Q: Do I have to accept what they offer?
If work comp just sends me a settlement check with no communication at all, do I have to accept it or can I negotiate the amount? How do they figure what the points are worth? How do they put a price on the loss of use of a body part?
A:
Workers compensation insurance carriers are required by statute to make payments when specific events happen, for example you are found TTD, or MMI. The statutes require the carrier make a good faith effort to pay PD at the end of TTD if you are not working. So the check might not be a settlement check, but a statutory payment. You would have been required to agree to a settlement before any settlement check was sent.
My advice is to cash the check, or any payments you receive. If the carrier makes a mistake and you were not responsible for it, then it is hard for the carrier to claim a credit. Certainly the credit can only be applied against a specific species of benefit. In other words, an over payment of TTD cannot be applied to PD in most circumstances.
At this point it might be a good idea to get an attorney. The attorney will most likely pay for his/her services by increasing the amount of any settlement and you will be better informed.
Ron Mahurin
Certified Legal Specialist Workers Compensation
A: The adjuster would NEVER send 'a settlement check with no communication at all'. the Labor Code requires that within 14 days of a new payment or stopping an existing payment, the adjuster issue a notice of what the change in payment is and why. The adjuster IS REQUIRED by the Labor Code is pay Permanent Disability when the adjuster receives a report showing some permanent partial disability. One Permanent Partial Disability Indemnity check IS NOT a 'settlement check'. One Permanent Partial Disability check is just one payment towards paying you all of the Permanent Disability monies requires by a particular medical report. The doctor's words on Whole Person Impairment in the Report result in a finding of a percentage of partial disability, then that percentage number gets 'rated' for age and occupation. IT IS ALL NEGOTIABLE but, of course, if you no nothing about Whole Person Impairment and which occupations rate higher for different body parts, you cannot possibly negotiate effectively. The adjuster puts a price on a loss of a body part based on the reporting physician's words, which equal a percentage of permanent disability, which equal certain dollars...all established by your State Senator and state Assemblywoman, signed into law by your governor.
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