There are three options in terms of how a workers’ compensation case can be resolved in California. They are as follows:
In a workers’ compensation trial, it is necessary for you to testify as to the injuries you have sustained, as well as the nature and extent to your disability and medical treatment. Thereafter, the judge would issue a Findings and Award indicating the nature and extent of you disability, with a permanent disability award and in all likelihood, an award of lifetime medical treatment, for the body parts the judge finds you have sustained injuries to while on the job. Then, that Findings and Award will be paid out bi-weekly until the gross amount of the permanent disability has been exhausted. You would thereafter have an award of lifetime medical treatment with no premium and no deductible, pertaining to the body parts injured. There is no lump-sum settlement when the matter proceeds to trial.
While you do have an award of lifetime future medical, this falls under the current laws regarding medical treatment. Thus, the carrier is likely to submit to utilization review based on their denials to independent medical review. (See our prior article addressing Medical determinations) This is not carte blanche medical treatment it is only for the body parts which were found industrial. There is no guarantee that five years into the future or ten years into the future the carrier will continue to pay for the medical treatment to that body part. While the award is given there is no guarantee to uphold the award;
This type of resolution is very similar to the trial; except you do not have to testify. In this manner, the defendants agree to the permanent disability be found by the judge, as well as lifetime medical treatment, and the parties prepare a Stipulation and forward it to the court for approval. When the court approves the Stipulation, the effect of the approval results in a Stipulation and Award, then the permanent disability and medical treatment are the same as is outlined above and discussed in the Trial section. In addition, you will have five years from the date of injury to reopen your claim in a Stipulation or Trial should your condition or injury get worse;
3. Compromise and Release
This type of settlement is a lump-sum settlement. A lump-sum settlement results as a result of determining the value of your permanent disability, after apportionment, and the value of your lifetime medical treatment. There is also consideration for additional compensation to close the matter by way of Compromise and Release.
There is an advantage to this because rather than waiting on a carrier to possibly approve medical treatment in the future, you can direct your own medical treatment. Thus, becoming the master of your own destiny.
In giving consideration to the type of settlement, you will need to be concerned with the following:
• In order for the defense to consider settlement by way of a Compromise and Release you will likely have to execute a letter of resignation; and be aware not all cases are approved to be settled by way of Compromise and Release it is done on a case by case basis. There is no way for us to force the defendant to settle by way of Compromise and Release.
• Medicare Set Aside: if you are going to seek medical treatment through Medicare or Medicaid in the near future, a certain portion of each settlement has to be set aside and exhausted before Medicare will take over treatment for any industrial injury. If you are going to be applying for Medicaid or Medicare within the next 36 months please advise our office so that we can get the proper documentation to find out about a Medicare Set Aside. (It appears the Affordable Care Act, a.k.a. ObamaCare, may allow for all pre-existing conditions as of January 1, 2014)
Should you wish to resolve your California Workers' Compensation claim through one of these methods, we would be happy to discuss additional details regarding your claim. Should you have additional questions about how to settle your Workers Compensation claim, please contact one our offices for a FREE consultation!