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How is settlement calculated in a workers comp claim that resulted in 500 thousand dollars in medical bills that insurance paid?

Grand Terrace, CA |

I was harassed at work for many years because of my ethnicity (asian) and the doctors attributed it to stress causing physical symptoms and I was hospitalized several times for heart attack and stroke which occurred while at work. I am curious as to how if I file a stress claim, will doctors be paid because it was already covered by private medical insurance.

Attorney Answers 5

Posted

The value of your claim is not directly related to the amount of money spent on your medical treatment the value is generally determined by the permanent and stationary report of your primary treating physician and if the defendants want to go to ame or a panel QME to dispute the primary treating physicians report they will have a second report to base your PERMANENT DISABILITY upon. You may hear term whole person impairment used to describe your Disabilty. But that whole person impairment is converted to permanent disability by adjusting for your age and occupation, Again the value of the medical that was used to treat you has no relationship directly to the value of your claim in Worker's Compensation

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Posted

The WC Insurance will have to potentially reimburse the Group Health for what Group Health paid if the treatment was related to a work injury. That may bolster the value of your future medical, but your case may be largely valued on the Whole Person Impairment that is given to you.

We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY upon any legal advice.

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Posted

As stated, there is little or no correlation between the amount of your medical bills and the amount of any settlement. Your medical bills were paid by your health insurance. Don't worry about that. If the health insurance wants to be reimbursed,they can file a lien. Not your problem!

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Posted

Answering your direct question: an AWARD (at trial) in a workers comp claim is calculated by your ACTIVITIES OF DAILY LIVING which are impaired or ended by the work injury, resulting in WHOLE PERSON IMPAIRMENT.

If a physician's report is persuasive you have Whole Person Impairment ATTRIBUTED TO THE WORK INJURY (pre-existing impairment and non-industrial disability gets subtracted), the judge would have that 'Rated' for a Permanent Disability finding.

The INsurance Adjuster would calculate that settlement offer taking around 1/2 of what the anticipated rating would be after Trial plus 1/2 the anticipated value of the future medical expenses.

My learned colleagues left out: Psychiatric INdustrial INjury must now be cause by a sudden or extraordinary event. MAYBE harassment for being an ethnic minority could be considered extraordinary...but maybe not. The new law took effect 1/1/13.

Unless you go to trial and get a Finding & Award that the Injury to Psyche and Cardiovascular and Circulatory was caused 51% by events at work, your personal physicians wouldn't recover in workers compensation lien trials, maybe just 2 or 2% 'nuisance' value.

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I'm not licensed in California but I don't know of any state in which a workers compensation settlement or judgment is calculated based on the amount of medical bills. The amount a workers compensation settlement of judgment should be is generally based on the part(s) of the body injured, permanent impairment rating for that body part(s), permanent physical limitations or restrictions, age, education, prior work history, vocational impairment and compensation rate. As you can tell, you should contact a workers compensation attorney in your local area to represent you with your case. Don't try to figure it out yourself ... you only get one shot so make sure it's done right! Good luck!

This response is given solely as a general response to the question and does not create an attorney / client relationship between the questioner and responder.

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