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How do I start settlement talks to settle my workers' comp case?
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- Опубликовано: 8 авг 2024
- This video reviews starting settlement talks. 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.
Many injured workers aren't sure how to get settlement talks started. However, assuming no attorney on either side, it's really as easy as picking up the phone and telling the adjuster you want to settle. Will you get a good offer, or will the adjuster even answer? That's another issue entirely.
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.
If you have any questions, let us know at questions@mywcguide.com
Great video as always. I have a lawyer. In a diffrent state than you. But honestly your videos are more informative than my attorney. 👍🏾
Thanks. I started the videos to help injured workers without attorneys, but it seems many of my comments come from injured workers with attorneys but that aren't getting answers. In your case, just be careful as everything I talk about is aimed at California injured workers in our California system. It's a strange system, and other states vary. Best of luck.
@@myworkerscompguide yeah I know thank you. I'm in New york. Although diffrent states I still learn from the basics of your comments.
@@myworkerscompguide I been out for 3 months I have two torn meniscus in bi lateral knees. Three herniated disc's lower back and one bolging disc lower back. And a slight tear In my elbow.
@@williamlevi5051 glad to hear it. Best of luck.
@@myworkerscompguide how do I dispute my treating doctor's impairment rating. My case is CTS and Im at MMI. My doctor did not measure the range of motion. Insurance company didnt send me to an Independent Medical Examiner (IME) but I have a scheduled hearing in September.
My case is moving so slow. I know my lawyer is trying his best. Thank you for this video because it answered a question I had.
Glad to help inform. Workers' comp is a slow process. And by slow, I mean SLOOOOW. I tell my clients that no matter how slow they think it will be, it will be even slower than that. Best of luck to you.
Solid advice, thanks.
Happy to help inform.
Thank you so much for the tip..
Happy to help inform. Best of luck.
Great video
Thanks!
Very helpful info thanks. Question is a claim manager and a adjuster the same thing for a self insured company???
A self-insured company will generally have a Third Part Administrator (TPA) such as Sedgwick or TriStar or Risico administer their claims. At those TPA's, claims adjusters generally handle the files, while claims managers generally oversee the claims adjusters. So at most TPA's, the claims manager is more of a supervisor of the adjusters.
Thanks for this video! I've been on workmans comp for over a year and a half now. I've been off work since February of this year. I think you answered this question, but wanted to verify. If I wanted to settle right now, but wasn't happy with offer, can I continue with my doctor visits and pt? I could resume my regular care through workmans insurance if I change my mind about settling?
If treatment is ongoing, and the injured worker isn't yet permanent and stationary, then the insurance company can't force a settlement. Treatment needs to continue until P&S status, and even then, the insurance company can't force an injured worker to close out medical. The only way the insurance company can buy out all future medical treatment and close the file is if both sides agree, and the judge approves the settlement.
Good afternoon, thank you for all the information. I have a question. It's true that if I had surgery and I'm not working on the money I receive every week, they're going to reduce it at the end of the case. Yes, I've been almost a year old, thank you
I can read your question two different ways, so let me try to answer both - If you're not working now and you are getting temporary disability, then it is true that when TD ends that permanent disability advances (PDA's) will start, and PDA checks are almost always less than TD checks. For example, you might get a TD check every two weeks which is $1,143.58, but when that ends your PDA checks will likely be $580.00. The other thing you might mean, is that PDA checks are "advances" on the settlement. So any PDA checks that are issued do get deducted from the settlement at the end. So you might end up settling for $50,000, but if insurance paid you $20,000 in PDA's, then you're only getting a check for $30,000 after the judge issues the award. Any TD checks do not get deducted from the final settlement - only PDA checks get deducted as they are advances on the settlement.
I have a question I have multiple injury’s ( semi truck rollover ) one being whiplash in my neck the other being 3 tears in my left shoulder . I have lost a little range not a lot but I have pain still in shoulder . Lost some range in my neck as well . I also have a hip labrum tear . I’ve been doing pt on my hip but my ptp & / my Specialist for my hip thinks it might be my lower back & hip but I haven’t got any mri on my back yet . And thinking they might request one since pt isn’t helping my hip . Surgeon said tear isn’t big enough on hip but my pain says otherwise. I already done pt on my other injury’s and seen a Specialist for my shoulder already he said surgery is 50/50 on fixing the problem .I went to an AME once but returning for my 2nd AME in July . Do you think my AME will MMI or p&s me come July ? Also I’ve been on workers comp for about 18 months now I’m burnt out . I’ve learned to manage my pain & deal with it best I can would it be smart to make my lawyer demand a settlement or wait to see what AME says . I just feel like after my AME in July if we proceed to get one of my lower back it’s going to be other 10 + months . Like I stated before I’m burnt . Been on restrictions & employer is Discriminating/retaliating against me every since I hired my lawyer & my lawyer bearly filed a 132a form . I just guess what I’m asking for is legal advice on would I should do & would I ruin my settlement amount by just cutting my losses by just with the information they have now and moving on with my life .
I can say that workers' comp cases can take way too long to settle. So you mentioned 18 months, and in the realm of workers' comp that is not very long. That would be doubly true with a possible labrum tear and possible back surgery. It's just a frustrating and slow process. As you have an attorney, he or she would know best as to strategy and an expected timeline. Every case is different, and some cases are best to settle fast while others are best to really work up and get a full picture to maximize settlement value. Talk to your attorney about strategy on your case.
I have a case almost four years. Still going on so what should I do please let me know. I had a back and neck injury happened 2018. Still I am under treatment. No surgery yet. How much should I get the money?
The first step is to get treatment so that your condition is leveled off, or what we call P&S. Once your condition is at a plateau, then you can see a QME to address your level of permanent disability. Once you get that report, then you can settle. But every case is unique, and some settle after a few months and some settle after several years. I can't give you advice as to what you should do in your specific case. I'd recommend reaching out to a local attorney for a free consultation. You can do a Google search and also search for attorneys in your area who are certified specialists in workers' comp by the State of California at apps.calbar.ca.gov/attorney/LicenseeSearch/QuickSearch#searchlink and click on Advanced Search
I have no idea if I am getting a fair shake or not I previously worked for a large airline carrier here in California.( non union I was let go I feel like for retaliation). while working on the job last year I sustained a right knee injury . After I was let go I was contacted by a sedwick agent suggesting I take a settlement and the best he could offer is 10k . My PD is 5% I do from time to time still feel pain in this knee. I don't know if this is a good offer or not
It's tough to say over this system. Knee injuries often have low PD ratings, and it could be only 5%. If your knee is doing good and no doctors are concerned about future surgery, then $10,000 might be fair. I'd recommend either reaching out to your local I&A officer at the WCAB, or a local attorney who is a certified specialist in workers' comp. You can do a search for a certified specialist in your area by going to apps.calbar.ca.gov/attorney/LicenseeSearch/QuickSearch#searchlink and clicking on Advanced Search
I have a hearing in July for my workers comp claim that has been going since July of 2022 I reached out to my attorney and told him I want to settle. But my attorney’s office sucks with communication, what’s the best way to light a fire under them? I call and typically get no response… Sidenote; my employer’s attorney said my claim was “compensable”.
Just keep following up with your attorney's office. Because workers' comp settlements are often so small, and because the attorney only gets 15% of the final settlement, most applicant attorneys handle many cases at one time, so the offices are very busy.
I got a wpi of 18 percent what is the next steps on how to settle? And is wpi the same as disability rating?
The QME or adjuster will likely send the report to the DEU to get rated. The 18% WPI will get rated out for age and occupation, and may end up being in the range of 25% permanent disability or so. Then that may get lowered based on apportionment. Then you'll need to talk to the adjuster about whether you want a C&R and whether they do, and if either doesn't, then you'll probably move forward with Stipulations.
My company went out of business. I was on modified duty which my employer could not accommodate. Now I expect my PTP to release me to full duty next week. Will my TD payments continue till I find work? Or untill P&S? Is it my best interest to wait to find employment untill offer settlement?
Your TD payments will continue until your doctor releases you to full duties or finds your condition P&S, generally. Since your employer cannot offer modified duties, your TD will continue until P&S or released to full duties. If you find work, then you need to notify your adjuster so you are not receiving TD and wages at the same time. Your TD might end, or you might get temporary partial disability if your new job pays less. As to waiting to find work, I generally tell my clients to find work as soon as they can, and as soon as they can do it, because workers' comp settlements are so small. Plus, if you are P&S, then the adjuster will start PDA's and those are only $290 a week (which is tough to live on), and they get deducted from your final settlement making it seem even smaller.
What if the claim has not been approved? And waiting on employer statement to.
A workers' comp case can be settled at any time, including when the claim is on delay or after it has been denied. I have also settled cases at the injured worker's deposition when the case was on delay or denied, and I've even settled cases at witness depositions before. Whether or not it makes sense to settle early in discovery or later is a strategic decision.
Does my attorney have to meet up with the da to start the settlement?
Generally when both sides have counsel, either side will reach out to the other to start talks. It may be email, phone call, or in person. It might be the attorney or a paralegal in the office.
Got hurt 3 weeks ago at work, Lower back injury and got many restrictions that my employer sent me home . the medication that was prescribed by the treating physician still hasn’t been approved by the insurance companies and it’s been 3 weeks and still haven’t received any type of money for the weeks I haven’t been working , Also my adjuster went on vacation and didn’t even notify me lol now the new adjuster that got assigned is not answering my calls or responding my emails. Wat should I do ??
Your complaints are very common. If your injury is accepted, then insurance generally must pay temporary disability within two weeks. If the claim is on delay or denied, then they do not owe any TD. You can apply for State Disability through EDD online. Just make sure that if workers' comp starts paying TD that you let both the adjuster and EDD know that you're getting benefits so there isn't a duplication. As to the medication, if the claim is denied then they will not pay for meds. If the claim is accepted or on delay, then it depends on if the doctor has actually completed a Request for Authorization and sent it to workers' comp, and whether UR has authorized the meds or not. You may want to reach out to a local attorney for a consult (you can search Google and also use the California State Bar website to search for certified specialists in workers' comp in your area), and you may want to reach out to the Information and Assistance Officer at your local WCAB for free answers.
@@myworkerscompguide well I already have a Case Number , Does that mean it’s accepted
Good afternoon. I been on workers comp for 6 months. I reported my all pains to my employer and put me to workers comp right away. I had neck, shoulder, back and arm pain that can't tolerate anymore, numbness on my both arms and a big headache everyday. Been doing my work for this company for 12 yrs now. What happens was i got it from repetitive stress, been working on computer for like 8 to 10 hrs most of the day and weekends. I had no problem w my workers comp adjuster and all the treatment I had been approved. MRI shows i have pinched nerve on my C5 & C6. Doctor says I need to a surgery. So I did, 3 or 4 months later all the pain came back and he said I needed to have shoulder surgery which I refuse to have and put a hold on it. He said possible the pain is coming from the shoulder. So PT again for a month. After a month i came to see my doctor and he said my condition will not improve that i had a nerve damage and a chronic pain that will endure for the rest of my life. He sent me to go back to work the next day. Now Im back to work with the same pain when I left. He put me on MMI with restriction and now waiting for his notes to adjuster and adjuster told me to wait for his offer but not until he gets the doctors report. I still have pending surgery and carpal tunnel issue that haven't been address. How can my treating physician release me to go back to work while still in pain. I'm a hard worker and I love my job. My employer took me back even on restriction. I was lost when doctor release me to go back to work. Is that right? What could have been done correctly in your opinion? I been back to work for a month now and trying to do my work the best I can.
What you are describing is common. Even though you may still be in pain, the doctors will try to release you to modified or temporary light duty work to see how you handle it. Sometimes it helps and sometimes it doesn't. If working makes your pain worse, and you may need surgery, then it may be best to take you off work so you can pursue the surgery. However, if you're not going to have the surgery now, the doctors might be out of options. The TD payments will only last for two years, and after that you really need to be working in order to make enough money to survive. You may want to consider changing your primary treating physician, or getting a second opinion from another surgeon. Both would take time, but it might get you a different perspective or different recommendations. Also, if the adjuster is waiting for the PTP's report before offering you settlement, you often would be best served by seeing a QME of your choice. Lastly, if you keep working at that employer then you'll likely settle with Stips which will include open future medical care which could include that surgery.
@@myworkerscompguide thank you so much for getting back to me. I appreciate it. God bless.
@@raneefabros889 Happy to help inform. Best of luck to you.
@@myworkerscompguide just in case i needed a lawyer to represent me, do you serve So Cal too?
@@raneefabros889 In some cases I will. You can reach out to questions@mywcguide.com and my staff can work with you.
I learned a lot from you what about permanent implant
Permanent disability in the California workers' comp system is based on the AMA Guides, and those are based on whole person impairment. So generally an implant (a pain pump, or a spinal cord stimulator, or the like) is more related to treatment, and the final PD will be based more on the current level of functioning and the current diagnosis.
I'm already permanent and stationary and I do have a tourney
In that instance, your attorney would know the strategy in your case best, and would know what the current PD ratings are. Best of luck to you.
My MRI Report shows that I have two herniated discs on my lower back L-4 L-5 and is bulging again a nerve that causes tremendous pain when I stand for long periods of times and stand long periods of time , my question is that what happens when I fully recover or recover more than what I currently and I’m seen by a QME , would they give me a Big Settlkement based on what my MRI says ? Please help
Your settlement will depend on how you are doing once your condition is at permanent and stationary status, more than how you are doing now or what your MRI shows now. The QME will address your impairment only once your condition is P&S, and he or she will also address anticipated future medical care at that time also.
@@myworkerscompguide Thanks so much for this information we appreciate you
It's almost been a year on my work comp case how long dose it usually take to see a QME usually
It depends. Either party can generally request a panel of QME's at any time. From the injured worker's perspective, if the claim is accepted and there is no dispute over body parts, there often is little benefit to getting a QME since benefits are being paid. Once the panel is requested from the Medical Unit, it usually issues within a few weeks, then it may take a month or two before the exam takes place, and then the QME has up to 75 days to issue the report.
I’m not an attorney but I can tell ya my case has been going on for 4 years . Every case is different. I believe your case has to be accepted by the insurance company. If it has you have to have some PT. And other possible diagnostic tests done and after that you may go forward with a qme . Be patient is all I can tell ya and follow your attorneys recommendation. I can tell ya I was patient and stayed the course and found out I had more medical problems than what I thought . Hopefully this helped ya
@@BearPapa49 I tell my clients at our first meeting that no matter how slow they think the workers' comp process will go, that it will go slower than that. Much slower.
Can you tell me for how much can I sattle my trimalleolar fracture accident???this happens 10 months ago I... had 2 surgerys and plaque and screws on my unckle
I couldn't really give an estimate as case values in workers' comp depend largely on how the injured worker is at the end of the case. It's that level of whole person impairment once the injured worker's condition has plateaued. The type of injury matters less than how the injured worker recovers. So the type of fracture matters less than your range of motion, strength, balance, whether you limp when you walk, etc. That will all generally be determined by the QME.
My workers comp adjuster sent my attorney a letter saying they are in a position to resolve and final settlement. They said I been released on permanent work restrictions. What's next for me.
As to your case, you would have to ask your attorney as he or she will know best the strategy they are going to apply. In general, I can say that sometimes what is next is settlement as all med/legal reporting is done and there are no disputes. Other times it means the PTP found the injured worker P&S, but the applicant is going to go to a QME to another opinion. Other times it means the PTP and the QME have issued reporting, but perhaps there is an ongoing dispute that requires putting together more records, or getting a supplemental report, or taking a deposition. It could really mean many different things. The only thing for certain is that the adjuster thinks it's time to settle.
? Does hard MRI proof of your injury increase your workers comp settlement?
In California we use the AMA Guides to determine the level of whole person impairment, and that gets converted to a permanent disability rating. An MRI, nerve conduction testing, or even X-rays can increase the level of WPI depending on the type of injury. Depending on what is shown that might be used to place the injured worker in a different, and higher rating, category.
@@myworkerscompguide thank you. What is a WPI. And a AMA?
@@williamlevi5051 This video helps explain all of the abbreviations we have in workers' comp - ruclips.net/video/uzWaroWuwLU/видео.html In short, WPI is whole person impairment. That is found using the AMA Guides, which is a book with a full title of AMA Guides to the Evaluation of Permanent Impairment. That book is used to find WPI, and that's converted to PD.
How does not being able to do the same job you did before your injury impact a case or a settlement?
The PD value of a settlement in workers' comp, whether Stips or a C&R, only depends (generally) on the whole person impairment found by the PTP or QME using the AMA Guides. It does not matter if the injured worker is still working or not when determining the level of WPI. However, if the injured worker is with the same employer and still working then generally Stips is the only way to settle, and a C&R is only an option when the injured worker is no longer with the same employer.
@@myworkerscompguide thanks for the great info, but I guess my question is if a worker can not do the same type of work what happens then?aside from the PD value of a settlement
@@jaliscomx328 If an injured worker cannot return to their job, then they are generally entitled to the Supplemental Job Displacement Benefit Voucher as well as an additional State of California program. That helps pay up to $6,000 towards job retraining and pays the injured worker $5,000 to help get through retraining.
@@myworkerscompguide thanks!
Today I was found P&S . I’m now ready to move forward with settlement should I wait a week or 2 for my insurance adjuster to receive that report? Or can I go ahead & let him know what I’d like to do. Is it smart to now contact an attorney?
In my experience, attorneys generally negotiate better settlements than injured workers without an attorney. You can start the talks now, or wait a few weeks.