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  1. #1
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    Apr 2018
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    Default WC 100% Disabled and MSA

    I hope someone can help me. My husband was hurt 9 yrs ago. There is a 3rd party lawsuit. My lawyer has an MSA for the injury case in NY, he is trying to settle the case and is trying to get NJ WC to do there own MSA. My WC lawyer is trying to close his case for 100% disability. He said if the WC lien of 700,000 is paid, my husband's medical and checks are reduced to a 3rd. If my husband gets permanent disability and WC is responsible for a 3rd of his medical bills for the rest of his life, then why would WC do an MSA. If we don't settle and lose the liability my husband would get his full benefits and medical coverage for the rest if his life, do they still have to do an MSA . I'm so confused.

    Thanks

  2. #2
    Join Date
    Oct 1971
    Posts
    5,056

    Default Re: WC 100% Disabled and MSA

    Your case is too complicated for anyone in this forum to comment, there are too many variables.
    The only person who can give a credible opinion is the lawyer handling this case, he knows the relevant details.
    Sorry I can't be more helpful.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    May 2010
    Posts
    590

    Default Re: WC 100% Disabled and MSA

    I couldn't even begin going through how my WC settlement went.....Most accurate was I was on SSDI so I got the mandatory MSA(which ins company did).....My attorneys fought for me to control my MSA.....So out of my settlement I put money aside for MSA.....As for WC bills, they were abaut 850k and I remember them cutting a deal....Think out of my settlement I gave them 75k?.....Its been some time and my memory is poor.

    Have faith in your attorneys they work for you!....They made alot of money off me, but I am set for life.....

  4. #4
    Join Date
    Apr 2018
    Posts
    7

    Default Re: WC 100% Disabled and MSA

    Quote Quoting tony View Post
    Your case is too complicated for anyone in this forum to comment, there are too many variables.
    The only person who can give a credible opinion is the lawyer handling this case, he knows the relevant details.
    Sorry I can't be more helpful.

    Tony
    Thank You so much for replying. Can you at least tell me in nj how an MSA would work with 100% disability. I'm trying to meet with the workmans comp lawyer before 2 weeks when we have to go to another settlement conference.

    My husband is on SSD has been since the accident. This ins company wants the whole lien, they ain't playing. I don't care if they get it. I just don't want to drop the MSA my liability lawyer had done, because WC ins company doesn't send a check for weeks, they try almost every month to deny my husband's pain meds. They are harassing us constantly. Thank you so much for taking the time to reply.

    Quote Quoting tony View Post
    Your case is too complicated for anyone in this forum to comment, there are too many variables.
    The only person who can give a credible opinion is the lawyer handling this case, he knows the relevant details.
    Sorry I can't be more helpful.

    Tony
    Quote Quoting airdale View Post
    I couldn't even begin going through how my WC settlement went.....Most accurate was I was on SSDI so I got the mandatory MSA(which ins company did).....My attorneys fought for me to control my MSA.....So out of my settlement I put money aside for MSA.....As for WC bills, they were abaut 850k and I remember them cutting a deal....Think out of my settlement I gave them 75k?.....Its been some time and my memory is poor.

    Have faith in your attorneys they work for you!....They made alot of money off me, but I am set for life.....
    Sorry I'm new to this site and I think I messed up my posts. Thank you very much for taking the time to reply.

  5. #5
    Join Date
    Oct 1971
    Posts
    5,056

    Default Re: WC 100% Disabled and MSA

    As long as he's on SSD and Medicare Eligible, there must be an MSA , you'll never get out of that.
    Again, your lawyer can give details when you meet with him.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  6. #6
    Join Date
    Apr 2018
    Posts
    7

    Default Re: WC 100% Disabled and MSA

    Quote Quoting tony View Post
    Your case is too complicated for anyone in this forum to comment, there are too many variables.
    The only person who can give a credible opinion is the lawyer handling this case, he knows the relevant details.
    Sorry I can't be more helpful.

    Tony
    Quote Quoting tony View Post
    As long as he's on SSD and Medicare Eligible, there must be an MSA , you'll never get out of that.
    Again, your lawyer can give details when you meet with him.

    Tony
    Thank You, I don't want out of the MSA, I just want to make sure WC does it and can't mess around with it. I have read they do structured, I just want my husband to be able to use it for his treatment without them in the way. I have an MSA of 529,000 in my settlement already, then when my WC does one it over rides that one we have already have. I was just wondering if WC would control it.

    Tony thank you so much for your help

  7. #7
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    821

    Default Re: WC 100% Disabled and MSA

    Ceaden4,

    Hi welcome to the NJ WC forum.I must say you have presented a very complex NJWC case and 3rd party liability only makes it more difficult. I must agree with Tony in that with the little legal info given and the complex nature of an interstate 3rd party case no one here maybe including your NJWC lawyer can answer your case at this point as they should be working with a NY WC expert to tie up all the loose ends on that side of your case and your lawyer should be considered at least a NJWC specialist, your family lawyer should be able to tell you this. Also you can call the NJ BAR as they will give you some background info like how long he/she has been practicing law in NJ as well as any special areas of law he specializes in. They will also tell you if there have been any disaplinaries filed against him/her and the outcome, but if the outcome was in his favor the BAR tends to omit the filing as mute and say no disaplinaries as his record MUST be spotless. I call this doing your homework on the lawyer you hire as so much of your future is in their hands you need to vent them as much as possible.

    Im sure I cant give you the answers you seek but I can give you some advice on NJWC Law and some places to go to get some answers you seek and then put it all together and hopefully get you as close as possible to what you seek.

    Your lawyer most likely does not return calls or make courtesy calls to you to keep you updated on your case, this is expected as great WC lawyers are much to busy to do this and they make their $$$ by lawyering not making calls that dont involve advancing your case such as a hearing date or IME that you must attend to keep your case from being tossed out.

    As for any MSA concerns you may have Im sure you can get much information from the NJ Dept. of Human Services, Division of Ageing Services. They have an excellent program called State Health Ins Assistance Program or "SHIP" for short. You can find them at http://www.state.nj.us/humanservices...services/ship/

    To learn how your MSA from your NJWC injury is going I found a step by step process that may get you at least a figure, this may be found at:

    http://www.nj.gov/labor/forms_pdfs/w...o_medicare.pdf

    Actually this site was found on the Dept of Labor Workforce Development. WC legal In formation/ Legal Links. To give you access to all the Medicare info to date let me link you to that page as its difficult to navigate yourself to this site:
    http://www.nj.gov/labor/wc/legal/medicare_lien.html
    This may help you find a way to the info you seek on that issue. However b4 you do ANYTHING like contact a WC dept you need to clear this with your lawyer and if there is any objection GET A REASON WHY!!!!!!!! For lawyers who dont return calls sometimes having/making a good communication connection with his secretary or receptionist may benefit you as you can ask your questions through them, then in a day or 2 call her/him back to follow up on your original question after the lawyer has responded to the question with an answer.

    Its unfortunate that in many 3rd party WC cases the injured ends up with less than had they just gone forward with a total disability claim with the work injury,the lawyer benefits the most as he collects in most 3rd party claims up to 40% of all awards In any event it takes a very skilled WC lawyer to win a total disability case in a NJWC Courtroom, this is why your homework must be completely vented on the lawyer you hire as this is the biggest part you play in your case.

    It is important for me to know if your hubby worked under a work agreement or was an "at will" employee.Even if under a work agreement if this agreement doesn't specifically mention your circumstance in the work agreement it may be im-material he was a Union or work agreement worker and the bare bones WC rules may still apply. I have barely scratched the surface of your case, and answered none of your questions yet, but only put you on the path to getting the answers you seek. There is just a few exception to future medical, but this is not always wise as then the carrier can call in the IW for a IME at anytime and as often as they feel it necessary, wwhen they get one of their "Drs in pocket" to say hubby is able to do sedentary work, then his medical for his work injury stops as does any compensation, at that point its hard to find a lawyer unless you pay them yourself as your attorney of record was paid his fee of 20% of all past monies due and was also paid 20% of your SIF benefit up to hubby's age of 65. If he is an honorable lawyer he should represent you since he has been payed, but I dont see any rule or law requiring him to do so. This why TONYS reply was so correct, which I agree 100% with.

    With all said I do believe there is a rule or law that requires NJWC to make a set aside for MEDICARE.

    OK now lets get to your NJWC case. The only way he can get WC responsible for any future medical is if his work agreement specifically states this in his work agreement. AS in NJ the employers liability ends when the injured worker reached MMI. At that point all medical and benefits end. Then if the lawyer feels there is a strong case for total disability which in your case there IS if his reason for SSDI is directly related to his Work injury. It would have been helpful to know if he is still receiving any compensation OTHER THAN A LIEN-ABLE ADVANCE!!

    Sorry for such a newspaper reply but I just wanted you to understand the gravity of your case and situation. Always be respectful to your legal team as they are your future.

    Please feel free to ask any specific questions, just understand I have been in poor health qand it may take me a while to get back to you. We have many outstandingly bright folks on this forum, but like anything weigh out what you are told vs.what you know to be the case (including my writings) and go from there.

    WE ALL ARE HERE TO HELP YOU!!!! Please visit this thread it will help you understand NJWC

    https://www.workerscompensationinsur...y-Workers-Comp

    .Wishing you both well,
    BUG

  8. #8
    Join Date
    Apr 2018
    Posts
    7

    Default Re: WC 100% Disabled and MSA

    Quote Quoting bugmann View Post
    Ceaden4,

    Hi welcome to the NJ WC forum.I must say you have presented a very complex NJWC case and 3rd party liability only makes it more difficult. I must agree with Tony in that with the little legal info given and the complex nature of an interstate 3rd party case no one here maybe including your NJWC lawyer can answer your case at this point as they should be working with a NY WC expert to tie up all the loose ends on that side of your case and your lawyer should be considered at least a NJWC specialist, your family lawyer should be able to tell you this. Also you can call the NJ BAR as they will give you some background info like how long he/she has been practicing law in NJ as well as any special areas of law he specializes in. They will also tell you if there have been any disaplinaries filed against him/her and the outcome, but if the outcome was in his favor the BAR tends to omit the filing as mute and say no disaplinaries as his record MUST be spotless. I call this doing your homework on the lawyer you hire as so much of your future is in their hands you need to vent them as much as possible.

    Im sure I cant give you the answers you seek but I can give you some advice on NJWC Law and some places to go to get some answers you seek and then put it all together and hopefully get you as close as possible to what you seek.

    Your lawyer most likely does not return calls or make courtesy calls to you to keep you updated on your case, this is expected as great WC lawyers are much to busy to do this and they make their $$$ by lawyering not making calls that dont involve advancing your case such as a hearing date or IME that you must attend to keep your case from being tossed out.

    As for any MSA concerns you may have Im sure you can get much information from the NJ Dept. of Human Services, Division of Ageing Services. They have an excellent program called State Health Ins Assistance Program or "SHIP" for short. You can find them at http://www.state.nj.us/humanservices...services/ship/

    To learn how your MSA from your NJWC injury is going I found a step by step process that may get you at least a figure, this may be found at:

    http://www.nj.gov/labor/forms_pdfs/w...o_medicare.pdf

    Actually this site was found on the Dept of Labor Workforce Development. WC legal In formation/ Legal Links. To give you access to all the Medicare info to date let me link you to that page as its difficult to navigate yourself to this site:
    http://www.nj.gov/labor/wc/legal/medicare_lien.html
    This may help you find a way to the info you seek on that issue. However b4 you do ANYTHING like contact a WC dept you need to clear this with your lawyer and if there is any objection GET A REASON WHY!!!!!!!! For lawyers who dont return calls sometimes having/making a good communication connection with his secretary or receptionist may benefit you as you can ask your questions through them, then in a day or 2 call her/him back to follow up on your original question after the lawyer has responded to the question with an answer.

    Its unfortunate that in many 3rd party WC cases the injured ends up with less than had they just gone forward with a total disability claim with the work injury,the lawyer benefits the most as he collects in most 3rd party claims up to 40% of all awards In any event it takes a very skilled WC lawyer to win a total disability case in a NJWC Courtroom, this is why your homework must be completely vented on the lawyer you hire as this is the biggest part you play in your case.

    It is important for me to know if your hubby worked under a work agreement or was an "at will" employee.Even if under a work agreement if this agreement doesn't specifically mention your circumstance in the work agreement it may be im-material he was a Union or work agreement worker and the bare bones WC rules may still apply. I have barely scratched the surface of your case, and answered none of your questions yet, but only put you on the path to getting the answers you seek. There is just a few exception to future medical, but this is not always wise as then the carrier can call in the IW for a IME at anytime and as often as they feel it necessary, wwhen they get one of their "Drs in pocket" to say hubby is able to do sedentary work, then his medical for his work injury stops as does any compensation, at that point its hard to find a lawyer unless you pay them yourself as your attorney of record was paid his fee of 20% of all past monies due and was also paid 20% of your SIF benefit up to hubby's age of 65. If he is an honorable lawyer he should represent you since he has been payed, but I dont see any rule or law requiring him to do so. This why TONYS reply was so correct, which I agree 100% with.

    With all said I do believe there is a rule or law that requires NJWC to make a set aside for MEDICARE.

    OK now lets get to your NJWC case. The only way he can get WC responsible for any future medical is if his work agreement specifically states this in his work agreement. AS in NJ the employers liability ends when the injured worker reached MMI. At that point all medical and benefits end. Then if the lawyer feels there is a strong case for total disability which in your case there IS if his reason for SSDI is directly related to his Work injury. It would have been helpful to know if he is still receiving any compensation OTHER THAN A LIEN-ABLE ADVANCE!!

    Sorry for such a newspaper reply but I just wanted you to understand the gravity of your case and situation. Always be respectful to your legal team as they are your future.

    Please feel free to ask any specific questions, just understand I have been in poor health qand it may take me a while to get back to you. We have many outstandingly bright folks on this forum, but like anything weigh out what you are told vs.what you know to be the case (including my writings) and go from there.

    WE ALL ARE HERE TO HELP YOU!!!! Please visit this thread it will help you understand NJWC

    https://www.workerscompensationinsur...y-Workers-Comp

    .Wishing you both well,
    BUG
    Thank You so much for taking the time to answer. Sorry it took so long for me to thank you. My husband met the 400 week max, but still being medically treated. Now I just found out when his workers comp case is over, they don't have to give me the 15 months they stopped paying him in 2010 and the last 4 months since he met max. Every time we turn around its more bad news. Has anyone met the 400 max and recieved 100% disability rating and can tell me how long you get paid and will there be any lump sum money . I have bills piling up since they stopped paying him 4 months ago, and from what I've read it could take 2 yrs if you go to trial.

    Yes my husband still gets SSD from his accident. I've just learned if he gets 100% disability and wins his 3rd party suit. The NJ WC is responsible for 1/3 of his pay and a 3rd of medical bills and Medicare will never cover him for his back. If I settled his NJ WC for less than 100%. Then NJ WC must do an MSA and when that's exhausted Medicare would then cover his injury. This case is incredibly complex. Thanks to all who has responded

  9. #9
    Join Date
    Jan 2007
    Location
    PA, but worked in NJ
    Posts
    821

    Default Re: WC 100% Disabled and MSA

    Ceaden4,

    Getting on NJWC is just bad news to begin with, it seems like all will be OK until they begin taking away benefits. Its very unusual for anyone to max out the 400 week max of temp total disability benefits in NJWC. I call this step 1. Consider yourself fortunate. Thats why I asked if he was a union worker, as those have agreements if anyione gets hurt on the job and your hubbys Union must be as long as he is undder care WC continues, however this agreement cant rewrite the NJWC Laws & rules. After I was MMI'd it took me 2 years of no income to get my SSDI approved then it took another 2-3 years to get my SIF benefits or Total Disability from NJWC. However each case is based on its merits therefore there is no one size fits all answers. You must consider the backlog of cases as well as your lawyers ability to put together your application for SIF benefits. Also I think you have a 3rd party claim as well and this may need to settle 1st b4 SIF case may move forward.

    Your case is called up b4 the Judge every 3-4 weeks this is called rotation, and this is to inform the JUDGE of progress each side has made.You will get NO back pay for the 400 weeks of total disability as you have allreqdy received your award amount. So take your weekly TTD amount and X it by the weeks you get no income and that would be your award should you be approved for SIF. Less your lawyer fees and in cases like this the ins co pays a very high % of your fees but your lawyer will get 20% of all the benefits hubby would get until he is 65. If you want I can dig up the law that explains this part. Someone had to have mis informed you as I said WC liability for medical terminates at MMI, therefore you will not get 1/3 of any medical bill as they are only responsible for all medical. After NJWC is not liable for his injuries YES MEDICARE WILL pay for all medical at 80% unless you get something like a HIGHMARK MEDICARE plan which I strongly suggest you get. It is complex as well as full of BS and you need wings to stay above it. YOU MUST STAY ABOVE IT or sink in it. Im sure I can help you prepare and give you the choices in advance of what you will need to face with the exception of the 3rd party claim as thaqt is personql injury and I hope your lawyer is not a personal injury lawyer as they rarely know the ins and outs of NJWC Law and rules WC is its own separate courthouse. Just b very careful of what you post as investigators troll these kinds of sites looking for those they need info on. We dont want to make their job any easier if at all possible.

    Most of us here have been where you are now except we got there sooner thn 400 weeks I was there in 16 weeks and had to live on savings and assistance. from my local township

    I hope this is help ful if not please tell me where I drifted off point from your questions

    Good nite 4 now,
    BUG


    Quote Quoting Ceaden4 View Post
    Thank You so much for taking the time to answer. Sorry it took so long for me to thank you. My husband met the 400 week max, but still being medically treated. Now I just found out when his workers comp case is over, they don't have to give me the 15 months they stopped paying him in 2010 and the last 4 months since he met max. Every time we turn around its more bad news. Has anyone met the 400 max and recieved 100% disability rating and can tell me how long you get paid and will there be any lump sum money . I have bills piling up since they stopped paying him 4 months ago, and from what I've read it could take 2 yrs if you go to trial.

    Yes my husband still gets SSD from his accident. I've just learned if he gets 100% disability and wins his 3rd party suit. The NJ WC is responsible for 1/3 of his pay and a 3rd of medical bills and Medicare will never cover him for his back. If I settled his NJ WC for less than 100%. Then NJ WC must do an MSA and when that's exhausted Medicare would then cover his injury. This case is incredibly complex. Thanks to all who has responded

  10. #10
    Join Date
    Apr 2018
    Posts
    7

    Default Re: WC 100% Disabled and MSA

    Thank you again!!!!

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