sunkiss
06-05-2007, 03:44 AM
Starting with P&S, permanent and stationary. Or MMI in some states. That's when they've basically given you all the
active treatment, such as surgery, etc., and you are "as good as you're going to get." It does NOT mean that you don't
get more treatment, meds, P/T or even surgery. It's just that you've basically hit some sort of plateau.
In your final report, you will have "future med" described by your doctor. This paragraph is terribly important. If you
might need surgery later, or know you need it now but don't want it now, your doctor MUST indicate that in the future,
you will need access to a "x" surgeon and possible surgery. Likewise, if you need P/T, the doc needs to describe it. Plus
access a certain type of meds, etc. In the report, it will describe what body parts and/or condition this work injury is
limited to. So, as for your stimulator, as long as it is listed in this description, you can still fight for it later via hearing.
Next, qualified injured worker status means that you definitely cannot go back to your old line of work. You're too
injured. So they will either have to offer you a job that matches the restrictions he's written out, and even have him
approve it, or, then they have to follow the guidelines on providing you vocational rehabilitation.
Voc Rehab has been changed by recent laws. Sounds like you have an old injury. So they previously had to pay TTD rate
VR, (your money), and schooling up to $16K in value. Or, skip school they could give you another $10K cash. Now, there
are some new rules that it would increase your PD by 15% if they don't have a job, but I don't know if that new rule has
been implemented yet. So you must talk to your attorney about this one. And you could negotiate for higher than $10K
cash if your attorney will go for it.
Next, ratings. Your description of restrictions don't match anything I've known, so my guess is you're doing your best to
remember what he said. Did he say anything about sedentary or semi-sedentary restrictions? There is a BIG jump when
you hit 70%. You also will get a lifetime pension in addition, when you hit 70%. So, if you use a cane, or have severe
pain, make sure that's in the final report, so you get bumped up accordingly by your apparatus and/or subjective pain
levels. If 60%, have your attorney show you on the chart how much money that is, and ask about the lifetime pension.
Rating a report - whenever you rate a report, you almost never, never will lose points by having a Board Rater rate your
report. Every single time they come out higher than we thought. So demand that your report gets rated when you arrive
at court. Do not settle without a true rater's rating, (unless it's something totally easy like a back injury with one
restriction description), as every single time this comes out higher.
Settling out future med. So when you see on the chart how much your case is worth - and I don't have a current money
chart on me - but let's say it's $130K, without a pension. Then, you consider VR. And let's say you don't want school, so
top it off another $10K. Next is future med. Meds, P/T, 3 ortho visits a year, 3 injections and possible surgery. I can tell
you that's about $20K per year, for the rest of your life. If you live 20 more years, that's $400K, without surgery, which
is about $70K. So I'd consider settling that case for maybe $400K today's money. That's a guesstimate. You'd have to be
responsible for your med in the future, for that body part(s), but you'd get cash now to invest and use as you need.
Medicare would have to be supplied the agreement, and sign off on it, and Medicare would NOT provide you treatment to
the specific body part - they would refer you back to your own settlement. (This is new in the last 2 years, and yes, some
people get away with Medicare paying anyways. I don't want to debate this one.) This way, you have the $400K and can
will it to your kids.
Let's say you have a failed back and other body systems are having problems. No amount of money would really be
worth buying out future med, as you don't know if your situation will become terribly expensive. So you'll take the money
bi-weekly for life. (Depending upon the amount.) You cannot will away this money. It stops when you do. If you died
because of your work injury, your kids get a right to sue for death. (Ranges in amt. but about $130K when I last looked
for a spouse.)
You will now get PD benefits until either VR starts or you settle. (When the insurance company receives a final
settlement, they are supposed to begin PD payments, up to 15% of the PD anticipated.) If you are a QIW (as your report
states) then they are to issue vocational rehabilitation payments at the TD amount, until you are processed by a VR
counselor, and then, they are to continue to a total value of classes and VRTD to a total of $16K. (Your initial payments
being outside of the cap.)
Any payments that are late or not started at all or are in the wrong amount can all be required to be paid with penalties
and interest, so before any final settlement, a good attorney should ask for a benefits printout, and review it carefully,
coordinating the dates and then making sure you're getting all of your money due.
Usually an MSC is set, takes a few months. Total settlement could include a trial, and could take a year. Don't back down
or skulk off without your FULL pay. Even after a trial, and you are getting weekly benefits, you can at any time explore
settling for a lump sum. I used to get hired to try to coerce old-timers to settle out and close their files for a lump sum.
Especially back injuries, insurance companies fear you'll have a surgery and end up a vegetable and they will have to pay
for it all, including nurses at home.
Do NOT try to get a job now while you are settling. Tell them you are looking, and do look, but unless the job is
APPROVED by your doc and you follow his restrictions to the "T", do NOT mess up during this time. You will be surveilled
during this time, especially during doctor's visits.
P.S. Get his final report in your own hands and read it carefully. If he has left anything out or doesn't get how bad off you
are, set a doctor's appt. and go in and talk about it. He can issue a "Supplemental Report" and change his opinions a bit.
active treatment, such as surgery, etc., and you are "as good as you're going to get." It does NOT mean that you don't
get more treatment, meds, P/T or even surgery. It's just that you've basically hit some sort of plateau.
In your final report, you will have "future med" described by your doctor. This paragraph is terribly important. If you
might need surgery later, or know you need it now but don't want it now, your doctor MUST indicate that in the future,
you will need access to a "x" surgeon and possible surgery. Likewise, if you need P/T, the doc needs to describe it. Plus
access a certain type of meds, etc. In the report, it will describe what body parts and/or condition this work injury is
limited to. So, as for your stimulator, as long as it is listed in this description, you can still fight for it later via hearing.
Next, qualified injured worker status means that you definitely cannot go back to your old line of work. You're too
injured. So they will either have to offer you a job that matches the restrictions he's written out, and even have him
approve it, or, then they have to follow the guidelines on providing you vocational rehabilitation.
Voc Rehab has been changed by recent laws. Sounds like you have an old injury. So they previously had to pay TTD rate
VR, (your money), and schooling up to $16K in value. Or, skip school they could give you another $10K cash. Now, there
are some new rules that it would increase your PD by 15% if they don't have a job, but I don't know if that new rule has
been implemented yet. So you must talk to your attorney about this one. And you could negotiate for higher than $10K
cash if your attorney will go for it.
Next, ratings. Your description of restrictions don't match anything I've known, so my guess is you're doing your best to
remember what he said. Did he say anything about sedentary or semi-sedentary restrictions? There is a BIG jump when
you hit 70%. You also will get a lifetime pension in addition, when you hit 70%. So, if you use a cane, or have severe
pain, make sure that's in the final report, so you get bumped up accordingly by your apparatus and/or subjective pain
levels. If 60%, have your attorney show you on the chart how much money that is, and ask about the lifetime pension.
Rating a report - whenever you rate a report, you almost never, never will lose points by having a Board Rater rate your
report. Every single time they come out higher than we thought. So demand that your report gets rated when you arrive
at court. Do not settle without a true rater's rating, (unless it's something totally easy like a back injury with one
restriction description), as every single time this comes out higher.
Settling out future med. So when you see on the chart how much your case is worth - and I don't have a current money
chart on me - but let's say it's $130K, without a pension. Then, you consider VR. And let's say you don't want school, so
top it off another $10K. Next is future med. Meds, P/T, 3 ortho visits a year, 3 injections and possible surgery. I can tell
you that's about $20K per year, for the rest of your life. If you live 20 more years, that's $400K, without surgery, which
is about $70K. So I'd consider settling that case for maybe $400K today's money. That's a guesstimate. You'd have to be
responsible for your med in the future, for that body part(s), but you'd get cash now to invest and use as you need.
Medicare would have to be supplied the agreement, and sign off on it, and Medicare would NOT provide you treatment to
the specific body part - they would refer you back to your own settlement. (This is new in the last 2 years, and yes, some
people get away with Medicare paying anyways. I don't want to debate this one.) This way, you have the $400K and can
will it to your kids.
Let's say you have a failed back and other body systems are having problems. No amount of money would really be
worth buying out future med, as you don't know if your situation will become terribly expensive. So you'll take the money
bi-weekly for life. (Depending upon the amount.) You cannot will away this money. It stops when you do. If you died
because of your work injury, your kids get a right to sue for death. (Ranges in amt. but about $130K when I last looked
for a spouse.)
You will now get PD benefits until either VR starts or you settle. (When the insurance company receives a final
settlement, they are supposed to begin PD payments, up to 15% of the PD anticipated.) If you are a QIW (as your report
states) then they are to issue vocational rehabilitation payments at the TD amount, until you are processed by a VR
counselor, and then, they are to continue to a total value of classes and VRTD to a total of $16K. (Your initial payments
being outside of the cap.)
Any payments that are late or not started at all or are in the wrong amount can all be required to be paid with penalties
and interest, so before any final settlement, a good attorney should ask for a benefits printout, and review it carefully,
coordinating the dates and then making sure you're getting all of your money due.
Usually an MSC is set, takes a few months. Total settlement could include a trial, and could take a year. Don't back down
or skulk off without your FULL pay. Even after a trial, and you are getting weekly benefits, you can at any time explore
settling for a lump sum. I used to get hired to try to coerce old-timers to settle out and close their files for a lump sum.
Especially back injuries, insurance companies fear you'll have a surgery and end up a vegetable and they will have to pay
for it all, including nurses at home.
Do NOT try to get a job now while you are settling. Tell them you are looking, and do look, but unless the job is
APPROVED by your doc and you follow his restrictions to the "T", do NOT mess up during this time. You will be surveilled
during this time, especially during doctor's visits.
P.S. Get his final report in your own hands and read it carefully. If he has left anything out or doesn't get how bad off you
are, set a doctor's appt. and go in and talk about it. He can issue a "Supplemental Report" and change his opinions a bit.