How long will it take for workmans comp to start offering a settlement amount?

Asked over 2 years ago - Sacramento, CA

I have been on workmans comp since september 2011. For my lower back of my L5-S1 injury. I have had treatment from my dr and physical therapst with no luck and seen a pain managment dr that did an esi. I think the workmans comp company will take forever because of my mileage check still hasnt came and its been a month since I sent it out.

Attorney answers (3)

  1. Brett A. Borah

    Contributor Level 20

    3

    Lawyers agree

    Answered . Time from injury to settlement can vary greatly. You can't settle your case until your treating doctors declare that you have reached maximum medical improvement. How long will that take? No one knows. I think estimates by my colleagues are optimistic. If you need surgery for your back, that will take a year to recover from. You're already 6 months from injury. But you're right about the insurance taking forever. Whatever your case is eventually worth, the $$ is sitting in their bank account getting interest...not in yours and they're in no hurry to move it to you.

    The rule for mileage reimbursement is "reasonable." While Mr. Schwartz thinks that means 45 days, I usually think it means 60. In either case, it's not very fast.

    If you feel you want an attorney to guide you through this process, there are some excellent ones in Sacramento. Find a good one here at www.avvo.com or at www.caaa.org. CAAA is the association for attorneys here in California who represent injured workers. Or you can call me for a referral.

    Good luck.

  2. Scott Alan Schwartz

    Pro

    Contributor Level 11

    2

    Lawyers agree

    1

    Answered . Temporary Disability:

    First off, you may be entitled to temporary disability payments if your treating physician certifies that you are temporarily totally disabled. Temporary disability payments from the State of California (i.e., EDD) will last for up to one year. If you're injury is accepted by the insurance company and you are treating within their Medical Provider Network (which your lawyer can tell you), you can receive temporary disability payments for two years insofar as you are certified as temporarily totally disabled.

    Mileage Checks:

    With respect to your mileage check, the insurance company has 45 days to issue payment to you, again, if the appointments were to visit physicians within the Medical Provider Network and the claim is accepted.

    Settlement:

    You will begin to receive your settlement once you become permanent and stationary (i.e., not getting any better or worse). At that point, your primary treating physician will write a report as to the extent of your permanent disability because of the injury. If this is an accepted claim and the physician who declares you permanent and stationary is within the Medical Provider Network, insurance companies will often times issue you a check that they believe is reasonable based on the treating physician's permanent and stationary report. Of course, the insurance company and/or your attorney may object to the permanent and stationary report of your primary treating physician or still want to fight the claim on other grounds, such as the injury existed prior to the claim you filed or that the injury did not arise in the course and scope of your employment, etc.

    So, when will I get paid?

    The majority of the time, insurance companies and your attorney will either agree to an independent physician known as an Agreed Medical Examiner (AME) or disagree on any independent physician, in which case you will eventually see a Qualified Medical Examiner (QME) based on a list of three physicians issued by the State of California. Your attorney will "strike" (i.e., eliminate) one doctor on the list and so will the insurance company -- you will visit the remaining doctor, who will issue a report as to your permanent disability. Do you get paid after seeing the AME or QME physician? If either physician states that you are permanent and stationary and no party issues an objection to the report, you should start to receive bi-weekly checks based on your permanent disability. Of course, there are caveats to the foregoing, such as the insurance company not agreeing with the AME and wanting to take his/her deposition to change his opinion or in the case of a report by a QME, taking the case to trial, among other things.

    About 10% of my cases settle before anything described in the above paragraph. But, I personally choose not to settle cases in advance of the AME/QME process where there is a bad injury because I don't want my clients' to receive less money than they're entitled to without an independent physician discussing how bad their injury is and how much future medical care they will will need.

    The fact that you just received an Epidural leads me to believe that you are not yet permanent and stationary, as the physicians are trying to ascertain whether or not you are a surgical candidate.

    You can ask your attorney to write a demand letter and see how the insurance company responds. But, the insurance companies don't usually initiate settlement negotiations, in my experience, unless they're afraid that they're going to take a real beating with AME/QME report.

    In general, my cases settle within 1 to 2 years.

    I hope this helps and that you find your way on the road to recovery.

    Scott A. Schwartz, Esq.
    http://www.scottaschwartzlaw.com

    The answer provided herein does not create an attorney-client relationship and is only meant as general advice... more
  3. George Ellis Corson IV

    Contributor Level 20

    1

    Lawyer agrees

    Answered . A year to 18 months is average.

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