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  1. #1
    Join Date
    Oct 2018
    Posts
    5

    Default Whole Body vs. Scheduled Member

    My workers compensation claim was made in the State of: Iowa

    I called the WC insurance manager today because it's been a couple months knowing they had the dr's MMI report and I hadn't received a letter of explanation from WC.
    Turns out the manager claimed to have sent one and is sending a second letter out now.
    My ratings from the dr are 18% of the shoulder (400weeks) and 11% whole body(500weeks).
    The WC manager told me they are paying on the whole body. I mentioned I felt that's wrong because the superspinatus is completely and permanently torn away and it should be shoulder (schedule member) based. Which would obviously grant me more weeks. Also mentioned the weakness in the arm is the result of the torn shoulder.
    WC claimed that it wouldn't be considered shoulder and they would put me down as scheduled member for the arm(250weeks) instead lowering my settlement weeks.
    Before I call my "lawman" these next couple days.....this sounded like a common scheme to lower my settlement.
    By the way,I'm recieving weekly annuity and I haven't signed or seen any explanation of their settlement.
    Can they really make their own decision on paying either of ratings based on their cost savings?
    Thanks

  2. #2
    Join Date
    Oct 1971
    Posts
    5,008

    Default Re: Whole Body vs. Scheduled Member

    DM59
    Can they really make their own decision on paying either of ratings based on their cost savings?
    Sure, unless you enforce your rights the carrier is free to play any game they wish.

    You are the clamant, it's your responsibility to assure your claim is filed properly and supported with objective evidence.
    Without a lawyer you're at the mercy of the carrier - they'll chew you up and spit you out.
    I strongly advise you to contact a "lawman" and have no further contact with that carrier or employer until you do so.

    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.

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