The Ultimate Guide To Settling Your Workers' Comp Case

Settling a workers' comp case if a big deal. Many injured workers' fear that if they settle too soon they might loose out on benefits they will later need. Unfortunately, the easiest answer to give is, it depends. We know how discouraging it could be to hear that, because that's really not a helpful answer. Luckily, we share examples and analyzed this topic enough that we think we can help you figure out clues to finding out if settling your case makes sense.
Bilal Kassem, President and co-founder of Pacific Workers', The Lawyers for Injured Workers the #1 Northern CA. Workers' Comp Law Firm has already helped thousands of injured workers with their case. In this episode he explains what to look out for and shares clues that could help you determine if it's the right time to settle your case.
If you are dealing with a workers' comp case and would like a free consultation from one of attorneys, call us at 800-606-6999. Get the answers to the questions you have and find out if you are on the right path to getting what you deserve.

[@francesg.1587]

Absolutely the most accurate description of everything I've been going through! Thank you for the vindication of voicing MY truth!

[@WorkCompTalkPodcast]

Oh man, wishing you the best of luck!

[@barbarabalzarini5119]

Filling out the application for jobs. I’m very curious

[@william3329]

Great KZbin channel! Question: What happens if you settle and you start getting checks but pass away a year into the settlement from a heart attack that is part of the claim. Does the checks from the insurance company continue to the family or does it stop with the passing away? Thank you in advance!

[@WorkCompTalkPodcast]

Hi William, thank you for asking a great question. If you pass away, the insurance company is no longer obligated to pay benefits, the outstanding benefits will not pass to your heirs. That being said, if your death was in any way related to your work injury, your dependents may be able file a death claim. This would depend on the type of settlement and date of death.

[@william3329]

@@WorkCompTalkPodcast I really appreciate the helpful information!

[@kylesanderson3598]

It would be nice if you could talk about what happens if you have multiple injuries & both require surgery . If you choose to hold off until you can’t handle the pain anymore wether it be 1 yr or 20 yrs. What happens does you benefits stop right away . Like for my situation I have 2 tears in my rotator cuff the surgeon requested surgery after AME also requested surgery but I think I wanna try & manage for awhile with out it but I also have a hip injury I have a tear in my joint that I’m being sent to a surgeon to be looked at . Will I be cutt off Benefits if I refuse shoulder surgery but still not done getting treatment for my hip? Will my benefits be canceled?

[@IceESole]

Hey..where are you now with your injuries etc?

[@CATALINAG1]

They canceled mines for not wanting surgery for that one body part. But I have 2 other body parts that they did not even treat and still claim I was un cooperative. My lawyer stood back and let them do this. Am asking to take it back to court because I feel it's very unfair to report to insurance company that I was not complying so insurance company lets me know in a letter and I call lawyer and they cannot be reached at all , I feels like one big lie and cover up after another , they are pros at denying people unfairly.

[@Trash.Axx.]

How you guys doing, just came across your channel randomly today and I love the content. I also have a question. I've been on Workmans Comp since July of last year and I just recently had my knee surgery in January. The first doctor I had was obviously stringing me along and disregarding my knee injury and my symptoms. On my last visit with him before I was granted a change of Doctor I asked him why is it he's recommending surgery to the guy right next to me who had the same injury and symptoms that I was complaining about but he isn't recommending surgery for me? This doctor looked me in the eyes and says Do you look like him? He asked me twice. Before I got upset. I'm African American and the other guy was Hispanic. Before it seems like I'm playing the race card I want to point out that I had to ask this doctor for the 2 MRI's that I had done which showed I had torn my meniscus on both sides of the same knee. This doctor had this information since August. My first visit with the New Doctor recommended surgery instantly and asked me why didnt the first guy recommended it and I didn't have an answer for him. My question to you guys is, Can I sue this doctor, the clinic, or the state of Florida Workmans comp for malpractice? Or discrimination? I have the video where he says to me do I look like the other guy. I also have all the medical information from the start of my claim. I would love you guy's opinion on this

[@Trash.Axx.]

I work for FedEx as a delivery driver. Just adding some context for my question

[@Trash.Axx.]

I've been out of work since July

[@WorkCompTalkPodcast]

While we don't practice law on the state of Florida, as a workers' comp law firm we can suggest you to pay a visit to an attorney and get a case evaluation. Most of the time they are free of charge and can help you get the answers to many of your questions. You have nothing to lose and so much to gain if in fact you have a case. We wish you great luck with you legal matters.

[@marierosequijano4269]

I have an attorney for my WC however they don’t really help me. I’m still in pain with my left shoulder and hands and my WC Doctor puts me back to my regular work schedule.

[@WorkCompTalkPodcast]

Your attorney should be fighting with you, not against you, and they need to be your advocate. Sometimes it can feel like your attorney isn't doing much, but that can be the system at work (we all know the workers' comp system is terrible!). If it's not the system and it's just your attorney, you can always switch! All you need to do is file substitution and dismissal forms. Your attorney may file a lien for the work they have done, but hiring a new attorney won't increase your costs. The new attorney and old attorney will fight over how to split the fee.

[@dogsdroolllquinavancepasre6756]

They’re not your friend, they hold on to your trust fund in hopes of keeping the majority of it & you get peanuts.

[@donnymac990]

How do yall see workers comp covid cases working out? I got covid and was in the hostipal for several months and my.job/insurance has denied everything. My attorney has set up a priority conference next week and im really nervous.

[@WorkCompTalkPodcast]

It all depends on the facts. We've had cases who have turned out successful. Your attorney will have your back and guide you. Don't be nervous, you have support. Wishing you the best!

[@bonnierickards6973]

Wish some one would talk about settling if you are 80 years old and on Medicare. Lawyers says they will make no money because you have to buy away a certain amount from your settlement for future expenses from possible continued treatment. I live in Florida.

[@WorkCompTalkPodcast]

So at least in California (not sure about Florida), Medicare gets involved in workers' comp cases. The idea is that Medicare does not want to pay for medical treatment that should have been covered by insurance. To make sure they don't get stuck paying the bills, usually settlements involving a medical buyout, include what is called a Medicare Set Aside (MSA). The MSA makes up the portion of the settlement that accounts for your future medical needs. Provided that the settlement meets threshold review criteria, Center for Medicare Services (CMS) will typically review the MSA to make sure that the amount adequately accounts for your medical needs so their financial interest is protected. The pain point is that the MSA money has to be kept separate and cannot be used for anything except what would normally be Medicare covered medical expenses. So even though its your money, it comes with restrictions and subject to audits. Once you use up the MSA money then Medicare will cover treatment for your work injury. That being said, attorneys aren't supposed to take fees from the MSA. I guess its conceivable that if the value of the settlement is mostly an MSA, then there wouldn't be much for the attorney. Thats usually not the case. Our firm in particluar handles tons of cases that involve MSAs and Medicare/Social Security. Again, not sure about Florida law. Either way, sorry to hear you are going through a tough time. We wish you the best!

[@johnduffant9694]

I’ve been going through the process, it’s been 5 years at this point my back was broken at work, I went through 4 months of PT, multiple treatments, an epidural that only lasted 2 weeks.... they are saying my condition is from past life experience, I’ve had a spinal fusion of L4-5. My life is completely different most of the pain went away but I still have back pain and pain in several other areas. What do you think I should do. Thanks.

[@robertcraig1391]

We are at the mercy of a process called Utilization Review by a doctor who never sees us and has the authority to override the treating physician. In simple terms California Workers’ Compensation is a racketeering system benefiting large corporations and the insurance company. Both of which donate heavily to politicians.

[@betterthanezra2583]

I got injured In late 2021 a big herniated disc in my back, had surgery late September 2022! I’m still hurt and was told by my doctor and physician said I could never have a physical job again! How long should I wait for a settlement? Btw this happened in WA State

[@WorkCompTalkPodcast]

Here in CA, usually once the doctor feels as if there is nothing else they can do for you and you're deemed permanent and stationary that's when you usually get offered a settlement but it all depends, every case is different.

[@bettymiranda4267]

I have a approved surgery for fusion can I get a second opinion?

[@WorkCompTalkPodcast]

Of course you can! You have the right to seek a second opinion. If the insurance company has an MPN (medical provider network) you can ask the adjuster for a link for your search. Once you select a doctor, notify your adjuster that you want to see that doctor for the second opinion consultation. Some MPN listings may be outdated and the doctors on the list may not be taking new patients. So, it's always good to call the doctor's office first to see if they are still taking new workers' comp patients before notifying the adjuster that you have selected a doctor.

[@bettymiranda4267]

My lawyer's office want me to tell them if I want the surgery or not right away. But I want this surgery but not at the moment by law I have a deadline? My surgery approved end 8/22 what happened if a do not do it :(. I not want to loose this surgery if I will need in the future..in moment I want to wait for my body to heal or get worse ..I do not want to get worse by the surgery risk. Any advice will be appreciated. Thank you.

[@WorkCompTalkPodcast]

First off, you are never required to undergo any invasive procedures under the claim if you do not want to. If you decide not to do the surgery at this time, then you may be declared permanent and stationary, which would allow the carrier to stop wage loss benefits (TTD), if you are receiving them. In the event you later decide to have the surgery, benefits would start again on the date of the procedure, subject to a limited number of defenses. In terms of a time limit, the UR determination will generally have a time frame for authorization on the letter, which the carrier will assert is the maximum time you have to think about the procedure. However, that is an arbitrary time period and can generally be extended with for a reasonable amount of time pressing the issue with the carrier OR with the surgeon simply requesting an extension. This is all said with the caveat that we have not seen any of the paperwork, it's always best to consult with your attorney. If you are not happy with your current attorney, you can always change lawyers. All you have to do is complete a substitution of attorney and dismissal of attorney forms and have those filed with the court. (This is something the new lawyer will do on your behalf.) So no work on your end. Additionally, the cost does not increase when you switch attorneys, the old one and the new one just end up fighting over what share of the fee each respective lawyer should get. It's usually based on the time/amount of work done. Wishing you the best of luck, if you are in CA and would like to reach out to us you can do so by calling us at 800 606 6999.

[@skeeter1070]

It’s been 16 months for me been through hell finally got approval for surgery can’t wait till this is over such a battle

[@WorkCompTalkPodcast]

This is great news! Congratulations we wish you nothing but the best.

[@CATALINAG1]

So what if finally get approved for surgery after a year and half but now that part that Dr says is a complete tare that needs repair is feeling better after all that time you change your mind and do not believe you need surgery do I still get a settlement for that body part that was injured.?

[@CATALINAG1]

I'm glad to hear my suspicions spoken out , I want a second opinion and I don't think I need surgery , I would believe it within the first year and even going into the second but now I don't feel the constant pain I had before, Altho there's stiffness and obvious damage I don't feel that it's getting worse so I do have to ask for second opinion and another Dr. at this point. I dont appreciate the care or no care I have been given.

[@RedeemedRogueMolecules]

I was assaulted at work in November on the job. No one at work or comp has paid the bills and now they sent ME to collections. I don’t know what to do. Help.

[@CATALINAG1]

Get a lawyer

[@dogsdroolllquinavancepasre6756]

What if they hold on to a case for a decade and want injured worker to still comply to everything even though medical documentation proves extensive damages without a doubt? What’s that about?

[@WorkCompTalkPodcast]

That's the workers' comp system at it's best. The idea is that the longer the case lives the sooner they hope the injured worker gives up when things get harder to manage or even get approved.

[@badgalsheilabb2548]

Does pd stop during settlement demand letter

[@WorkCompTalkPodcast]

Once Permanent and Stationary and you are given your PD rating, you will continue to receive payments until they have been exhausted.

[@badgalsheilabb2548]

@WorkCompTalkPodcast so they going to pay me 56,000 worth of ppd does my attorney get money out of it

[@robertcraig1391]

Running up the tap on the insurance company sounds like a good tactics for the worker to follow. However, the reality of the safety valve called UR exist in California and is used to excess by insurance companies. Review the UR company mission statement on their web sites and ask yourself who the client is. It isn’t the injured worker and the insurance company will and does use a work around to communicate to the UR doctor to avoid potential charges of conspiracy to commit fraud. The fraud is still there. The insurance company communicates with a nurse working for the UR or intercepts a request under pre review and cites prior denial or non certification by the Ur within one year or the active date. If the injured worker uses a private insurance or third party government medical service the insurance company has no record of the treatment and claim plausible deniability of the extent of the injury. Sounds good but wasn’t thought through very well. This advice often sets a trap for the injured worker to not receive justice or have the employers and insurance company take responsibility for their actions.

[@WorkCompTalkPodcast]

It's complicated and we always recommend seeking legal council.

[@robertcraig1391]

@@WorkCompTalkPodcast Sweet advice when lawyers look at the facts and say it’s too old. What happened to the US Constitution and the long standing standard “A law repugnant to the US Constitution can not be law.” I don’t any Amendments revoking my right to sue in matter exceeding $20.

[@unclerudy9797]

Completely Inane...

[@benalexender3046]

❤

[@MissDuke2012]

“If you’ve *catched* our episodes” ??? Wow….

[@mojorisin7317]

What's sad is if you were injured the same way but not working you'd be awarded far better benefits and settlement amount. The fact that workers comp has no pain and suffering clause is criminal for the severe injured. They already have the no fault clause where no matter the fault of the injured your covered but you can't sue your employer unless its criminal. The scarring and disfigurement payments are laughable. Lose a leg get 100k 😮 don't you think a leg is worth more then 100k? Get burned on 60%:of your body but is covered by pants and a long-sleeved shirt you get NOTHING 😮 Get your penis cut off its worth NOTHING. Your settlement more or less is just your expected lifetime weekly payment at 60% of your salary more or less depending on your work's state statutes. You can negotiate your future medical and future weekly payments but it's definitely going to be not worth including your medical if your permanently disabled. Anyways the basic conclusion workers are lucky there insurance to begin with. The negotiated legal terms of workers comp is a raw deal for workers and benefits BUSINESS as usual, the employer and the insurance company have the upper hand and the worker is left with the miserable deal that is giving. So unless you have a 3rd party case YOU WILL NOT MAKE ANY SUBSTANTIAL MONEY ON A SETTLEMENT like you will on personal injury and 3rd party claims. Please educate yourself on your workers state workers comp laws. Some states are far worst then others. Get a good experienced workers comp lawyer to help you navigate and educate you on the BS of workers comp rules. Also to speak on your behalf with the insurance company. Remember they will take at least 20% and 30-40% on personal injury and 3rd party settlements but each law firm and state sets the allowed rates.

[@victorvalenzuela6949]

Worker’s compensation is a broken system because of all the fraud. People having previous injuries or getting hurt elsewhere on their own property and opening a claim at work. It messed up for those of us that are really hurt broken bones fractures hardware in my elbow and back. I also had internal bleeding in my head do to a fall from a 2nd story ladder. Torn rotator cuff’s torn meniscus tear on hip. Like you said we get no pain and suffering settlement. I was unconscious the whole time the ambulance 🚑 took me from the job site to the hospital. In situations like this there should be pain and suffering settlements.

[@mojorisin7317]

@@victorvalenzuela6949 agreed, sorry for your pain and suffering. The fact they use the excuse of fraud is appalling. For the obviously injured there should be no question, they can have contingencies and certain parameters to qualify but should be an option for people like yourself and never mind my case, got run over by a 30 ton forklift and suffered serious injuries and a almost 7 month stint in the hospital. So for me all that time with obvious pain and suffering awards me and people like me NOTHING. That's criminal. There will always be fraud regardless of the rules and strict monitoring of those rules. The negotiated terms should have been something like your in the hospital for more then a month you qualify, amputation of body parts you qualify, level 1 trauma you qualify etc. It's not rocket science and a testament to actually the erroneous minded structure that again benefits more businesses and insurance carriers then workers.

[@WorkCompTalkPodcast]

so true!

[@michaelzelaya1207]

Good advice guys thank you, btw Carmen's super hot 🔥

[@WorkCompTalkPodcast]

Glad we can help!

[@SuZySueSuzyQ]

Helpful discussion but I really don’t appreciate the *profanity, absolutely no need for it here! Otherwise, great information & appreciated! 😇🤗✅✨

[@WorkCompTalkPodcast]

Fair enough! Thank you for the comment.