Did insurance send a Compromise & Release to you to settle your case? Watch for these issues.
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- Опубликовано: 3 авг 2021
- This video reviews the Compromise and Release (C&R) often used to settle workers’ comp cases. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
Once the injured worker and insurance company (or their attorney) come to an agreement, the insurance will usually draft the settlement documents to send to the injured employee. Assuming an agreement is reached to close out all issues, a C&R will be drafted. This option generally provides for a lump sum payment, and will close out the injured worker’s future medical care and right to reopen. This video reviews some of the common issues that come up, and watch to what for when reviewing a C&R.
Jeremy Lusk is a certified specialist in workers’ compensation with almost two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
The C&R referenced in the video is available here - www.dir.ca.gov/dwc/FORMS/EAMS...
If you have any questions, let us know at questions@mywcguide.com
Thanks sir. You are wonderful. I like to hear your thoughts and speak about worker's comp things.
Thank you for the kind words. Happy to help inform.
Thank you for taking your time to explain this document.
Happy to help inform.
That was a damn good video so ppd checks is your settlement
Thanks! The permanent partial disability checks are part of your settlement. If you settle with Stipulations with Request for Award, the payments that are made are your permanent partial disability. Those are the checks issued every two weeks. The insurance company will also pay permanent disability advances before the Award issues, as they are required to do so in the Labor Code. Because those are advances, they are part of the final settlement. Things are a bit different if you settle with a C&R, as the permanent disability is only part of the settlement. A C&R also includes future medical, closure value, and potentially resolves other disputes as well.
Thank you for your willingness to help those without an attorney! I was wondering if you could explain Medicare set aside, the importance of a Medicare set aside review, and how a lump sum settlement is paid out if you are on Medicare? Thank you again!
That is a very involved question, and presentations that cover that topic last for hours and barely scratch the surface. In short, if a person is on Medicare or expects to be within 30 months of settling, the parties have to take into consideration Medicare's interests, and that is generally done through a Medicare Set Aside analysis that reviews medical treatment to date and anticipated, and makes an estimate of what medical costs will be for the injured worker's lifetime for Medicare covered expenses. If a MSA is generated, and approved by CMS, and is worked into the settlement, the payment may be made in a lump sum to the injured worker to be self-administered, it may be paid in a lump sum to be professionally administered, or it may be paid with a seed amount and annual payments. Also, it does not take into account non-Medicare covered expenses. It is a very complicated area of the law, and I strongly recommend that any injured worker going in to such a settlement talk to an attorney.
How does the settlement payout work ? Does the insurance carrier write the attorney a check and then the law firm write a check to the injured worker? What if the worker does not have a bank account? Can the firm give the worker prepaid debit cards or a cashier's check ?
Very informative. One question WC benefits were paid to me for 1 year and they claimed edd of one year I was on it . Making it two years paid benefits claimed by the insurance company . If I filed for edd again does that part come out of my settlement or is the WC benefit on the hook for that benefit of edd to be paid back ?
Thanks for the compliment. As to the EDD, there are a number of variables that can come in to play. If workers' comp paid for one year of TD, and EDD paid for one additional year of TD (different dates), what generally happens at claim resolution is that workers' comp will reimburse EDD for that one year of payments. This assumes that you were temporarily totally disabled for the full two years (or on modified duties but couldn't return to work). This is because workers' comp owes a maximum of two years of TD generally, and when they reimburse EDD for that one year then workers' comp gets to take credit for the one year it paid and the one year EDD paid, so in the end workers' comp paid for two years. When that happens, the money paid to the EDD does go back into your account so you can file again down the road for disability or unemployment. Generally workers' comp ends up paying EDD unless you were getting benefits from EDD and workers' comp but didn't tell anyone in which case EDD reimbursement may come from your part of the settlement. It is not as common for an injured worker to pay back EDD, and you may want to reach out to your local Information and Assistance officer at your WCAB office for further answers, or reach out to an attorney for a consult. If you have more questions, let us know.
Does older age decrease the value of w/c Case?
Even grand father lived 104?
Appreciate your valuable responses
Does untreated body parts have to be listed on the c/r?
Am still miss up can't get a lawyer an can't work still frightened them on it .
Which pays more?
CDA OR C&R ?
Is there a max fee % allowed by state for attorneys fees? My attorney wants 30% of settlement. Can I back out of the settlement if I dont like the amount and not have to pay the attorney if they are on contingency?
I'm only familiar with California workers' comp, and I don't know what a CDA is. In California, the maximum allowed for attorney fees is generally 15%. I've never seen anything close to 30% awarded, but again, that's for California.
Milage coverage
Is it declined if treating doctors are not within the insurance company network?
What if your claim got approved, had IMEs that recommended that the insurer pay benefits, you're unable to work due to permanent disabilities related to your injury. What happens next? But insurance denied all further treatments last month pending the last IME which is next month. But even if the injury is stationary, I still need to see doctors. My attorney said they started negotiating almost a year ago. Is this something that may go to trial?
It may go to trial. It seems odd that if your claim is accepted that workers' comp would deny all treatment. However, since you have an attorney you really need to ask him or her as that person knows the facts of your case best. I would only be guessing as to what is happening in your specific case.
I’m skeptical of my lawyer I signed my portion of a compromise and release settlement and apparently my attorney did as well. The defendants haven’t filed anything to workers comp judge and it’s been over 3 weeks since I signed. Apparently they are waiting on a letter from edd which is clearance or proof that I don’t have any liens that I owe. Which I don’t and never received any payments or unemployment as I never stopped working. Is that a real thing they need? That edd letter ?
Your attorney would know best in your case, but I will say that this is a possibility. A lot of judges at the Workers' Compensation Appeals Board are reluctant to approve a C&R without EDD "signing off." Essentially it is EDD confirming that there is no outstanding balance. Sometimes it is very simple, there is no balance, and the attorneys just need a quick form that the EDD provides. That streamlines the WCAB approval. However, if benefits have been paid it can create a real headache for everyone as sometimes the defendant must reimburse EDD, sometimes they don't get reimbursed, sometimes the injured worker must reimburse, and sometimes it's a complicated mix of all three depending on dates paid, rates paid, and why. So, as to your question of trying to get EDD approval and is that a real thing - yes, it can be a real thing.
@@myworkerscompguide thank you so much for the information I really appreciate it!
Hey how are you? Got a ? Workers comp insurance just offered me a compromise and release. With the stipulation I resign. I turned it down. So my question is if I turned it down. Am I still eligible for a monetary settlement when I go back to work ?
If you keep working at the same employer, generally the only option for settlement is Stipulations with Request for Award. So the insurance company will pay you any permanent partial disability (often the $580 checks every two weeks), but they will not buy out your future medical care. So you cannot generally settle with a C&R, which is a lump sum payment, if you keep working there. Here's a video as to why - ruclips.net/video/ekbTQ1pJ-NA/видео.html
Do medical bills amount effect the final settlement value /offer?
Is there a way for injured employee to explain what it feels to a judge if have an attorney?
Medical bills that have been incurred do not usually directly influence the settlement amount. However, if there have been more medical bills than average it likely is a more serious injury which may mean a higher settlement. The settlement is really based on the PD value and potentially the future medical care. If you have an attorney, you need to ask him or her about what your settlement will be based on as every case is different. As to talking to a judge, settlements are generally based on the medical reporting, and not on what an injured worker tells a judge.
My California C&R settlement was approved $50k minus 15% attorney fees and a few advance permanent partial paymets so the total written was a little ovwr $37k for me take home. 1 week after the judge approved it I got a $7k direct deposit from the insurance. I'm confused as my attorney said it would be one lump sum paymet in Check form delivered to my address in full $37. I dont have child support or EDD pending. So why only $7k and not the full amount in a check form?
I have seen situations in which the insurance company pays the C&R settlement with several checks instead of just one. It's not common, but it happens. As to your situation, I could not say. You would need to ask your attorney what's happening with that payment.
Can private insurance be used for a work injury that was settled under compromised and release?
I'm not sure I understand your question. If you are asking if you can pursue medical treatment through your private health insurance after settling a case with a C&R, from what I have seen lately that has been working. Years back insurance companies would not authorize treatment, but these days it seems that most do. I'd recommend checking with your insurance company.
How long after signed does it take to get a check I also got a voucher for job placement
After signing the settlement documents the time can vary. Then the adjuster or defense attorney needs to sign, and they may need to get clearance from the EDD. Then they need to get e-filed with the WCAB. Once they are filed with the Board the judge generally has 15 days to approve, deny, or suspend action on the settlement. Once approved, insurance generally needs to cut a check within 30 days.
Hi! A judge already granted my c&r. Would you happen to know if I will receive my settlement check via USPS?
I am a little worried I might miss the check or it might get stolen or lost.
Thank you.
There's no law that I know of as to how the settlement check has to be sent out. The important thing is the timing. If I had to place a bet, I'd say the adjuster will send it out via US Mail, as that's what I always see. The adjuster has 30 days to issue the check, but they usually issue it within a couple of weeks of receipt of the Order Approving.
Sign up with your postal office online to receive an email pictures of what mail you will be receiving everyday
Where to sign the document compromise and R. in the interpreter office or lawyer office? Anyway what is the difference they alredy filled out the form for me.
The location where you sign the C&R does not matter, so it can be in an attorney's office or in the interpreter's office. The form will be filled out, but it still must be signed by the injured worker and either notarized or witnessed by two other people.
I sing mine 6 weeks ago and my lawyers assistant said they haven’t filed it, what can I do? I always call them but never hear back from them. What can I do I tried to fired them but they are just play games
There could be a number of reasons it has not been filed yet such as getting clearance from the EDD that there is no lien, perhaps getting defense attorney to agree to changes made by your attorney, or perhaps waiting on the defense attorney to sign. You can fire your attorney at any time, but it sounds like your case is in its final days, so I'd recommend to continue following up with your attorney.
You explained everything great, but the C&R drafted by the lawyer representing the insurance company does not have my DOB or SS# on the C&R paper, just my name & mailing address. Also when I do get it signed, they want it notarized. Is that standard practice if both parties are not there together. I just find it odd that they are waiting for my signature, but it has to be notarized, but they can sign there signatures later to be sent to Industry Commission to be approved for my settlement check.
Sometimes defense attorneys will leave blank areas because they want the injured worker to fill them in, such as correct mailing address for the final settlement check. Getting the C&R notarized when the injured worker signs it is common. California law requires either two witnesses to the applicant signing, or that it is notarized. That requirement only pertains to the injured worker's signature.
@@myworkerscompguide Thank you for responding so quickly!
@@starforcefighter Happy to help inform. Best of luck to you.
I have a 4 year old case but still not settled yet.
Unfortunately this is common. I have many cases that are many years old. Best of luck.
what about unpaid medical bills? I am being offered a C&R while my claim status is currently denied and the Insurer agreed to pay any outstanding liens including medical liens however a lien for the hospital bill related to my pled work injury has not been filed (the hospital has been sending me the bill as the claims adjuster told them my claim was denied. ) thanks
One option in that scenario is to have the hospital send the billing to the adjuster, and give them the claim number and everything. Another option is to put language into the C&R that the defendant will pay the outstanding billing related to the claimed injury. One of the worst options is to just ignore it and hope it all works out in the end.
Can someone get a new attorney for workers comp case after 3 and half years Living with pain and the offer is not reasonable also request to sign missing and incorrect information on the settlement c/r release?
Doe’s surgery decrease the offer offered now. Does going back to qme with his request cause he did not check one of the body part requested decrease the case value?
Is aggravated body parts that has injury from 21 years ago ( no previous claims) increase case value .
Does Abdul credit works in California now days?
Does working pt Uber driver wipes a way rights to collect benifits since w/c was retail w2 job?
Thank you sir
An injured worker can fire his or her attorney and hire a new attorney. However, it can be tough to do this as the fee will have to be split between the two attorneys. It sounds like you have an attorney, so I cannot speak as to any settlement offer or signing incorrect paperwork. You would have to ask your attorney as he or she knows your case best. He or she would know any impact on surgery on the settlement offer. I do not know what Abdul credit is. If you work at Uber it would not preclude you from filing a workers' comp claim against another employer where you got a W2. But it sounds like you may have an attorney, so you should ask him or her. Best of luck to you.
WHAT DOES THE COST OF ALL MEDICAL BILLS HAS TO DO WITH MY SETTLEMENT?
Past medical bills that have been paid by the insurance company generally do not factor in to a settlement whether by Stipulations or by C&R. The only time it's a factor is just to use as a general guide if you're settling out future medical with a C&R, and you want to see how much has been spent by year in the past on a claim, and use that as a predictor for future costs - but that assumes future medical treatment will be the same as past treatment. That's not very common. I would use that figure on a very old claim, with an injury that occurred fifteen years ago, and the applicant has a life expectancy of another fifteen years, as it can give some guidance then. If you're settling by way of Stipulations with open medical care, then how much insurance has paid for medical to date really doesn't matter.
My cr given to my attorney didnt have my social and defense filed without it. Issue?
Probably not. A Social Security number isn't required for workers' comp benefits, so a settlement can be approved even if the injured worker doesn't have one.
The JUDGE can ask for more $ if the amount is to low in comparison of total medical bills paid?
Not really, but in a way, yes. The judge cannot advocate for the injured worker. And the judge cannot ask the insurance company adjuster or defense attorney for more money in the settlement. However, if a settlement is presented to the judge, the judge can find the settlement to not be adequate as it is too small. The judge could then reject that settlement, unless more money was included. So the direct answer is that the judge cannot ask for more money. But in a way, he or she can reject a settlement until more is paid.
Thank you soo much for your videos first time here.
Quick question I signed my settlement and is been over two months seems they received it. Question is : Do they have to pay penalty because is being over two months ?
Penalties and interest generally only apply when a payment is due, and the payment for a settlement of a case is technically only due once a judge issues an Order Approving. So if the judge hasn't approved the C&R yet, there's no late fees or interest yet. The only potential difference would be if you settled with Stipulations with Request for Award, and for some reason the adjuster stopped PDA's pending the issuance of the Award. In that case, depending on the facts, there may be penalties.
I spoke with the defense attorney today on my case. He stated that the judge is going to think my settlement offer is too low. He is going to reach back out to the claim specialist for a higher settlement offer. Is that something that normally takes place?
He also stated that I need to witnesses to sign. Can one of them be a family member ?
How do you know if you have permanent disability advances? Is that once you agree to a settlement but haven’t signed paperwork yet or is that once you sign papers? I’m supposed to sign paperwork this week but we came to agreement on settlement June 17. After that the claim specialist ignored my emails for almost 5 weeks I’m just curious if that cost part of my settlement? I haven’t received anything from EDD (side note)
Defense attorneys often appear in front of judges, and after doing the job for a number of years can get a good feeling of what local judges will and will not approve. So it's not unheard of. The C&R does need to be signed either by two witnesses, or you can sign it with a notary public who notarizes your signature. Either works. As to a family member, the Labor Code says, "Every release or compromise agreement shall be in writing and duly executed, and the signature of the employee or other beneficiary shall be attested by two disinterested witnesses or acknowledged before a notary public." So a family member could sign, but it would need to be someone disinterested. So, not a spouse or child.
@@Analysemarie The defense attorney or adjuster can confirm if there are PDA's. They will also be listed on the C&R. A typical C&R is a set sum of money, less any PDA's listed specifically on the C&R at the time of drafting, and less any additional PDA's made after the drafting but subject to proof (so the defense has to show that they actually paid them).
@@myworkerscompguide OK great thank you so much.. to clarify if papers haven’t been drafted yet I wouldn’t have any PD advances?
@@myworkerscompguide thank you the defense attorney stated that he felt the judge would say it wasn’t an adequate settlement amount and more settlement. He stated that he’s going to reach out to the claim specialist and ask for a better settlement offer. He says that the judge works above him and he’s close friends outside of work with her yet she follows rules to the T.
Why is workers comp insurance company requesting a 1020 form from me all of a sudden?
I'm not familiar with a form 1020. Maybe it's for a state other than California?
Again - thank you for another helpful video. Would you be so kind to take the time to explain CA Lab code 5100 - 5106 and how the WCAB may or may not alter a C&R after all other parties have signed off on the agreement?
Good request. I've had several people ask about this recently. I'll do a video on that soon.
How do you get a stip instead of a C&R ?
You can just tell the adjuster that you don't want a C&R, and that you only want Stipulations instead. You generally have to be permanent and stationary first, and there must be a ratable report to address the level of permanent partial disability. But once you are at that stage, Stips are a common way to settle.
@@myworkerscompguide I am at that stage and received the C&R but I’m very concerned about future medical. I haven’t signed anything.
@@p.sherman3158 If you don't want the C&R, just don't sign it. Tell the adjuster you want to keep your medical open. Tell the adjuster to send Stips to you. They can't force you to agree to a C&R.
@@myworkerscompguide what’s it called again ? Stipulation with …..?
@@p.sherman3158 Stipulations with Request for Award. This video reviews the document ruclips.net/video/hN06ZC7D-Pw/видео.html
Not in texas they say no money.
I have no experience with Texas' law. Every state is different. Best of luck to you.
Is it common practice to sign away your right to sue the insurance company and your employer even before going into negotiations???
I'm not sure what you mean. Generally an injured employee in California cannot sue their employer, as workers' comp is the exclusive remedy and that's really against the insurance company. An injured worker could settle the case against the insurance company very early on, but that would require agreeing to terms and that would at least open the door to negotiations. The only way a workers' comp case really gets settled in California is if both sides agree to terms, sign the documents, and the judge finds the settlement to be adequate and approves it. So there wouldn't be a signing away of rights to sue before even negotiating a settlement.
@@myworkerscompguide it happened in iowa. And the insurance company denied my claim because of the coming and going clause, which didn’t apply to me as I was a traveler and was using a company vehicle while traveling.
They stayed on that stance until I got a lawyer involved, but he hasn’t gotten any evidence to help me. He didn’t file for the video from the hotel or the hospital.
@@MrSlicky77 Every state has its own unique workers' comp system, and I have no experience with Iowa's system. Best of luck to you.
@@myworkerscompguide what if your employers HR person helped delay your benefits by not send a letter saying I was a traveler and the coming and going clause doesn’t apply to me?
And it took them 7 or 9 nine months to start getting me medical treatment. Just because they believed I didn’t qualify solely because of that reason.
@@MrSlicky77 I really couldn't say, as you mentioned that you're in Iowa. I have no experience with the law there at all. In California the going and coming rule is used to deny cases, and then it may be overcome depending on the facts. But I just don't know about Iowa. I'd recommend talking to an attorney there who is familiar with Iowa's laws.
Hi great video. I'm in the settlement sage of my case and have moved from the state where i was injured. Will this affect my settlement?
I can only speak as to California workers' comp cases, as that's the system I know. If someone moves out of California during the settlement stage, it really doesn't affect it at all assuming the insurance company has the injured worker's new address to mail out the check. If future medical care is kept open, it won't really affect the settlement, but it can be a pain in the neck finding a treating doctor out of state to handle a California workers' comp case.
Unfortunately my Dad signed this, his attorney told him that was the best thing, that other path will take more years, and he will end with less money. So he signed and he ha sto resign from his job, The problem is my Dad is 65 years old and not elegible yet for social security or disability from them. Now he is unemployed and it's being hard for him find a job that accommodate his permanent restrictions 😢 I wish I watched this video before he signed.
Best of luck to your dad.
Hello Attorney Lusk, I tried to find the PDF form for the Petition to Set Aside A Compromise and Release Form for the Pro Per Applicant on the DWC SIte. I could not find can you send me a link please to the PDF. Thank you for your continued support.
There is no standard template, or form, for a Petition to Set Aside. It's going to require, generally, a Petition that lays out the facts of the case, and shows "good cause" per Labor Code section 5803 to set aside a C&R. From what you've described, you would outline the issues regarding the signatures. In short, you will need to show that there were facts not within the knowledge of the judge at the time of the approval. There are also time limits, so you want to make sure you file it as soon as possible. You may want to review these two forms to get an idea www.dir.ca.gov/dwc/FORMS/PetitionOfRecon.pdf and www.dir.ca.gov/dwc/FORMS/DWC_Form42.pdf and you will also need to file a verification under penalty of perjury with the petition.
Somebody told me if you turn down a compromise and release with resignation. And elect to go back to work. I heard a lot of employers look for any excuses to fire you cause your now a medical liability to the company and insurance company. And now they're looking to get away Scott free without having to pay any future medical.. Any truth to that? I told you I declined my compromise and release with resignation..
It is true that some employers may try to retaliate, but if an employer terminates an employee because they had an injury at work, or because they have a disability now, they are potentially liable for Labor Code violations, DFEH violations under California law, and ADA violations under Federal law. I suspect most employers would strive to avoid those issues. Also, if a case is resolved with Stipulations with Request for Award with open medical care, it doesn't matter what the employee does whether it's to stay with that employer, quit, or get fired. There is still an Award from the WCAB for open medical.
@@myworkerscompguide Thanks ..
I had a hearing today the judge was supposed to call me I had already spoken to my attorney my worker’s compensation settlement was signed from both ends and after I waited for the call no one was calling I started to worry so my attorney called me telling me there’s was a glitch by someone from the insurance carrier not wanting to go ahead with the settlement. I’m devastated. So my attorney said he will tell me what’s going on in couple of days. My Christmas and my dream is shuttered. What could’ve had gone wrong? Does the insurance carrier has th right to back out the settlement after they offered it and signed it?
Unfortunately every case is unique, and I have no way of knowing what is happening in your case. You would have to ask your attorney what is happening and why. Best of luck.
@@myworkerscompguide Thank you!
I just had ankle surgery about a week ago is it smart to ask my adjuster for a C&R before my MMI date if so, how would I ask? Just a simple email saying hey I’m interested in a C&R is this something you would consider?”
Possible to just ask for a C&R now? Yes. Smart? Not likely. What level of permanent impairment do you have? Will you need another surgery soon? Another surgery in a few years? What type of future medical do you need. Without the adjuster just throwing money at you (which rarely happens), the judge won't be able to determine adequacy, and the judge will likely want a QME report.
@@myworkerscompguide okay thank you! One more question if I may, how can I get that QME report when will it happen & when will my doctor give me a disability rating? Does all this happen once I reach my MMI date? I guess I’m just worried that when my doctor releases me back to work I won’t be ready he’s thinking 5 weeks I should be able to return to normal activities and if I simply can’t do it I don’t want my TTD benefits to end unexpectedly & have me left with no money to cover bills do I just need to be patient & let it play out? I apologise if I’m not being clear I know it’s vague
@@josephvillegas Unfortunately workers' comp is a very slow system. And by slow, I mean SLOW. Your treating doctor might not give you a disability rating. Some do, and some don't. Your doctor might release you to work, and recommend a QME to address disability. You can request a QME. If the adjuster hasn't sent the paperwork to you, you can call your local I&A Office for assistance here - www.dir.ca.gov/dwc/IandA.html#IandAoffices Also, your doctor might release you to work, but only light duty such as "must be able to sit or stand as needed, and no standing more than 20 minutes per hour." It will then depend on whether your employer can accommodate those restrictions. If yes, you can return to light duty work for a while; if no, then you stay home and keep collecting TD.
@@myworkerscompguide Got it awesome! Again, thank you so much for your help not many channels take the time to reply to the viewers comments & individual needs. You have gone above & beyond I’ve gotten more from you then I did anywhere else during this whole process your channel is by far underrated & needs to be shared so other people can get the help & answers they need! Will definitely be recommending this channel thank you, thank you, thank you!
@@josephvillegas Happy to help inform. When I served as a judge there were many injured workers who appeared in my courtroom, but they didn't have an attorney. When I left the bench I wanted to create resource to help those unrepresented injured workers who were trying to figure out this goofy system. Best of luck.