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Why is CA giving me a check for a lump sum when nothing has been discussed? Can I return the check?

Pasadena, CA |

Received my rating from DEU. I just got a check from the CA for the lump sum for the rating less my PDA with no explanation. My paperwork from DEU says that I would get payments every 2 wks. Which I would rather have even if I C&R. I haven't cash the check yet because I may want the summary rating reconsider by AD. I thought I had 30 days to decide whether I agree with the rating. Why is CA giving me a lump sum when we haven't discussed settlement options? DEU says future medical and I thought I was entitled to a 4000.00 retraining benefit and a 15% increase because my employer did not offer me any employement. They're going out of business.

Attorney Answers 4

Posted

Assuming that you have not been taken back to work making at least 85% of your pre-injury earnings, or have not gone to work elsewhere, making at least 100% of what you made at the time you were injured, they are required to begin making reasonable advances of permanent disability payments starting two weeks after your temporary disability payments end. If they haven't been making permanent disability payments up to now, then they were required to bring them up to date in order to avoid exposing themselves to penalties for unreasonable delay in providing benefits. Beyond that, getting money today is pretty much always preferable to having to wait to get it.

You are not waiving any rights by cashing or depositing the check. You are only bound to something if you sign settlement papers that are then approved by a judge. Nor does taking the money prevent you from asking to have the rating reconsidered. Also, this money has nothing to do with your right to the retraining voucher.

Whether you are entitled to the 15% increase in benefits depends on a few factors, including whether your employer had at least 50 employees at the time you were injured. It also only applies to injuries between 1/1/2006 and 12/31/2012.

If you and the defendant in your case are both agreeable to working out a settlement that will pay you extra money to cash out your right to future medical treatment, and settle everything for a lump sum of money (what we call a "compromise & release"), you are still free to do so.

Before you make any more decisions, however, I would urge you to have a free consultation with an experienced worker's comp attorney, and preferably a certified specialist. You can find attorneys on this site and at CAAA.org, the organization for attorneys who represent injured workers in California.

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6 comments

Asker

Posted

I need to clarify something my DOI was in mid 2008, TTD benefits ran out 2010. Then was paid PDA for 2 1/2 mos. When it ran out I applied to SDI and was able to get on SDI for a year. Remained TTD end of 2012 and was recently given WPI and became MMI by PTP in Jan 2013. Was rated Apr 2013 by DEU. So what your saying is the ins should have been paying me PDA from late 2010 - to early 2013? On the check it says PD benefit. It appears she sent me the check less my PDA that was paid to me in 2010. I haven't agreed to the rating or had any contact with CA yet. I just wanted to know why she would send me a check when I haven't agreed to anything at this point. Can I return the check to her? I may file for reconsideration this week. If I C&R can I have payments every 2 wks instead of a lump sum? I'm on SSDI and don't want a lump sum to stop my benefits. I would rather be paid every 2 wks so an offset would be taken instead. The future medical was on my paperwork from DEU so CA is aware of this. I would qualify both the 15% and SJDB benefits. Do I automatically get this or do I have to mention it to the CA? She has not been very cooperative.

Richard Andrew Harting

Richard Andrew Harting

Posted

These are probably accrued benefits. Please consult with a work comp atty for specific assistance with your matter.

Gerald Franklin Batchelder

Gerald Franklin Batchelder

Posted

You've got a number of complicated issues. You really do need to get an attorney. You've got too much at stake to try to do this on your own.

Asker

Posted

Ins did start PDA after the TTD ended this was in 2010 but like you said it was for a reasonable amount. That went on for 2 1/2 mos in 2010 then it stopped. I was sent a letter saying 2 1/2 mos was all they were going to pay until I was rated. I guess they considered a little over 1800 a reasonable amount. You never answered my question. Are you saying the ins was still supposed to be paying me PDA from 2010 - 2013? Yes / no? If your saying the check I was sent this month is accrued benefits from 2010 - 2013, I would have received alot more than what I've been given. 230.00x 260 wks is over 58k. The check says permanant partial and is base on the rating I was just given. The CA subtracted the PDA from 2010 from it. She's paying me for the rating. The 15% and SJDB I know I get this I just want to know if it's automatic or I have to tell her I get these benefits. The CA doesn't volunteer any of these things. She tried to settle before my rating and it was only for the injury and didn't mention any of this or the future medical. If I cash check my benefits with SSDI will stop that's why I wanted to know if I can send it back? Yes / No?

David Norman Rockwell

David Norman Rockwell

Posted

The carrier would still only pay up to 85% of the amount of the potential award based on the rating. In order for the accrued benefits to be over 58k, your rating would have to be over 40 percent. Unfortunately, you don't say what the rating is. If you are on Social Security Disability Insurance, that doesn't mean your payments will automatically stop if you cash the check. You really need to talk to an attorney about the complications you may face, especially since you were on SDI; SDI has a lien which may have to be paid out of the PD check you just received.

Asker

Posted

In 2010 there was no rating it didn't exist. So how could I be paid 85% PDA on a rating that didn't exist until Apr 2013. How does WC know what is a reasonable amount for a PDA when there is no rating to go by? So everyone is saying even though I was sent a letter from WC saying PDA would stop because they felt they had paid a reasonable amount and they would wait until I was MMI and rated they were still suppose to be paying me up until I was rated this year? From what I understand legally WC has to start PDA benefits 14 days after TTD benefits (104 wks) end because I wasn't MMI or rated yet. I didn't ask for the PDA. I applied for SDI because there site said I could apply as long as I wasn't on TTD . They know about the PDA and didn't pay me for the 2 1/2 mos. From what I read I couldn't be on TTD benefits, they don't say anything about PDA benefits. SDI gave me those 2 1/2 mos back because my SDI went 2 1/2 mos past the date my SDI started the yr before. As far as I know SDI would only take a lien if I was suppose to be paid TTD during that time and wasn't receiving it from WC under certain circumstances, ie; claim being denied, pymts stopped or ran out before claim was resolved. These are some of the reasons why someone on WC would apply for SDI. I have to let SSDI know if I get any monies from WC. What SSDI will do if I cash the check is stop my payments until the WC money runs out and then they will restart payments again. Been there done that already

Posted

The Insurance was probably paying accrued benefits. You are supposed to receive benefits consistently until exhausted, so a gap in past payments may have been recently corrected. The SJDB Voucher and benefit increase should still apply if you are not returned to work.

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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Richard Andrew Harting

Richard Andrew Harting

Posted

These are probably accrued benefits. Please consult with a work comp atty for specific assistance with your matter.

Posted

These are probably accrued benefits. Please consult with a work comp atty for specific assistance with your matter.

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Posted

In addition to the detailed answer given by Mr. Batchelder, I would point out that you do not get the voucher that can be used for retraining until after there is a final approval of a settlement by a judge. Thus, if you resolve your case by way of a stipulations with request for award, the carrier has sixty days after the judge okays the Award to send the voucher.
If you decide to close out your case by a Compromise and Release, in which you sell your right to future medical care and your right to reopen, be very careful about settling your right to the voucher. Check the paper work carefully to make sure you don't give it up.
As recommended, a free consultation with a workers' compensation attorney would be a good idea.

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