Q: I am rated at 32% by DEU, final doctor report states I will need a back fusion surgery. I elected a CNR, $38,000?
I have C spine and L spine injuries. I am rated at 32% by DEU and final doctor report states I will need back surgery (fusion in C spine). I elected CNR as I hate the workers comp system. The City of Carlsbad has offered $38,000. This dollar amount seems extremely low and I doubt it would cover the surgery. The city HR department has told me the amount comes from a table and is non-negotiable. I do not believe them. What can I do? Would it help to have an attorney at this point?
A: Yes, you should seek the help of an attorney.
The dollar figure for your permanent disability rating comes from a chart. The permanent disability value is based on a number of factors including the year of injury. for example, a 32% permanent disability for an injury between 2005 to 2012 is equal to 145 weeks of permanent disability payments at $265.50 per week (assuming you were earning more than $435.00 per week and did not return to work). This equals $38,056.79. This may be the figure the City has provided to you. This would only represent your permanent disability. It would not represent any other benefits to which you may be entitled. The City would need to provide additional money to resolve your right to medical care.
A: There offer is way too low!! You need to call and meet with an experienced workers comp attorney. I have settled these type of cases as high five to seven-figures if there are third party civil components. Every case is different. As a prior workers comp claims adjuster and working in the work comp profession for almost 30 years, its my advise you meet and get advise from an experienced and aggressive attorney. Insurance companies will never offer a reasonable offer unless you are being represented by a competent workers comp attorney. I wish you the best!
A: 32% PD (for injuries between 2014-2016) is $42050.00 so the WCAB Judge would reject this if you signed it. 2013 injury with 32% = 33,350. So you have left out a crucial part of the story. Is it 32% Whole Person Impairment, WPI? Or is there apportionment to 10% non-industrial factors, taking your 32 down to 29.8 ? ARE YOU RECEIVING SOCIAL SECURITY BENEFITS?? IF SO the feds will demand the entire amount of your settlement of offset what Medicare will be paying unless you have a MedicareSetAside. WISH YOU HAD AN ATTORNEY from the beginning...if this treating doc 'in bed' with the adjuster rates out to 32%, a real doc might have found more than 50%. YOU NEED a QME -- the right QME, not some 'hack' kissing up to the insurer -- ASAP. When the adjuster gets a QME report rating over70% that offer will go way up.
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