Worker’s Comp process and when do we need an attorney?
I am a nurse, and work on the insurance side of medicine. I need advice from anyone who works in Worker’s Comp.
Not a lot or room so make it quick. 33 y/o f Rt. Radial nerve damage at work. Undisputed. Worker’s comp has approved all care, treatment, and surgery. 8 months post op reveals permanent nerve damage with no set future treatment possible. Showing signs of early CRPS now. Undisputed she will never return to work.
My question is I need some detailed ideas of what to expect? We have done this without lawyers. We have not talked settlement, as the concern has been care, but we are almost to that point. Do I bring up settlement? What are we talking to expect if we chose to do it alone? She will never work again, but I have a home business and we have made accommodations for this. The government doesn’t recognize us and reality is she will never be able to make her own income again. How does that factor into this?
While I do appreciate the personal stories. I am in this business also. Attorney’s at this point would only hinder her care. My sister is a lawyer. I am not concerned from a legal standpoint and feel more than confident we can do this without one. I am looking for answers from WC case managers like myself. My question regarding attorneys was meant for other professionals like myself. Attorney’s are the best avenue for the average individual, but as I work in the same type of area disagree. There are points when only an attorney can solve the dispute, but generally only slow the process. We have no disputes at this time. Workman’s comp has been open to treatments, provided wonderful care, and has paid her without fail. My question is the process of settlement. If you had an attorney handle your case then you are not aware of that process hence paying the contingency fee.
She could probably be retrained. She can not return to her occupation of 15 years, a dog groomer, as a result of the injury. Due to the pain we do not plan to have her return to work (in another profession) as it is not necessary financially. We live in California and I understand they have abandoned the “Vocational Rehab” component in 2004. This more than likely is considered for a PPD not PTD. We are interested in the process to determine this. We are not interested in “screwing the system”, but yet want to get her what she is entitled. Any words of advice when to start settlement talks? What will be required then? How long should be expect? We are already 2 year in, but hear people say 5-10 years. So we can let the attorney issue lie for a bit. We have talked to several attorneys and the workers comp advocates through the state, but were told we were doing well and to come back if something was denied.
My ex-husband had 3 worker’s comp cases, by all means you should get an attorney. Most WC attorneys will take the case on contingency. You are entitled to a tax free settlement from employer and to have all medical bills paid as well. Attorneys will subpeona medical records and may even send you to a doctor they use to help facilitate the best possible settlement. Do not discuss settlement with the employer! on your own! They have their own best interest at heart and will try to settle for as little as possible. Be patient, cases take a good while to settle.
After settlement, I would then talk with a SSI attorney and file for disabililty.
I have a friend that her and her husband went through something like what you are going through except it was his back. If you are talking about her never being able to work again. Please I advise you to seek at least the council of an attorney. My friends got put through the wringer here in Texas and received nothing. Workers Comp is not about the injured worker but the malicious insurance agency. Please be wary when dealing with them one wrong move at this stage and you could get nothing.
the attorney will take one third
Well, you’re absolutely right, if there isn’t any dispute, there isn’t any point in bringing an attorney into this.
Having said that, the most crucial information was ommitted from your question: the state. Each state has its own rules and regulations. It’s possible any settlement will be limited to three years wages. It’s possible it could go to 65. You don’t say if it’s possible to do retraining for another position – are we talking total disability here, or partial?
In other words, there isn’t enough info here for anyone here to hazard a guess. IN which case, more detailed info and a free lawyer consult couldn’t hurt.
Why can this person not ever return to work?? I find that too hard to buy. No work comp settlement will ever pay enough to retire totally so the injured worker does need to think about working. An attorney can certainly help negotiate a settlement if the claim reaches that point. If this person is truly permanently totally disabled, they will need to apply for social security benefits. Work comp settlement could be based on wage established, age, type of work employee was doing, percentage of impairment, education. Depends on the state and 33 year old is pretty young to be written of as totally disabled. I am an adjuster and I would fight permanent total disability for radial nerve damage.
There are some factors that will make the exposure of this claim. If the injured worker will NOT return to work than it’s likely that the claimant will qualify for vocational rehab (VR). She will likely be qualified to retrain in a different field that will suit best to her needs.
Total exposure depending on state vary but I would estimate at least 2 years of lost time on top of books, tuition and other factors, possible that you maybe looking at $50,000 for just VR total.
I like to explore the option of settlement. The injured worker might not want to do any training. So settlement might be the best option, and the cheapest.
She may not qualify for VR too, if that’s the case you get off even more cheaper.
decent answer….there are NO VR benefits in Calif, only a
SJDV/voucher to be used by the IW for retraining purposes…on her
own. My question here is…WHY is the ‘nurse’ involved in any
settlement issues surrounding this claim. You as a provider have NO
interest in the claim, or IW. At one point you say you are a
NCM/Nurse Case Manager, as such, your job is to coordicate
treatment and a return to work. Not settlement. A DOCTOR will
evaluate and rate to PD/WPI when the IW becomes MMI. Any settlement
dollars for indemnity will be based on that rating. IF there is
need for future medical care, that would be provided through a FMC
award at the time the claim resolves. Either a stipulation w/award,
or Finding w/Award by a WCAB judge. If RSD/CRPS in indicated, that
should be found as a compensable consequence to the org injury
before there is any type of settlement to this claim. Your position
and involvement in this IW’s affairs is not clear by the
information you provide. If you are associated with the IC here, as
a NCM, you should definately step aside from this claim as you have
nothing to do with anything but the treatment of the IW. Once she
is MMI, you have NOTHING further to do with the IW or claim. Your
attempts to advocate for this IW are somewhat admirable, your
involvement to the extent you say here is not. Step aside, and let
the IW and I&A officers handle this, or a reputable attorney.
Not your sister.