[thursday]

I just got off the phone with my claims adjustor. My claim is headed toward settlement. If my doc would get off his rear and write the P&S report!!!
Anyway the adjustor just called and asked me for my recorded statement and it was hard not to feel like I was in the hot seat!! [The back story why I'm at the end and JUST getting around to this is b/c I've been on loopy meds and they can't get a statement when I am like that.] Luckily when he called I had my hands on my injury files (that are very complete and pretty well organized) and I was able to get thru it w/o stumbling too much. lesson: the best thing I've done throughout this ordeal is keeping such good records He even wanted to trip me up with my hobbies. I said I used to draw and then he went needling into that (how can you with tendonitis??). I hope I clarified well enough..... You just can never tell how they might twist things!!

At the end he asked if I wanted to add anything- and I didn't other than "I hope I was clear and if there are any questions they might have I'd be glad to clarify." I can't help but feel a little anxious now... Anybody have stories from their WC case closing while still injured. Horror stories? Things to anticipate? Worries? Mistakes? Did I make any by not adding anything? Also- he told me in the beginning that I didn't even have to do this recorded statement but I did anyway cos I thought it might help me more than hurt me- was I right???

Thank you!

[Jomar]

I had a interview like that but it was closer to the beginning my claim so it must have been a different thing.

I'd just go with you did your best and worrying won't change anything.

closing and a settlement can be two different things.

I had a 1999 RSI case that closed in 2000 as i was mostly Ok and stable.
When it all began back up again in 2003 and with new /other sx I wasn't sure if it was a new injury or a re injury - so that complicated my "new" wc claim and confused my new dr on my care/treatment plan.

Settlement final monies-
Just make sure to ask for more than you need for the future because they will counter offer/negotiate down.

Don't feel pressure to sign anything if it doesn't feel acceptable.
Because when you sign it's is pretty much done. You might have a limited time to reconsider. Before you are sent a second set of papers to confirm the agreement.

But don't hold me to that - I'm just trying to recall how it went for me in 05 and in Oregon, other places might be different.

[queen178]

Originally Posted by thursday

I just got off the phone with my claims adjustor. My claim is headed toward settlement. If my doc would get off his rear and write the P&S report!!!
Anyway the adjustor just called and asked me for my recorded statement and it was hard not to feel like I was in the hot seat!! [The back story why I'm at the end and JUST getting around to this is b/c I've been on loopy meds and they can't get a statement when I am like that.] Luckily when he called I had my hands on my injury files (that are very complete and pretty well organized) and I was able to get thru it w/o stumbling too much. lesson: the best thing I've done throughout this ordeal is keeping such good records He even wanted to trip me up with my hobbies. I said I used to draw and then he went needling into that (how can you with tendonitis??). I hope I clarified well enough..... You just can never tell how they might twist things!!

At the end he asked if I wanted to add anything- and I didn't other than "I hope I was clear and if there are any questions they might have I'd be glad to clarify." I can't help but feel a little anxious now... Anybody have stories from their WC case closing while still injured. Horror stories? Things to anticipate? Worries? Mistakes? Did I make any by not adding anything? Also- he told me in the beginning that I didn't even have to do this recorded statement but I did anyway cos I thought it might help me more than hurt me- was I right???

Thank you!

I am going through the same thing. I know that my foot will never be the same and I know that I will never be able to do the job that I used to. I have done all that I could to not suck from WC like... use vacation and sick pay etc. I only received WC payments for 1 month and I could not stand sitting at home any longer so I went to work for my parents. they know what I can and cannot do and the job is a totally sit on the butt job. Attorneys would not even talk to me because I am employed. My worry is that when they sell the business... who is going to hire me? I too am very scared for my future.

[thursday]

Originally Posted by queen178

I am going through the same thing. I know that my foot will never be the same and I know that I will never be able to do the job that I used to. I have done all that I could to not suck from WC like... use vacation and sick pay etc. I only received WC payments for 1 month and I could not stand sitting at home any longer so I went to work for my parents. they know what I can and cannot do and the job is a totally sit on the butt job. Attorneys would not even talk to me because I am employed. My worry is that when they sell the business... who is going to hire me? I too am very scared for my future.

Wow! That's rough! I understand the who-will-ever-hire-me feeling. I am curious how that would work for you too. Have you been in contact with your state's Human Resource Agency for disabled workers? Or your Department of Industrial Relations in your state? If not, try googling & check out the website and let the digging begin. I wish you luck!

[bebop]

I hope you have a great attorney working on this! good luck

[thursday]

Originally Posted by bebop

I hope you have a great attorney working on this! good luck

hmmmm. I don't- I was told earlier before I was P&S, by attys, that they couldn't see a big dollar sign along with my case.... but now that I am headed in a settlement-direction maybe that's different....

Wow. This just occurred to me!! An "ah-ha" moment!!!! I will investigate and report back

[Jomar]

be sure to ask about %% /fees or do the math cause they will be able to get up to 20% {state % may differ} up to a limit.
i think OR was 5000.00 when my claim closed

And I don't know if they will be able to really do much "work" for your case now that it is so close to close?? {they might just take case for the easy payout??}
Please be aware of that scenario...

sorry more for you to check into-
unless they have ideas on keeping it open longer and getting you better treatment and care for the long haul....

[lefthanded]

I was a Senior Claims Examiner with over 13 years of experience in worker's compensation in several states before my last employer put me on disability. Let me preface by saying every sate is different. I urge anyone on W/C to read the basic on how your state's w/c works.


A claim will stay open as long as your doctor can document that further treatment will improve your condition. Once he can no longer justify your being in treatment (even if the physical therapy, etc. keeps you from sliding backwards), you will likely be declared fixed and stable. At that point your claims examiner with do one of several options: a) prepare the claim to be closed, b) request a permanent disability evaluation from your doctor, or c) set up an independent medical evaluation for determination of permanent disability and/or restrictions.

I advise anyone nearing claim closure, that unless you feel just as healthy and fit as you did before your injury, and sometimes even if you do, request a permanent disability rating from your doctor. If he can not do one (not all doctors have the certification to do this) ask him to refer you to a doctor for a consultation for closure and determination of permanent impairment.

A permanent disability or permanent impairment rating should take into account all factors such as loss of strength, loss of range of motions, loss of sensation, residual pain, your age, and perhaps even your physical condition, and your education level. If your hand is injured, ask that your rating be to the arm, if your thumb, to the hand, etc. If you have a back, shoulder or hip injury it should automatically be rated as loss to the body as a whole. However, remember, your state may vary somewhat . . . but you can ask for a copy of the statute on disability/impairment (they are the same thing) ratings.

I urge you to not let your claim be closed without addressing permanency unless you truly feel so fully healed that you can not imagine ever having the injury site give you any grief as far as being able to work. Disability is rated with regard to ability to work, not with regard to bowling, playing golf, or climbing mountains or skiiing! (I have had every question in the book asked of me regarding sports and activities that a claimant could no longer do.. . . but unless it is a work activity, your industrial injury is most likely not going to be responsible.)

You will not get rich from your permanent impairment rating and award. It likely will seem like a mere pittance for what you have been through, unless you have suffered a severe injury like amputation or a severe head or back injury, requiring major surgery or extensive rehabilitation. if your rating seems too low, ask the doctor to explain how the figure was determined. If the state arranged your independent/rating exam and it seems unfairly low, ask for a second opinion, with your own choice of doctor.

Carpal tunnel surgery never used to carry an impairment, as it was believed surgery restored 100% function, but that was changing when last I worked. Fractures of the arms, hands, legs and feet should be rated for impairment, as should back injuries with residual pain and/or loss of flexibility, even if you did not have surgery. Hearing loss always has impairment, as does loss of sight, taste, or any of your senses. I once paid impairment for a claim for loss of the sense of taste when the treatment for the injury caused the loss, even though the injury itself did not. I also paid out a huge claim on top of the work injury when a therapist treating the work injury dropped a patient and cause paralysis! (The additional costs for the second injury went to subrogation, meaning the therapist was responsible for everything over and above the initial injury . . . but it was messy, as the patient was not nearly to the end of her treatment when the therapist dropped her!)

(Speaking of subrogation, if a third party is responsible for your injury, they will have an interest in what is paid out on your claim. However, do not let them have undue influence over the claim, or push for closure, early end of treatment, or less treatment than necessary. And do not deal with them directly . . . your employer or the claims person is responsible for dealing with this.)

The best way to deal with your claims person is to be calm, reasonable, not angry or upset, and to educate yourself as best you can, as this will get their attention. The worst thing you can do is threaten, act like you are or have an attorney (your ability to talk directly with a claims person, and sometimes even your employer, about your claim, ends when you get an attorney), or indicate that you expect to "own the company" once your claim is settled. Believe me, I have heard it all where closure, money and punishing "bad" employers and their representatives are concerned.

I used to tell my claimants who asked up front if they would need an attorney on their case: "not if I do my job correctly." And then I would tell them if at any time they feel they can no longer get what they think they need from me or the system, then that is when they might want to speak to an attorney. Fees can range from flat-rate hourly with the clock ticking on every phone call, even the ones that are not returned (number one complaint about attorneys is that they do not return client calls on w/c claims) to anywhere from 20% to 30% and more, plus expenses/costs. Some of the best reasons to get an attorney are:
1. Your claim is denied and you truly had an on the job injury. Not an accident, but an bona fide injury. An attorney will know how to best present your case before whatever review board your state provides.
2. Your claim is only allowed for part of the injury and you or your doctor feel that your injury is greater than what was allowed.
3. You are refused benefits and you have been unable to protest them out of your claims person. Remember, every order issued to you is likely able to be protested in writing. Learn to write a decent and neat (with spell check) business letter. It is beeter then righting one that culd make them laff and not take yu seeriusly.
4. Your claim is closed before you have finished treatment. Your doctor should protest this, but if he doesn't convince them, you might need an attorney.
5. If, in your state, your employer/claims person has the right to dictate which doctor treats you, and this doctor is seriously downplaying your injury, an attorney might be needed.
6. If your claim is closed without a disability rating and your claims person disregards your second opinion doctor's rating. Attorneys love ratings cases because they know approximately how much money they will make and have to spend to get it.
7. You have not received all of your time loss/loss of earning power benefits and your examiner closes your claim. After you have submitted a protest with your calculations, if you still feel they owe you for lost time or lost income benefits, you may need to get an attorney. Included here would be if your time loss rate was not calculated accurately, or does not include shift premiums, overtime or bonuses in the calculation. However, these usually must be protested within a specified period after you have received an order for payment and calculation of benefits. Do not miss this deadline . . or any deadlines, for that matter. You will be left out in the cold!
8. Your employer does something that appears to be retaliatory for your filing a claim. e.g. Your employer fires you for filing a claim and ruining their perfect no-injury record, or they treat you differently when you return to work, like forcing you to take a job that pays less even if your job position is available, or move you to another shift when there is an opening on your regular shift. This is a fuzzy area in the law, which is why you should at least ask an attorney if you feel any kind of discrimination or retaliation, and especially if it is for filing an injury claim.

This list is incomplete and may not apply to all cases in all states. I have tried to provide a summary of ideas to help you educate and protect your rights when it comes to on-the-job injuries. Learn if and how to protest any actions you feel are not timely or done improperly. Learn to speak up and stand up for yourself. It will feel like work. . . but hey, you are getting paid something in the neighborhood of 2/3 of what you had been earning before you were injured. Get to work protecting yourself!!!

[lefthanded]

By the way, I forgot to address the recorded statement. Answer only what you are asked: it is not necessary to embellish your answers unless you are asked for more detail or clarification. It generally is NOT something that should be difficult, but if you have more than one person requesting a statement, you might want to ask if they can not share the information you have already been given. There is no need to be defensive, either, but don't offer up too much information. Employers are often eager to deny claims when they know you just re-roofed the house or just put in a new retaining wall with your own bare hands if you have just filed a back strain injury.

And always keep all of your doctors appointments. I once had someone claim they had the flu and couldn't keep their appointments for a week . . . but when I got the notes from their first appointment after the bug passed, the doctor noted a fresh new suntan, even though it was the dead of winter. Oops! Don't lie when you have a claim. If you have a vacation that has been scheduled for a year, tell your employer and your doctor and your claims person! You are entitled. . . but remember, if you can not lift over 10lbs at work, you can not hoist your own luggage into the overhead bin on the plane! You never know who might be on that plane with you. . . .and fraud cases with witnesses or good information are hard to fight! And lying is a type of fraud.

Happy healing. . . .

[thursday]

THANK YOU so much for your postings lefthanded!!! This is super valuable info from "the inside"! I urge you to repost this in the thread you started: I have 13 years w/c experience and was senior claims examiner when I became disabled so that others might see it too!
Really- thank you!