearing yet from the state , also I just reached MMI on Monday , My Dr. said to me that he was sorry he couldn't get me better than he did and I should just be happy that I am not in a wheelchair , he checked off the box marked permanent impairment expected and told me he feels that I will no longer be able to drive truck again and advised me to sign up for SSDI ..I am new to all of this , don't know what to expect next . Will it take awhile for my actual impairment rating to be done ? and when that comes through what than ? Thank you guys for the input I'm really thankful for it .

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also ...just one more question ...does how many dependents I claim affect what my weekly benefit amount is in the state of Maine ? or is it just the flat 80% of my AWW that I should be getting ?

[tony]

It's just the flat 80% I see no additional amount for dependents.
http://www.maine.gov/wcb/departments...blications.htm

Tony

[jwdwater]

Thank you Tony ! That's what I thought , Acadia Insurance tells me my AWW was 542.88 and based on that started paying me 408.62 , but 80% would be 433.00

[tony]

Sorry, I screwed up, they do allow for dependents.
Look at the first link in the above source titled "Instructions for benefit tables"

Directions

1. Find the employee’s average gross weekly wage in the left column rounded to the nearest dollar (if .5 or greater, round up).
2. Determine the employee’s filing status.
3. Determine employee’s number of dependents. The number of dependents does not include the employee. “Dependents” equal
exemptions, as reported on federal Tax Form 1040 minus one. For example a single taxpayer with no spouse or children has
“0” dependents in most instances. The table entry for “0” dependents includes one exemption for the employee.
4. Match the appropriate average gross weekly wage and filing status with the appropriate number of dependents.
5. The figure shown is the weekly compensation rate and represents 80% of after tax average gross weekly wage.
http://www.maine.gov/wcb/departments...nsidecover.rtf

You have to scroll down aways in the below tables before the increase for dependents kick in.
Here's the tables once more.
http://www.maine.gov/wcb/departments...blications.htm

From what I see, with an AWW of $542 the max you can get is 409.10.
See pg 55 in the 2012 table -
http://www.maine.gov/wcb/departments...IT%20TABLE.rtf

Here it is, don't know if you can make sense of it in this format.
AWW= 542 Single 357.23 368.84 380.45 391.35 399.42 407.08 408.35 409.10 409.10 409.10 AWW=542
Married Joint 389.93 397.59 404.16 407.78 408.66 409.10 409.10 409.10 409.10
Head of Household 372.05 383.30 391.07 398.74 405.61 408.31 409.10 409.10 409.10 409.10
Married Separate 356.05 367.79 379.40 390.30 398.74 406.41 408.05 408.93 409.10 409.10

Tony

[jwdwater]

Thanks again Tony ! I didn't see this chart/table so glad you could help me out in figuring it have you got any thoughts on the MMI questions I asked about (since you are clearly more educated than myself in all of this lol)

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I thought of another question just now for you ..since my Dr. just told me I reached MMI (and on the paperwork he gave me he checked off the no work capacity and answered "yes" to the permanent impairment expected question , what does this mean for my weekly benefits ..sort of worried reading other peoples posts that workers comp stopped paying them after they reached MMI ..is this the same in my case ? will they stop paying me ?

[tony]

jwdwater

ince my Dr. just told me I reached MMI (and on the paperwork he gave me he checked off the no work capacity and answered "yes" to the permanent impairment expected question , what does this mean for my weekly benefits

It means your TTD benefits stop and your PPD or PTD benefits begin.

Benefits for Temporary Total Disability (TTD)
The percentage of worker's wage paid is 80% of worker's after tax earnings. For weekly payments, there is no minimum and the maximum is $622.20, 90% of SAWW. The maximum period of payments is the duration of disability. WC benefits are subject to benefit offsets, except if benefits started prior to date of injury, or if benefits are a spouse's entitlement.
Benefits for Permanent Total Disability (PTD)
The percentage of worker's wage paid is 80% of worker's after tax earnings. For weekly payments, there is no minimum and the maximum is $622.20, 90% of SAWW. The maximum period of payments is the duration of disability. WC benefits are subject to benefit offsets, except if benefits started prior to date of injury, or if benefits are a spouse's entitlement.
Benefits for Permanent Partial Disability (PPD)
The percentage of worker's wage paid is 80% of worker's after tax earnings. For weekly payments, there is no minimum and the maximum is $622.20, 90% of SAWW. For non-scheduled injuries, the maximum period of payments is 312 weeks or the duration of disability if impairment is in excess of 15% to the body, and the maximum payment amount is $194,126.

Tony

[jwdwater]

Tony THANK YOU so much . I wish I could do more to thank you for taking your time to answer some strangers questions like you have , God bless you for the help you offer to everyone , I have to say you are a prime example of human kindness . Have a great day and a happy 4th of July

[jwdwater]

I just got an email from my lawyers office that is scaring the @#$% out of me ... I had mediation on the AWW issue I spoke of in the first post of mine on here on april 17th 2013 , I have been emailing/calling the lawyer approx 3 times a month asking if they had heard anything on it ..finally reached the lawyer last week and he tells me " it can take awhile , when we hear something you will hear something" (fair enough I said to myself and went back to playing the waiting game) todays email tells me " unfortunately upon speaking with the w/c board we first have to file petitions in order to get a hearing" ...83 DAYS IT'S BEEN since mediation took place .....I am feeling like my lawyer should have known this . meanwhile ...NOW how long will I have to wait and are there any professionals out there who have an opinion as to if I should be concerned about my lawyers capability ??? Thanks in advance you guys .

[.SH]

did you check out your lawyers experience and specialty before you selected them?
you're the one that needs to be confident in their ability.
you can always talk to a few more
https://www.wilg.org/index.cfm?pg=publicdirectory
http://www.avvo.com/free-legal-advic...tion?loc=maine
or try the state bar
http://www.mainebar.org/public_lris.asp

[jwdwater]

Yes I did , I picked him because he specializes in workers comp cases . I was told today when I called about the concerning email I said " It sounds to me as if you made a mistake and di not know that you had to file a petition in order to get a hearing after mediation" and was told " I can see where you might think that but we really could not do anything until you reached MMI from your doctor " ....ummmm reaching MMI has nothing to do with my dispute on what my AWW should be ....right ? pretty sure smoke was just blown up my ass.