Demand Letters in Workers Compensation Cases

Attorney Joe Miller describes the basic elements that go into the demand letter, the document that he sends to the insurance company outlining the amount of money that is "demanded" for settlement of a workers compensation claim. Note: This is not a do-it-yourself guide to achieving a settlement in a workers compensation case. If you've been severely and permanently injured, we highly recommend you engage the services of a competent workers compensation lawyer.

[@emmavasquez6263]

Mr. Miller thank you for the information. I only wish you had offices here in California.. February 11, 2020 will be a day that my life change.. I was involved in a tboned car accident while i was being a driver for a mom & pop pharmacy..I ended up being hurt severly, concusion, neck, whole back, right shoulder fracture, trauma, hematomas, I was really bad.. Couldn't remember my daughtet's birthday.. As a matter of fact.. To thid day.. I still can't remember what happend.. I've been to every Doctor's appointment, physical therapy, I was put on 5 medications, on August 19, 2022 i was given my final report from my workers comp Doctor stating that.. My whole body impairment was 39% I am permanent & Stationary, my work restriction is now sedentary work..prior to delivery job.. I had a main job which was being a caregiver for the samd person for 24 years, because of the accident I can no longer work that job..& I also don't do the driving job..& The Insurance still hasn't made an effort to offer me settlement..communication between me & my lawyer is bad.. I have to act mean & nasty for me to get answer.. I am one who's injured & suffering.. I also had 2 surgeries & will be needing another one..because I had a main job while. Having the delivery job..I was being paid by the state of california.. Is the deffendent responsible for paying me for losing my main job.. I don't work for either job.. My benefits stop in April 14 2023 was my last check. I got the full 2 years ..plus tbey advance me 1 yr.. They sent me a notice saying ..they had paid me enough, after my case is settle.. My lawyer wants me to get another lawyer so I get social security benefits..since I won't be able to return to work..makes it very difficult for me since i am only 50yrs old..& most of my work was physical ..

[@KTMbrandon25]

Great info!! Learning a lot as a Legal Nurse Consultant.

[@JoeMillerLaw]

Thank you so much, I appreciate the positive feedback!

[@francesg.1587]

Brilliant helpful information. Thank you! I'm in Los Angeles. Wish there was someone like you here.

[@JoeMillerLaw]

Thank you so much.

[@relettacaudill9419]

Great video! I am 59 and always done hard manual labor. I tore my rotator cuff in two places! Very helpful!

[@JoeMillerLaw]

Thank you so much. I Love it when we are able to help injured workers and save them from making mistakes.

[@mirzabaig3657]

Great information

[@anthonywylie5771]

Nice very close to my case I have 21 percent 2 surgeries

[@JoeMillerLaw]

I hope you get a great settlement. If you are in VA or NC and you are not represented, I strongly encourage you to give us a call before agreeing to any final figures. That being said, we typically cannot give you an opinion on whether you are being paid a fair settlement without a full file review, for which we require you to engage our firm. We minimally charge 10% of the current offer, for such a review, even if we cannot get you more. Anything we get you over your last offer is at the customary fee rate of 20% in VA, 25%, in NC, should you choose to engage us.

[@samuelphillips6818]

My workers comp. adjuster has requested a demand letter to start settlement procedures-- Do i have any input or say that goes in the demand letter? I'm sure that my attorney don't know what i've been thru during these injuries(multiple w/ different dates of injuries) They are talking a global settlement-- My msa was already blessed by cms to a figure that i think is very low due to multiple surgeries planned-- i've watch all of your blogs on youtube & i think you're the best at getting your point across to injuried employees like myself (THANK YOU JOE). i'm in calif. & is represented--one question is needed for you to answer if you can in my case-- do my lawyer attach my msa account with a fee? he's not telling me, stating we'll come to some agreement about this. Joe i heard you mention that i shouldn't care how much was put in the msa account as long as cms bless that amount & when it is depleted --medical steps in --right? Also how long does it take to write a demand letter- I need to know this because my lawyer is keeping me in the dark. He hasn't even given a number yet- asked him to give me a ball park figure of settlement value of the case( should i know more a this in the settling phase?).Isn't a number supposed to be given in a demand letter? Well Mr. Miller I can go on & on picking your brains for further info-so i just watch all your blogs- Keep up the good work - wish you was in my area--again ; THANK YOU MR. MILLER- PLZ. REPLY ASAP.

[@JoeMillerLaw]

Thank you so much for your kind comments. So in "official" MSA's that are reviewed and approved by CMS, most states, to my knowledge, do not allow an attorney fee to be taken out of that portion of the money. Now what does happen sometimes is that the comp carrier will offer some medical money for items that are not covered by Medicare, such as attendant care or other items, and the attorney WOULD be entitled to a fee off of that portion, which would be outside the purview of the MSA. Insofar as what the CA Comp Commission's policy is on granting attorneys' fees from official MSA's, I can't say for sure. I also can't speak to your attorney's discussions with you about settlement. I can tell you that until i actually draw up a demand that is ready to go out, i don't discuss figures with my clients; however, once the demand is drawn up, I always schedule a telephone conference to go over every single element of the demand and my estimate of the value for each, as elicited in the above video. Of course, it's very important to note that the figure mentioned in the demand is usually just a place to start the discussion. I always emphasize to my clients that any figure I demand is NOT a representation of the value of the claim. It's typically a reasonable calculation of a "worst case scenario," which often assumes my client will never work again. Of course, if CA is like most states, "what i've been through" in terms of pain and suffering, is not relevant to the value of a Workers Comp claim. It' unfortunately, cold, hard numbers. Good luck to you and I hope you get a tremendous settlement that satisfies you.

[@dwilliams42170]

I really need your help sir. Very complicated situation. I currently have 2 work comp claims open and a PI for the same set of circumstance and the WC adjuster just asked for a demand letter prior to responding to a psych eval and a SLAP tear surgery RFA from the third doctor.

[@JoeMillerLaw]

Sorry for the late reply. We are happy to assist you if your cases are pending in VA or NC. Please call our office toll free at 877-622-8656 and we'd be happy to assist you. You will speak to the intake specialist, Andrew, or possibly Lisa if Andrew is out when you call. We look forward to hearing from you. If your case is not pending in VA or NC, I am sorry we really cannot assist you. If your case is pending in another state, I highly recommend you seek out an workers comp attorney in your state by going through AVVO online. AVVO is a very good site for finding an attorney where you can see ratings and comments from former clients.

[@amirewashington3904]

My worker’s compensation payments have stopped for weeks at a time in Maryland I have to have back surgery this is the second time my attorney is taking the insurance company to court for not paying me my workmens compensation the adjuster hasn’t responded to my attorney but the adjuster approved for me to have another mri that the surgeon wants me to have before my surgery why has my payments stopped?

[@JoeMillerLaw]

I'm so sorry but if your case is pending in MD, I cannot answer your question, as we only practice in VA and NC. The laws for workers comp are different in every state. In Virginia at least, though, once you are under an Award, they cannot randomly stop payments without filing other papers to terminate your ongoing Award. Usually, the reason is due to your return to work. But I do not know your laws in Maryland. You should direct your questions to your attorney as to MD Comp law.

[@relettacaudill9419]

They have stopped paying me for 3 months at a time and had to take them to court! I live in Ohio. They do you this in hopes you will go broke and settle for a small amount of money!

[@JoeMillerLaw]

@@relettacaudill9419 Glad you called them out on it. Yes, it's a common tactic. They'll try to make excuses for it, but I think it's often on purpose. In VA, if the payment is more than 14 days late from when due, it's a penalty of 20% on that check. In NC, 10%.

[@realtalk37851]

@@relettacaudill9419 They always do it and it's a tactic like you said. I'm in Maryland and I've been through this so many times. Just don't give up. Keep fighting for your rights

[@emiliocastaneda906]

Is there a timeframe with the insurance have tour response or close out?

[@JoeMillerLaw]

Very hard to answer that question. Sometimes, for whatever reason, the insurance co does not want to settle, but just leave the case open. As I explain in another video, all full settlements in workers comp are voluntary on the part of the insurance company, unless there is something akin to a Mediation Agreement which is at least NC can be legally enforced. But I would say that if you have not even received an acknowledgement as to the receipt of the demand by the defense attorney or adjuster, as the case, may be, after 30-45 days, you should follow up and make sure the demand has been received. Because many times, for whatever reason, things get overlooked. Bottom line is the time frame depends on the interest of the insurance company in settling the case. I have seen cases where they are paying the maximum compensation rate along with lots of medical expenses go on for years... zero interest from the company in settling. Others I thought might never settle and they resolve quickly. In other cases, many years go by. Then, out of the sky comes a call from the defense attorney... There's a new adjuster and they want to try and resolve this case! So unless you are flat out told there is no interest in resolving the claim from the other side, and you're sure they've received the demand, just be patient. I do not purport to know what goes on in the bowels of insurance companies, but I do know It takes time for them to evaluate these things, push things up the chain of command, and get monetary authority to resolve the case. This can be particularly daunting if you were a State employee and therefore you are waiting for the State government to respond to your demand. In Virginia, at least, if your case is not on the Statewide "list" of cases the Attorney General wants to settle, it will not get settled.. Period.

[@emiliocastaneda906]

👌🏻 thank you very much for answering my question. I really appreciate it a lot. It makes me see things much clearly with your response. It would’ve been nice if you had an office right here in California.

[@JoeMillerLaw]

@@emiliocastaneda906 Thank you so much. Yes, we used to spend a good deal of time in Orange County when my mother-in-law was alive. Awesome place. But yes, if you have not already, you might want to consult with a CA Workers Comp lawyer. Each State's Worker's Comp laws are very different.

[@josephwashington6658]

So what if they say they are ready for a full and final settlement.

[@JoeMillerLaw]

Mr. Washington, I'm sorry for taking so long to reply. Depending on the circumstances of your case, it may or may NOT be appropriate at this time to settle your claim. For instance if you are still in a great deal of pain and require a lot more treatment, this might not be a good time to settle. 8 I would certainly take the opportunity to consult with a workers compensation lawyer in the State where your claim is pending before negotiating a single thing. If you were hurt in either VA or NC, please give us a call and we''d be happy to discuss your case.

[@mojorisin7317]

Ok the problem with the system 1st and foremost is that insurance companies don't have to settle in a workers compensation case. Sure a lawyer pushes paperwork easier and may know a few angles and will try to humanize you to the insurance companies but in workers compensation cases insurance companies and employers are overly protected by state and federal regulations. 2: you can't sue the employer regardless of fault unless criminally involved. 3: you don't get pain and suffering only if a 3rd party case was involved or can be ordered to pay you, like your working for the post office and while delivering a package to Home Depot their forklift operator runs you over, you can now go after Home Depot for the damages even though you got hurt on work delivering a package. If you were at the post office and got runned over by one of your fellow employees then you couldn't claim a 3rd party claim and won't be entitled to pain and suffering money no matter how long your recuperating. That alone, especially for severe cases is a big deal and a huge loss for the injured person. 4: Disfigurement/scarring is not payable for body parts that wouldn't show while wearing a suit. So especially woman who get burned or cut severely on their legs that would show scarring while wearing a dress wouldn't get compensation for that, like if it were their face or hands nor would anyone get compensation if the body was disfigured that again wouldn't show while wearing a suit. 5: Lawyers will take up tp 28% of your meager albeit tax free but tiny settlement while doing very little as they don't have the power like in a 3rd party case or non work related injury. So the biggest tip is to try not to be unlucky and get hurt at work especially without a 3rd party case and of course that's impossible to predict or prevent in most cases. Most state and federal laws heavily protect the employers and insurance companies and workers are lucky they are even covered in the first place. Get educated because all this information is publicly available if you know how to find it. Knowledge is power ✌🏽🇺🇸

[@JoeMillerLaw]

I would agree with almost everything you say except for the 28% attorneys fee. I definitely agree on the protection/power and lobbying of insurance companies. The amount of information that employees are actually mandated by law to be told by employers about workers compensation is MINISCULE compared with what they SHOULD be aware of. Many, many folks who COULD HAVE been our clients and had successful cases make fatal mistakes before ever speaking to a lawyer. That is one of the main reasons I do these videos and why I am so passionate about doing them. To combat the almost complete lack of quality information or guidance that is out there for folks who get hurt on the job. As to attorney fees, they are set by the Commission in VA and NC. In VA, the Workers Comp Commission will typically approve 20% of any full and final settlement. Occasionally, there are additionally some smaller fees (usually in the hundreds of dollars) for getting claimants under an Award. In North Carolina, the Industrial Commission will typically approve 25% of any full and final settlement, otherwise known as a "clincher." Occasionally, if we have to got to Hearing, in NC, or litigate a major issue on a case, the Industrial Commission will approve us getting every 4th comp check (Again, 25%) in addition to the clincher fee.

[@a.k.a-salute1564]

Hey I'm in NC, workers comp case. Scheduled for 2nd back surgery. Representing by brent and adams, but not idea on the potential value of my case and the medicine future wages is incredible. Please contact me. This injury happen july 2021 herniated disc

[@dennismosley9163]

How ya doing?

[@a.k.a-salute1564]

@@dennismosley9163 thanks for asking Dennis.. Tbh, it's a struggle but I'm hanging in there

[@realtalk37851]

No attorney will tell you how much your case is worth because they don't know. Every case is different and they don't wanna promise you anything because they're not sure

[@dennismosley9163]

What's up Joe

[@puntasquenada]

Im in the process of permanent disabled since 2001. I will be 65 in August and Workers Compensation is denying treatment. They are rejecting me breaking my foot even thou Drs have said its related to surgery in l4 l5 fused. After trying stimulator, epidureal injections 4 Neurosurgeons from Rush, Northwestern and U of C have all documented the nerves have wrapped around the titanium hinges & screws. Surgery was recommended in 2019 it was approved by Traveler’s Case Manager along with exterior work needed, rehab hospital and to have a advocate to settle. In 2019 my Attorney retired I asked for 1.5 million to settle. All was agreed until Traveler’s put a new case manager on my case. Been on opiates for over 10 years caused erosion to my teeth. Causing out if pocket cost that has been refused to reimburse me. I have bills and medicare has been charged. I need help in getting treatment extended hours recommended by doctors.

[@JoeMillerLaw]

It is difficult for me to comment on your case since it appears your case is pending in a State other than VA or NC. Every state's laws are different re workers comp. I strongly advise you to obtain another attorney as soon as possible in your state. AVVO.com is a very good resource. Make sure the attorney is rated well and specializes in Workers Compensation in your State. You may already know this, but regardless of the State, if you are now a Medicare recipient, Federal Law dictates that the future medical portion of any settlement must be approved by the Center for Medicare Services. (CMS). This is known as a Medicare Set-Aside. (MSA) That process takes some time. It is possible that is causing some issues, but it does sound like there are many other issues going on. Here's a link to my video re MSA's: kzbin.info/www/bejne/m2XbmnRph55mrbc Best of luck to you, so sorry you are going through so much.

[@glennieholland6839]

Texas is really missing injurys peoples bad I am 1 of them can't work anymore on ssi ssd the government is pay everything for me work comp at doing nothing give me 5 injury for life ant paying notting the state is doing it for me can't get no Texas lawyer to help me on it so sad how work comp does there injury s workers.

[@JoeMillerLaw]

Yes, I've heard TX comp laws are particularly bad. Think about the laws being written by Ebenezer Scrooge. That's what the attorneys have to work with down there. I'm so sorry you could not get a good result, that's really hard.

[@glennieholland6839]

@@JoeMillerLaw Mr Miller I hit the wrong button when I tap you the frist time sorry what you get a office in texas to help people s down her you can do it with God help needs good lawyer like you how help injury s peoples when the insurance company trying to get over the injury s workers sir God will help you just try it you will see .

[@JoeMillerLaw]

@@glennieholland6839 Thanks so much. I'm not admitted to the bar in Texas, but I am sure there is someone down there somewhere who has what it takes. Use AVVO.com to find good workers comp lawyers in TX

[@Tampertownmediagroup]

In the racist and anti city of Beacon NY our neighbors take it upon themselves to investigate injuries. They stalk and park and look for reasons to lurk around your home.

[@JoeMillerLaw]

That's awful. I'm not admitted to the NY Bar, but according to what I've seen, the penal Code in NY defines stalking as follows: "Stalking in the 4th degree: intentionally and with no legitimate purpose engages in conduct that s/he knows or should reasonably know: will cause reasonable fear of material harm to victim or member of victim's immediate family or causes material harm to mental or emotional health of victim or member of victim's immediate family or causes a reasonable fear that victim's employment or business is threatened; 3rd degree: Same as 4th degree when: 3 or more victims involved or victim has reasonable fear of physical harm or serious bodily injury; 2nd degree: same as 3rd degree when a weapon is involved in commission or 2nd conviction within 5 yrs. or if victim is 14 or under and actor is 21 or older; 1st degree: same as 3rd or 2nd degree with intentional or reckless physical harm to victim." Not sure if they would do anything, but you should certainly call the cops if you are afraid of getting hurt from these racist bigots.

[@Tampertownmediagroup]

@@JoeMillerLaw lol I’ve called… Up here it’s been a perfect storm. At this point I just want to pass on what I’ve learned so if anyone else gets hurt they can become more aware!!!! Thank You……..

[@JoeMillerLaw]

@@Tampertownmediagroup You are very welcome

[@JoeMillerLaw]

@@nelsonmartinez6486 True that. At the end of the Day, if God wills it, it will happen. If he does not, it will not. Do what you have to do within the law, but most importantly, pray and conduct yourself in such a way that you are worthy of God's Blessing. I think that's pretty much it.