Is it a good idea to do a settle with a section 32 under workman's comp NYS ?

Asked about 1 year ago - Jamestown, NY

I was injured on aug 28th 2009 ii have acouple blown disks in my lower back. I have been off work since the injury, fighting monthly with Hartford insurance for everything
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I am sick of the games Hartford plays and i have been on Full SSD for 2 years now so the last time they asked if i was interested to settle i said yes and they are haveing me see the Doc for perm placement and whatever else i have to do before they offer me a check...Since then i was informed by a family member that i shouldn't settle because medicare and my wife insurance will not cover anything to do with my back because i settled for it. And will it effect my SSD income negatively? i was also told there was a new law that limits the amount of payments i get form comp. When didthat start and am i grandfathered in

Attorney answers (3)

  1. Leonard Bernard Feld

    Contributor Level 13

    2

    Lawyers agree

    Answered . Dear Madam or Sir in Jamestown:

    Your claim is affected by the CAP, which means your payments stop after a stated number of weeks. The Cap is figured when the medicals say you have a permanent partial disability or that you have reached maximum medical improvement.

    When you are getting SSDB, they usually figure a Set Aside amount from your settlement. You get the money but you are supposed to "set aside" that figure in a separate account and keep track of the payments. OUt of that account, you pay medical bills for your causally related condition (should you get any treatment after the settlement).

    The idea is that Medicare is to take over those payments AFTER the set aside is used up.

    Good Luck

    Leonard Feld

    The foregoing is based on the little information provided; additional facts may change the comments given.
  2. William Ward Crossett

    Pro

    Contributor Level 11

    Answered . To accept a section 32 settlement of a case is the biggest decision you will have to make. Typically a section 32 agreement will end the carrier’s obligation to make lost wage payments to you and end your medical coverage.
    When considering accepting a one-time payment instead of ongoing payments you have to weigh many factors including how long the lost wages benefits will continue. In March of 2007 the law was changed by putting limits or caps on how long lost wage benefits are paid. The duration of the payments is determined by your Loss of Wage Earning Capacity (LWEC) in combination with your reduced earnings if you are working or your level of impairment if not working. The LWEC is either agreed to or found by the Judge.
    The fact that you are on SSD,I while of some value is not a determination that you have a 100% LWEC for purposed of New York Workers Compensation.
    Now because federal law prohibits a transfer of your medical care from the Workers Compensation carrier to the federal system of Medicare, unless a monetary provision for the care is made in the settlement. A Medicare Set Aside ( MSA) amount is determined. The MSA is a sum of money that you are required to hold/use for your future medical care and treatment. The idea is that if you exhaust the MSA that Medicare will then pick up your care, subject to Medicare's rules.
    The entire process can be very complicated as it requires good faith projections as to you future lost wage benefits and medical care as well as serious negotiations with the carrier, who may or may not be interested in a section 32 agreement.
    Because of the complicated nature your interest are likely best served by working with a local attorney who has experience with the process and can offer advice and strategy that works with your situation and goals.

    Please remember the answer to this question is in general and without knowledge to the specific facts of your case.... more
  3. John M Connell

    Pro

    Contributor Level 19

    1

    Lawyer agrees

    Answered . You really should consider getting a lawyer the insurance company will have to do a Medicare set aside since you are on SSD Avoid work comp lawyer can guide you through that a maximize your settlement

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