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Thread Title: Ready to settle, but need help
Created On Thursday September 29, 2005 1:03 PM


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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Thursday September 29, 2005 1:03 PM

I am in the process of settling, the defence Dr said that I have a 85% diability, I am going to get VR, the rating that I was given was 51.5 %, what is the $$ amt for my injury, I am 58 years old, had a lower back injury, had 3 back surgery, one was a fusion on my C4&5,and a lamenectomy on my lower back, my last surgery was a A lift, this was a major surgery, the defence Dr said that i cannot go back to my previous line of wokk as it would aggravate the injury and cause pain, he also recomend future medical, I was a Licensed Vocational nurse for the past 34 years.
I also think that my attorney is stressing me out and lying to me, I will explain after your response.

-------------------------
nena j

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art
Senior Member

Posts: 2111
Joined: Aug 2004

Thursday September 29, 2005 1:16 PM

N/A,

1) To maintain anonymity you might want to edit your post and remove your real name.
2) They'll need your date of injury.
3) On the sheet with your rating is a string of letters and numbers. Post that exactly as it appears and someone who can rate reports will be able to help you. Without those #'s they can't help you.

g' Luck

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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Thursday September 29, 2005 7:21 PM

what #s on the rating? there was none, that is why I know that my attorney is lying to me, the date of injury was 12/19/2001.

nena

-------------------------
nena j

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andyourlittledogtoo
Senior Member

Posts: 504
Joined: Jul 2005

Thursday September 29, 2005 7:49 PM

Under the new apportionment laws, that 85% rating probably got some of it apportioned away, resulting in a lower PD percentage for you. That's just an assumption, I can't know that for sure, but based on your age there would have to be apportionment to at the very least the natural aging process.

Your attorney may not be lying to you just because he hasn't given you the actual formula for the rating. The formula doesn't usually mean much on it's face to the nonprofessional. Most people just want to know what the final percentage is not the formula used.

In order to give you any idea of a settlement, we'd need to know your TTD and PD rates, when you were declared P&S, if you've ever received any voc rehab benefits, and what exactly your future medical care is determined to be, both by your PTP and by the defense QME and if you had one an applicant QME. If there was an AME that is even more important to know what the AME said.

-------------------------
"For a long time it had seemed to me that life was about to begin, real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life." Alfred D'Souza

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art
Senior Member

Posts: 2111
Joined: Aug 2004

Thursday September 29, 2005 7:59 PM

nena,

"I also think that my attorney is stressing me out and lying to me, ..."-- While I agree that this does happen (all too frequently), I've also learned that although it may appear to be what's happening, sometimes their double-speak is just their way of dealing with people they think incapable of grasping WC's arcane details. I'm just suggesting you don't jump to a premature conclusion, compromise your relationship with your atty. and inadvertently harm your case. (If he does turn out to be a total weasel I'll share the plans I have for settling the score with mine. As long as you have a roll or two of Saran Wrap, two cans of expanding foam insulation, one roll of duct tape, a few marbles and a staple-gun along with a depraved imagination you'll be prepared.)

As to the numbers you asked about. When the DEU issues their rating it includes a hyphenated string of letters and numbers that represent your age, occupational code etc. These are the elements they entered into the formula they use to arrive at your % of PD. Since the DEU can take months to issue a rating, your atty. may have done his own "ballpark" rating. This may explain why you think he hasn't had the report rated yet. Ask the atty. for a copy of the DEU rating and see what s/he says.

G' Luck..

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art
Senior Member

Posts: 2111
Joined: Aug 2004

Thursday September 29, 2005 8:06 PM

ayldt's totally right about the formula/numbers being useless to a non-professional like me, but if you get them and post them here Ginger can rate them and hopefully her #'s will agree with your atty.'s and you'll be able to put your mind at ease.

Later...

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andyourlittledogtoo
Senior Member

Posts: 504
Joined: Jul 2005

Thursday September 29, 2005 9:06 PM

Very true. (And now I remember why I didn't want to go to law school. Saran Wrap makes me itchy.)

-------------------------
"For a long time it had seemed to me that life was about to begin, real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life." Alfred D'Souza

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injuredworker101@yahoo.com
Senior Member

Posts: 1527
Joined: Apr 2004

Thursday September 29, 2005 9:33 PM

Art....man you're going to have to go to a warehouse store and buy the jumbo size. Then we can have a party. I've got a couple of customers awaiting. There's a defense attorney or two that could stand to join in the fun as well.

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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Tuesday October 04, 2005 11:33 AM

TTD rate started in august, and I am asking for an advance on my PD, I was declared PS on 07/23/05, I am recieving Voc rehab benifits, the QME I saw was the defence Dr, he was the one that recomends that I recieved future medical care and gave me the rating of 85% disability, my attorney will have me see a AME, whose side is the AME on.
Should I settle on C&R or should I go with the stimulation award, My attorney was explaining these to me, what is the pro's & con's.

-------------------------
nena j

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gaiassoul1@yahoo.com
Senior Member

Posts: 2155
Joined: Feb 2004

Tuesday October 04, 2005 3:17 PM

ok what piece of paper gave you an alleged 85% or 51.5% rating?

Something from the insurance company? IF it was an notice from the insurance company it might have said they rated the disability at 85% but disagreed with that rating. ALSO apportionment should knock a piece of that out.

Something from the Disability Evaluation Unit at the WCAB? That is the only piece of paper that counts, list there numbers on this forum and we can tell you what it means. The attorney might not be lying to you, since the Disability Evaluation Unit is up to 9 months behind depending on the board, no binding formal rating would have issued yet. Not from a 7/25/05 treating physician report because those are the last priority.

IF you were P&S after 1/1/05 in order to get even close to an 85% rating, you would have to be a quadripalegic? That makes no sense. Under AMA Guidelines you have to be dead to get 100% and in a coma to get 90%.

The AME technically is on nobody's side. However, the AMEs are very aware that they only get more business if they write reports that keep everyone semi-happy, so most AMEs do the low down dirty job and just split the baby up the middle of the evidence.

Not sure if your attorney has a defense qme that rates 85% why in the heck he would risk an AME. That is sheer insanity.

A C&R closes your case forever, for good until the end of all time and pays in a lump sum.

A stipulation means you get your PD paid out every two weeks and then the insurance company remains liable for your future medical care.

No one can tell you what to choose as that is a highly personal decision. SO the bottom line is that you should consider what your financial management skills are and how much in control of your medical care you want to be in. IF you C&R paying the medical bills becomes your sole responsibility and does not consider the unknown that no one can totally accurately forecast what your future medical care is going to cost.

SO were you ever P&S prior to 1/1/045,

-------------------------
Ginger

To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
reformers - or both. Elizabeth Charles

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andyourlittledogtoo
Senior Member

Posts: 504
Joined: Jul 2005

Tuesday October 04, 2005 8:09 PM

Ginger, when I was training on the new rating system, there were some statutorily defined permanent disabilities that rated to 100%, but that was a California-mandated arbitrary decision, not part of the AMA rating system necessarily. I don't have the references here with me but I seem to recall they were things that would similarly have automatically resulted in 100% PD under the old system, such as total blindness.....

I keep hearing people say you can't get to 100% unless you're dead or in a vegetative state and those other conditions pop up in the back of my head, reminding me that this isnt' entirely true....

-------------------------
"For a long time it had seemed to me that life was about to begin, real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life." Alfred D'Souza

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gaiassoul1@yahoo.com
Senior Member

Posts: 2155
Joined: Feb 2004

Wednesday October 05, 2005 12:24 PM

I agree AYLDT, but I think that is an advanced discussion that did not apply to the facts in evidence.

I also believe LeBeouf is still viable. So you and I are probably in the same thought process, just not for this case. I should have stated that to leave better tracks, mea culpa.

-------------------------
Ginger

To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
reformers - or both. Elizabeth Charles

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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Thursday October 06, 2005 7:48 PM

the 85% was the % of disability that the defence Dr gave me, when I talk to my attorney last week he said that the insurance is willing to settle for 60g with a 51.5 rating, when I ask him to fax me a copy of that rating he said that he dont have it, when I question him he stated that he cannot recall if it was sent by mail or it was given over the phone, I was pissed off, I then call the insurance Co, they told me that an offer was made but I would need to talk to my attorney, I then went ahead and told him what my attorney had said, I then ask him to fax whatever offer was made to me but his Supervisor told him not to, I ask him to contact my attorney and have him fax the offer to me which he did, the letter was all fudge up by my attorney, I can tell, as there was no heading, it was poorly written I have copy.
I still cant understand how the offer was for 60g, with 3 back surgeries, and I mean 3 major back surgeries, unable to go back to my usual line of work, they want me to be retrained for some small paying job, I was making almost $25.00 an hour, now they want me to work for minium wage, they are really pissing me off.

-------------------------
nena j

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gaiassoul1@yahoo.com
Senior Member

Posts: 2155
Joined: Feb 2004

Friday October 07, 2005 1:12 PM

Three major back surgeries does not necessarily result in major disability. A 60g offer for a 50% disability and limited future medical as there is nothing else to do for your back is not totally out of line with the limited facts posted here.

The system does not compensate for ongoing wage loss it compensates for loss of earning capacity in the open labor market within the timeframe that the legislature decided you should be able to re-educate and economically rehabilitate your self.

I have a feeling the insurance company did the rating themselves. I have a feeling that your attorney does not know how to rate. For total piece of mind as to the best rating you are going to get, you could choose to tell the attorney you would like to risk a DEU rating and have the attorney file for a rating MSC on a DOR. Beware on DEU ratings, the insurance company may be wrong, you may get less you may get more - -nothing is risk free.

-------------------------
Ginger

To know how to say what others only know how to think is what makes men poets or sages; and to dare to say what others only dare to think makes men martyrs or
reformers - or both. Elizabeth Charles

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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Wednesday October 19, 2005 9:47 PM

I have a copy of the QME rating of 85% disability, the QME went over all this infomation before I left his office, later on I recieved a copy of his report from my Attorney, I have not seen my treating Physian report, but I was told that my Attorney has it.
How soon should I expect a settlement, also this VR is a joke, they are only there for the money about 4G.

-------------------------
nena j

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N/A
Junior Member

Posts: 8
Joined: Sep 2005

Wednesday October 19, 2005 9:49 PM

-------------------------
nena j

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STEVEPSCA@YAHOO.COM
Senior Member

Posts: 990
Joined: Jun 2002

Thursday October 20, 2005 8:02 AM

"How soon should I expect a settlement,"

There is nothing that says you will...the IC is under no obligation to offer a C&R...and won't unless it is in their favor, there must be some incentive.
It would be in their favor to just pay out the PD, leave the future medical open and see what your needs will be. And after the PD is paid out, you will begin to receive the "life pension", provided your rating is in fact over 70%.

Posts: 43
Joined: Oct 2005

Thursday October 20, 2005 8:41 AM

I have a 75% disability rating and will not be settling until after my knees are replaced, but my question is what is a" Life Pension". I will not be taking a C&R.

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STEVEPSCA@YAHOO.COM
Senior Member

Posts: 990
Joined: Jun 2002

Thursday October 20, 2005 9:20 AM

A "life pension" exsitst when you have a PD rating of 70% or higher. After the PDA's are exhausted, the pension will begin. The amount is based on your DOI and %PD.

Life Pensions are discussed in section LC4659 ...

4659. (a) If the permanent disability is at least 70 percent, but
less than 100 percent, 1.5 percent of the average weekly earnings for
each 1 percent of disability in excess of 60 percent is to be paid
during the remainder of life, after payment for the maximum number of
weeks specified in Section 4658 has been made. For the purposes of
this subdivision only, average weekly earnings shall be taken at not
more than one hundred seven dollars and sixty-nine cents ($107.69).
For injuries occurring on or after July 1, 1994, average weekly wages
shall not be taken at more than one hundred fifty-seven dollars and
sixty-nine cents ($157.69). For injuries occurring on or after July
1, 1995, average weekly wages shall not be taken at more than two
hundred seven dollars and sixty-nine cents ($207.69). For injuries
occurring on or after July 1, 1996, average weekly wages shall not be
taken at more than two hundred fifty-seven dollars and sixty-nine
cents ($257.69). For injuries occurring on or after January 1, 2006,
average weekly wages shall not be taken at more than five hundred
fifteen dollars and thirty-eight cents ($515.38).
(b) If the permanent disability is total, the indemnity based upon
the average weekly earnings determined under Section 4453 shall be
paid during the remainder of life.
(c) For injuries occurring on or after January 1, 2003, an
employee who becomes entitled to receive a life pension or total
permanent disability indemnity as set forth in subdivisions (a) and
(b) shall have that payment increased annually commencing on January
1, 2004, and each January 1 thereafter, by an amount equal to the
percentage increase in the "state average weekly wage" as compared to
the prior year. For purposes of this subdivision, "state average
weekly wage" means the average weekly wage paid by employers to
employees covered by unemployment insurance as reported by the United
States Department of Labor for California for the 12 months ending
March 31 of the calendar year preceding the year in which the injury
occurred.

IF you C&R your case, you would also be compensated for the life pension...a C&R releases the IC of ALL future liability. BUT, if you have a PD rating that high, it's not that far to 100% if you are rated under the 'old' rules... I don't know about post SB899...apportionment becomes an issue in any rating now.

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rumbler
Senior Member

Posts: 683
Joined: Dec 2005

Tuesday December 20, 2005 4:55 PM

Gosh--I wasn't aware of this life pension provision. If the IW sttles by C&R, is the IC obligated to calculate the pension as stated under LL4659, or is it also negotiated? How would they factor in the yearly increases that you referred to if DOI was after Jan. 1,2003?
Also, under C&R how is life-expectancy determined?
Very informative post!!
Thanks

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