Do to an accident at work (no third party), my husband had a below the knee amputation.?
California Workers Comp has taken care of everything to this point. My husband has returned to work on a part-time basis. We want to leave his medical open. Will there be a monetary settlement offered? If so, how is the amount determined and how would the payment be set? Thanks for your comments!
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Your husband will likely have what is called a permanent partial disability/impairment (PPD/PPI). The way this works is that each body part is worth a certain %. I believe CA uses a formula that uses all sorts of numbers. It’s tough to say how much it is as a amputation at the knee or below the knee is different amounts.
Now if he qualifies for vocational rehab and your hubby opts not to go to school you can settle this portion of the claim and completely close out the indemnity and keep medicals open. It could be an additional $5,000-$25,000 added. But you are giving up school.
California has the most complicated worker’s comp system in the country.
Permanent disability is rated based on the “American Medical Association guides” or also know as the AMA Guides. Under these guidelines, the doctor will give you a Whole Person Impairment rating. This number is then adjusted according to your age and occupation. . (Here is how you do the formula or just email me and I can do it for you).
http://www.dir.ca.gov/dwc/pdr.pdf
Impairment percentage numbers equates to a certain dollar amount
http://www.pdratings.com/2010pdchart.pdf
If the employer cannot accommodate permanent modified work and the company employs over 50 employees at the time of policy inception, the permanent disability rate gets bumped up by 15%. (Regular rate is usually $230 per week, but can be bumped up to $264.50 if no modified work is offered- effective 60 days after your reached maximum medical improvement). Payments are paid bi-weekly.
Since your husband wants to keep his future medical open, he is only eligible for the settlement called a “Stipulation Award”. This basically stipulates and pays out only the permanent disability benefits and the insurance carrier covers lifetime medical for your husband. There is no more Vocational Rehab since 2004. California now only has school vouchers where the value is bound by the specific PD rating. The maxium amount is $10K.
The Stipulation Award is a great type of settlement, but it has it’s down sides.
1.) Most treatment needs to be pre-authorized.
2.) Treatment is subject to Utilization Review and must follow the American College of Occupational and Environmental Medicine (also known as ACOEM).
3.) You have to stay within the insurance carrier Medical Provider Network or MPN.
Good luck.
Panda provides the closest thing to valid information The 15%
increase/decrease in PD indemnity is based on the date of injury,
the number of employees etc, but has nothing to do with the date
the policy was initiated. THis is labor code specific, not policy
date. The access to medical care after a stipulation with award, or
finding w/award by a judge remains the exact same procedure as pre
settlement. No change whatsoever. The ”down side” to a stipulated
award is the bi weekly payements continue until the indemnity is
satisfied. You can petition the WCAB court for a commutation of
remaining indemnity due. There is a statutory 3% commutation
rate… and you must show due cause for the commutation to be
granted. The employer/carrier of course may appeal a favorble
decision.