Job injury in 04 fall resulted in back fusion, and two knee replacements. I was told it would take a year after each surgery before going to court by my lawyer. I was also told my back injury would not allow a schedule loss for my knees . The long period since the injury was due to hospital stays, rehab and Pt per year per body injury. still being treated for back pain sciatic but I am mobile and willing to work. No IME was scheduled for these injuries prior to court hearing now the insurance company wants classification...what do I do dismayed. I retired early due to injuries per Dr. advice.
It sounds like classification is proper in your case.
A partially disabled claimant is required to look for work within their restrictions. That is the law and if your doctors are reporting a partial disability that is why you have to look for work.
At this point in the claim the issues can be somewhat complicated. Have your attorney explain this all to you.
Dear Retiree in Mt. Vernon:
It is hard to believe the Carrier has not conducted an IME since your 2004 accident at work.
Customarily, a case with a Back Fusion and 2 Knee replacements ends up being classified with a Permanent Partial or Permanent Total Disability, (PPD). You don't get both a PPD and a Schedule award.
It sounds like you went back to work for a while and then retired. The Carrier may make an issue over whether you retired because of the injuries or not. That will be a factual inquiry.
Your doctor has to fill out a form C-4.3. The first question on p. 2 is whether you have achieved Maximum Medical Improvement; further treatment will not improve your function. If he says NO, the Judge will order testimony of doctors.
If he says YES, then he goes to the lower third of the second page and answers the Table and Severity. The more severe he finds your condition, the larger the letter. Severity "A" is the lowest, etc.
You have a lawyer; why aren't you asking him about this?
The foregoing is based on the little information provided; additional facts may change the comments given.
This is a "rule" copied from other states at the constant pushing of the insurance and business interests. It is a trap to catch the unwary claimant, who may not have a lawyer telling them about it. The theory is ...let's say you have a 50% disability...hypothetically that means you also have a 50% ABILITY. You should work within your remaining 50% rather that sit home watching Oprah on the TV. The other incentive is you are entitled to reduced earnings if you are disabled, working with your remaining ability, but making less money that your average weekly wage at the time of the accident. So if you were making $1500 a week when you were hurt and now are earning only $750 a week, you'd ne losing $750 a week and would make a claim for 2/3 of that or $500....subject to the cap in place at the time of your accident. Thus a person making $3000 a week in 2018 who has a 50% disability and is making $1500 a week would not get $1000 a week no matter how much Reduction in earnings they have as the current cap is a max of $870 a week. if you hurt the legs and back in the same injury you can not get classified and have a schedule loss too. The conditions merge. Sometimes claimants are better off with the schedule loss awards and drop their back or neck claims. Given the length of time of your case, your disability payments have probably already exceeded what you would have gotten on pure schedules, and your attorney's strategy to work off the back condition is a very good strategy in your case to maximize benefits. Three questions for you: What is your age? Did you have a lawsuit against any third party from the fall? Did you apply for and are you receiving Social Security Disability. On the bottom of the response page I am noting that you do not need to hire a lawyer since you apparently already have one and the lawyer obviously knows what he or she is doing.
This is merely a general response to a common inquiry and does not create an attorney client relationship. An attorney client relationship can only be established by a meeting with the writer or a member of his firm, and a written authorization to represent. The writer can be reached at 1-800-416-5454.
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