Will settling my workers compensation case affect my disability retirement? Will my medical insurance cover future care?

Asked about 2 years ago - Santa Rosa, CA

I was injured on the job as a firefighter/paramedic approx six years ago. Due to the injury I was retired out on disability. After two surgeries my surgeon states that I am "permanent and stationary, and cured with no residual factors of deformity or disability". My work comp carrier has my permanent disability at 6%. I was sent a letter of compromise and release from a settlement specialist on behalf of my work comp carrier. I'm considering settling my case, but I'm wondering if this will affect my disability retirement through CalPERS? Will my private medical insurance cover any future care (cortisone injections, etc)? Is any part of the settlement taxable?

Attorney answers (2)

  1. George Ellis Corson IV

    Pro

    Contributor Level 20

    4

    Lawyers agree

    Answered . I don't think 6% will impact your retirement, but CalPers will be happy to talk with you. Honestly, you should talk to Brett Borah or another No Cal WC attorney before you settle your claim by Compromise and Release. The WC carrier has an obligation to pay for your injured body part(s). The Private Insurance might claim subrogation credit if you take money to settle your future treatment, and then ask Kaiser or Blue Cross to cover the WC body parts. Even the 10% chance is something to discuss with a qualified WC attorney before settling. If you take the Stipulated Award and keep medical open, you have no problem. A Certified Specialist in WC can also discuss/recommend a Panel QME, which could raise the value of your case. All surgeons think they have fixed the problem, but a Panel QME may be a bit more objective.

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  2. Jon Carl Marlowe

    Pro

    Contributor Level 6

    2

    Lawyers agree

    Answered . Regarding the affect of a compromise and release (C&R) on your retirement, it depends on the language of your retirement plan. If your retirement plan includes an "integration clause" then your workers' compensation settlement may offset your retirement benefits. Your settlement by C&R will include a permanent disability and future medical component. The permanent disability portion may offset your retirement. In situations such as yours as well as injured workers receiving SSDI benefits, an experienced attorney will add language in the settlement agreement to expressly characterize the portion of the award that is permanent disability and what portion is for future medical expenses in order to minimize any potential offset.

    Regarding coverage by your medical insurance for future care, your private medical insurance will most likely deny coverage of future medical treatment relating to your work injury because your claim was accepted. The future medical award in a C&R is intended to cover future medical expenses. If you received money for future medical expenses in the C&R and then received coverage from your private medical insurance, you would be double dipping. You may need to consider a medical set aside to cover future medical treatment. You should contact your medical insurance carrier to see if work injuries are exempt for the policy.

    As with Mr. Corson, the 6% PD rating seems low given that you had two surgeries for your injury. You definitely need a second opinion on your PD rating. A qualified medical examiner (QME) in the appropriate medical discipline would be better suited to determine your PD rating. Additionally, the QME will most likely comment on appropriate future medical care for your injury. The QME report will most likely give you a higher bases for determining the settlement value of your case. I suggest contacting an experienced workers' compensation attorney to assist you in the QME and settlement process of your case. I second the recommendation of Brett Borah.

    Work comp settlements are not taxable.

    The information provided above pertains to the law and is intended to help the person posting on this site with... more

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