RSD & Worker Comp Settlement Issues
 

I've had RSD for nearly three years. It's so debilitating and painful that I haven't been able to return to work and there's no telling when or if that day will ever arrive. My Worker's Comp people are getting fed up with me, mainly because I'm not responding to any treatments and it looks like I might have to get another operation on the same injured knee that led to the RSD in the first place. Long story short, they want to settle.

I haven't received a dollar amount from them yet but I'm thinking that it's right around the corner. My question to you is:

For you RSD sufferers who have received settlements through Worker's Comp, what's a reasonable ballpark figure? Some (or most) of you might not want to discuss this on a forum but perhaps you wouldn't mind emailing me privately.

I'm afraid the insurance company will give me a low-ball figure and because I wouldn't know a good settlement amount from a bad one, I'm hoping that with your help, I can respond to their proposition from a position of strength instead of ignorance.

Thanks in Advance,

Jennifer D.

If Oregon is anything like California, you will undergo an "impairment evaluation" first. That will establish an impairment rating to the whole person based on AMA Guidelines, that then goes to something like an Office of Benefit Determination who then pulls out a chart that is based upon your occupation, rate of pay and age, etc., and then will determine what the value of the case is. That then goes back to the adjustor who will "make you an offer. " Whatever you do, don't let them buy you out of "future medical" care. That has potentially far more value than any settlement. I am not into lawyers, but because of the far-reaching impact that this one settlement may have upon you for the rest of your life, you may want to sit down with one and hear them out.

I agree, for something that most likely will be a long term condition , you really need to look for a good wc atty to represent you.

interview with many before making a choice, look at their office, staff, and how they handle other cases, try to see them in action. and look them up online and the state site for as much info as possible.

Thanks. I haven't secured an attorney yet. My insurance company has been very good to me, which I'm aware is not the norm, but I believe it will probably in my best interest to get one unless the insurance company makes an offer that seems more than fair. But that's the problem.


What is fair? I'm disabled enough to have received SSD on my first try, which I've been told is rare. There's a good chance that I'll never be able to return to my prior occupation as a massage therapist.

I'm in constant pain, very limited, and the medication I'm taking doesn't do enough to provide any sort of quality of life. I haven't given up on a cure or at least getting better but from how I feel, the length of time I've had the condition, the lack of any breakthrough in treatment, and from what I've heard from people who've had the condition for several years, there's a good chance that I'll remain disabled for the rest of my life. And that's a hard thing to write.

That's why I'm wondering what to expect for settlement.

Any ideas?

Hi Jennifer,
I've sent message back by pm but not sure if you got it. gave you my ph. number. let me know if you got it or not and i'll try again. Loretta Jewell

My experience with wc was just one of the many horror stories of an injured worker. In Florida you can't hire an attorney just because you're on wc. A lawyer here will only take your case after you've been denied something. For instance, in my case they weren't paying me and were denying me physical therapy. I think in Arizona you can't hire a lawyer until wc closes your case. At that point you can get a lawyer and have your case re-opened. That one is the silliest thing I've ever heard of but that's the way they wrote their laws.

As for settlement, I'm sure just as each state has different rules, they also reach a figure for settlement differently as well. I've seen a lot of people say they had to go for an exam to determine the % of disability(impairment rating) so wc could throw a number for settlement out there based on whatever the % for a body part(s) is. I was never sent to a doc for a impairment rating. In my case, wc added up what they had spent on my care up until that point in time(a yr and a half), then came up with a number of what they might spend on me in the next yr.

Since wc doesn't pay for pain and suffering or lost wages, the settlement will never be enough. If you're lucky to live in a state with lifetime medical that's good. Florida has no lifetime medical so there was no reason for me to stay on wc and fight while they destroyed my life. I went to mediation, bantered back and forth for about 2 hours and settled on a $$ amount for settlement. The best I got was 40k, 10 of that went to my lawyer so I got a check for 30.

Each of our cases are unique, just as the laws are. I don't think anyone can say what a fair or reasonable amount may be because it depends on the state, the wc laws and whatever else they use to figure things out. They don't care that this is a lifelong condition and won't take that into account when tossing out a $$ amount to settle with you.

If you're unsure of what your wc laws are for your state, then your best bet would be to pick a wc lawyer and take advantage of the free consultation they have. Then you can ask them when you are able to hire a lawyer or if wc has lifetime medical in your state. WC lawyers are paid when your case is over and settlement is reached. You don't have to pay them any money up front to hire them or anything like that. I do know every state has a % that lawyers can take. Like here in florida, the Fee Schedule is 20% of the first $5,000.00, 15% of the next $5,000.00 of all benefits obtained and 10% of the benefits in excess of $10,000.00 during the first 10 years, and 5% of the benefits obtained after 10 years. We also get a lump sum settlement which means we get it all at once. I had a friend in california on wc. There, the settlement is given by annuity. When she settled she was mailed a check every month I think it was and that continues until all of the amount of her settlement is paid out. Out there they also take a portion of your settlement and put it into a separate account. That money is used only for paying for docs,pt and meds or docs and meds, whatever you have need of. Once that money is gone you have to self pay.

Sorry this is so long. I really hope this helps you somehow.

Hugs,

Karen

hi I am overcomer,
I just received w/c settlement and as has been said, it will never be enough when you have a disability w/not much chance to return to work - my injury was 5/2008, placed on ssd 10.2008 - as disability required lifetime care and I was looking at future surgery and insertion of neurotransmitter, w/c figured it was cheaper to settle - I also received a medicare set aside fund for the next 23 years for future care then after that fund runs out, medicare will pick up the cost as they indicated it was a w/c injury and w/c needed to pay - there is some sort of way they determine how many years w/c has to pay before medicare picks up - also, in the state of georgia, medicare does not start once you are on disability for 25 mos but even as I speak, medicare is evaluating my medicare set aside to see if it will be enough, if no, w/c will have to put more into the fund, if they say less, w/c cannot take anything away - it looks like they will have to put me in medicare before the 25 mos in order for me to use the fund because you have to prove you are on medicare to get medicare prices for treatment - you really need to find a lawyer who is aware of what rsd is are you will be short changed, my lawyer had specified on his site that he was familiar w/rsd and warned that all lawyers are not - what I did was went to the internet and looked up rsd lawyers, went on their sites as some will give you cases about rsd and othe conditions w/the amount that was won so that is how I knew about how much to expect - the sad part about this is you look at w/c cases on these lawyer sites and then you look at personal injury and the is succccccchhh a bigggg difference that you cry but that is how w/c is - my lawyer did tell me that the reason there is no pay for pain and suffering is that w/c considers paying your bill pain and suffering and personal injury cases are pvt iunsurance or if md is aware of personal injury/you have a lawyer they will treat you then get funds when you settle so you get money to also pay medical bill - hope this helps - I know each state is different and I live in the state of georgia and we do not have lifetime insurance -

Rsd wc
 

Hi Jennifer,

I can't tell you what a reasonable settlement is but I can tell you that the IC in my state, Pa. offered my husband who has had RSD for 4 years 150K. They did a life plan or something like that to figure future medical expenses for medicare set asideand estimated he would live to be 81. He is now 50 so that 150K is about 4800 bucks a year. That is crazy. We had our own impairment rating evaluation (IRE) and he is 63% impaired. The IC has yet to do an IRE but they have just filed a petition to modify/suspend benefits.



Good Luck.

Dear jennifer d,
I wanted to email you privately but can't find the stupid button to do so. If you want to do that it would be great. All I can say is it is a joke here in PA and from what I've heard over the years you are lucky if you get about 60K from them. Sometimes before they settle they will want you to do a 4 hour test or something. I am bedridden pretty much with full-body RSD and that was not an option I could do but had to settle. It was a joke for sure. The one thing I would have done differently is to have them give you monthly payments forever instead of a lump sum. Here in PA the social security disability considers that settlement as income and subtracts it for years from your monthly amount. So, there were months I only received $174.00 per month from SSD and had to dig into my savings to just live each month. It has been a mess.

The interesting info I have learned is that there are civilian cases where people ONLY have RSD in one part of their body and have received 15 million (yes, take yourself off the floor) and I want to cry each day cause I got peanuts for sure because it is workers comp. I don't know who made these rules up but they were either paid by workers comp or it was workers comp themselves. So not only are we in pain, lost our jobs, our families, friends, lives in general we now get the shaft for settlements too. All I can say (to rationalize this in my head) is that God has great plans for all of us for all the suffering we do each day. If you have any questions and feel like PMing me feel free to do so. Good luck. Stick to your guns and if they come in low tell them no way and make it higher.
kathy d

Get a good wcom attorney
 

My friend has had RSD for almost 4 years (full body now) from a job related injury.

He finally got an attoney to take his case a year ago. and as it goes it is still on going:

The insurance company has been OK - but they are not your friend no matter how well they treat you - you are a long term liabilty on the books.

Never/ever settle your medical benefits.

If you take a lump sum settlement it could have effects on your current SSD benefits.

It has been rumored to his attorney that they are going to offer a settlement and it will be mulit million dollar ( he is currently 62 - 58 at time of accident).
He has no intention of ever settleing this case as the cost of just living expense, transportion, hiring someone to do what you can not is just too hard to determine.

Right now a million dollars may look good - but 5 yrs down the road you may ask why did I do that. The ploy of the insureace company is to be your friend and put a big dollar sign in front of you and say sign on the dotted line.

GET A GOOD ATTONEY on your side. Once settle you can not undo it.
Prayers and wishes for pain free days ahead.

Dear Sailmaker510,
I do agree with you about your posting but I do want to point out something I think I need to clear up. You said "Right now a million dollars may look good - but 5 yrs down the road you may ask why did I do that. The ploy of the insureace company is to be your friend and put a big dollar sign in front of you and say sign on the dotted line." I don't believe the ploy of the ins co is to be your friend. They may think so but they have many different ways to make you change your mind. You say the money may look good now but but 5 years down the line ---...The ins co may be out of business or merged with another co by then and you could be cutoff OR what happens in case the patient dies by some random thing (I know I hate to think this way too) then will his/her suvivors get any money or will it just be cut off since the patient died?

If this is a workers comp settlement social security treats the money received as income and spreads it out over the years. You could wind up not getting a dime of SS money for several years as a result of the settlement. Maybe you could specify what is for transportation, PT, etc. before the settlement this way soc sec doesn't include it all as income. I know there are so many ways of looking at this and your ideas are correct. What has been happening to me is that the workers comp doesn't want to pay for me to get my Ketamine treatment so they are constantly filing court docs to go before a judge to keep me from getting them and it goes on and on for years. This is the way they stop your treatments. They want you to get so annoyed and frustrated you just give up. If you settle monetarily make sure you don't settle your health benefits. This way you can continue to get benefits even if you have to fight for them. Hopefully, Pres Obama will cutout disqualifying us for ins because of preexisting conditions. It will be interesting to see what happens. THanks for your email.
kathy d

One thing I advise very strongly before you settle is to make sure you have what is called an "open file" which is what the wc company has to pay for the rest of your life. That is what they would have to cover pertaining to your rsd whether it be docs visits, surgery, meds. etc. That is the biggest thing with me because it does get rather expensive. I have been fighting since 2003, settled out once, then wc renigged on what we settled on so we are now fighting again. If you don't have health ins. you will probably have a very difficult time getting it. I was denied 3 times in 1 summer because of my rsd. So please try to make sure to settle at least with an "open file". It will be one of the best things you will have done. Take care and good luck.

Sincerely,
Tracy

I know u wrote about this a yr and half ago..but here goes
 

Hurt in FL at work, 2 knee surgeries later, RSd/CRPSII , then systemic CRPS II. The value of an entire leg being amputated in FL is $25,000. They do not have lifetime medical and to top it off..my company went under the FEDERAL BANKRUPTCY ACT protection. My choices were 1) wait 4-5 yrs to see if any monies were available after all other debtors were pd or 2) take a settlement. Since was living in FL alone with no help and wanted to move home to GA for $assistance, mobility assistance, yadda, yadda...I tk the crappy amount of 50,000 leaving me with 37,000...30,000 for medical. THAT ran out on less than 9 months. With the loans from family and agencies I finally made it to the finish line....2 denials for SSDI, then with an atty won in may this yr. Still have not seen a lump sum....THEY ARE WORKING ON IT. I think they are trying to stretch out my med amount of 30,000 out as a monthly income but my atty says the ARE CRAZY AND CANNOT DO THIS. What is your status?:(:confused::(

You received a favorable SSDI judgement and to this day you've not received your retro pay? If so, this is borderline criminal.

JK....the amount of SSDI backpay is offset by WC when combined they would equal over 80% of your pre injury income.

It sounds like in BD's case it will come down to how the WC settlement was written. I don't think it's fair to count medical payments/compensation against SSDI backpay, but if the settlement was written just as a final settlement/payment maybe SSDI could justify not 'double paying' for that period. I hope it works out for you BD

That's not exactly correct. With a good life-care planner who researched future medical and an economic expert who runs the numbers and it can be determined fairly accurately.

I'm not familiar with WC claims, but through a car accident causing CRPS I know a friend settled for more than $500,000. That was even without going to court. Insurance didnt fight it.

No fault won that case... Im on comp.. and they have offered me 4 different settlements .I refused them all.. I will not settle.. this beast seems to be here to stay. i will need them to cover treatments for many years to come until one sticks.. and then even if it does stick it might come back.. nope I won't settle ..especially for 14 grand when in the last year they have spent over 400 grand on medical alone.. they know the real worth .. and they are insulting my intelligence . and they will do the same to all that do not know the worth of medical they will need in the future.....

I've always wondered why the heck this is even allowed. Anyone with a serious injury taking a lump sum generally won't receive a fraction of what is really needed to cover their medical care. It seems to encourage fraud... Or shift the monetary burden to tax payers...

Don't get me wrong, WC is generally miserable to deal with, so I can understand wanting to get them out of one's life.

Attorneys also encourage their clients to settle for a lump sum so that they end up getting a % of the medical (unless of course the injured worker is in a state with max attorney fees.)

Every doc I've ever spoken with has said it's foolish to settle out medical with WC, yet most of their patients seem to make that choice. I decided early on that the only thing I could worry about was keeping my medical open, which resulted in me being without out a dime of income for a long stretch at one point--without the help of family I would have ended up homeless...

Just to add my 2 cents...when it comes to settlements it really is different in every single case. I did not want to settle and initially did not. We went to trial, won, and I had open medical. Then things got worse and I couldn't reopen the case and take advantage of open medical because work comp was appealing. So there I was, in limbo, getting worse daily, and forced to use my regular insurance because work comp would not approve anything. Bad situation made worse (in my opinion) by an awful lawyer who was in way over his head and then turned nasty on me (and yes...this is MY lawyer I am talking about). No other lawyer would touch it because we had already gone to trial.

So after a year...I finally took a settlement. Work comp was against me, MY lawyer was bullying me and being mean trying to FORCE me to take a settlement, no one else would touch the case, I was getting no income, and had to pay for all my own medical. So once I was released back to work I made the decision to settle because I needed to get out from under all this stress which was only making me worse. I feel like work comp won on this one because they were able to force a situation where I felt like I had no choice but to either settle or go bankrupt, lose my job, and have to wait another 5 years before the appeals and all that were done (all while being harassed and bullied by work comp, my lawyer, and dealing with the stresses of having no money and no way to keep paying for insurance).

Did my settlement even cover a fraction of the medical I will continue to need in the future? Heck no...it didn't even cover the medical paid out of pocket last year while they were messing around. But it's OVER. I struggled with the decision for a long time...but I honestly feel like the decision I made was in my best interest long term for my physical and mental health.

If the situation had been different (different lawyer mostly) then I never would have settled. I don't regret my decision because it was the best I could make of a bad situation...but I do wish things had been different. Unfortunately the system is just so corrupt and sometimes you just have to make the best of it. But I am very proud of my decision to refuse their offer to resign my job for more money. That just plain insulted me and it is terrible that in MOST cases they get people to agree to this. They pushed that hard on me but I absolutely refused.

I agree with you LitLove that the fact that insurance companies can offer lump sum settlements does encourage fraud. It sucks too because the only ones who really benefit from the current system the way it's set up are the ones who are exaggerating or faking injuries because the settlements are not nearly enough to take care of those who legitimately need the money for medical costs and are too much for those who won't really have any future medical costs. So frustrating.

But I do realize that my situation is also unique because I have been able to return to work and therefore have insurance and income to help me pay my future medical bills. This is not the case for many with RSD who end up losing their jobs, friends, family, etc because of the condition.

There are situations where settling may be the best situation for someone, though, since this is not a perfect world and we are surrounded by corruption and those who are willing to hurt us for the bottom line. Sad...but true. The work comp system needs to be majorly overhauled...but I just don't know how you make it better and free from the corruption that currently causes it to be so bad. And the corruption is on both sides because I realize that as much as work comp sucks and take advantage...there are just as many employees who work the system too.

Exactly Catra!

IF there is a chance of the medical portion of WC going away, and we go to a system of insurance with no pre existing conditions being an issue, that would take care of a lot of the wastefulness.

Injured Workers are spoken of so frequently with disdain. Until someone goes through the experience themselves or a family member, they just don't understand.

A national WC system would also be a good idea IMO. Things vary so widely from state to state.

RSD is more complicated and unpredictable than many common work injuries. So, I think we're susceptible to the systems shortcomings in a way that many Injured Workers just aren't.

It's odd, but there seems to be a major shift in the culture where people have very little empathy for the disabled, or ill. Or maybe I'm just getting cynical as I get older?

End rant... ;)

I am saddened by the truth behind all of this.. The world looks to itself instead of others, then to others first. I try to teach my children right. It is even in proper speech. that when speaking of yourself and another or a group that you come last, that others come first.
If this is how our speech was originated, then that means that we a a group are"expected" to care for each other. In all I know and feel. most people wish this is how the world will be but the truth is it gets worse as time goes on.
the more people that live the less others are thought of first. selfishness becomes the way of life. .. survival of the fittest become the law. and truth is as a species we come up short of being fit of the eden we have been given. I have heard that man had been cast from eden. I do not believe it .. we corrupt it. no matter what religion or belief you have I'm sure this can be seen as true.
we are seeing this corruption with the way the system treats US. ok I've ranted on and on and on and ..ok Ill stop. If there was a way to change this . I wish it would present itself. and then i would pray that I was smart enough to recognize it and what to do at that point. Until then we wade in this pool together with either comp, no-fault, or private insurance. we each have our obstacles to over come.. and thankfully we have each other here to help in this labyrinth . god speed every one. soft hugs to you all

I'm in CA and was "lucky" (lol) to be injured prior to WC reform here. You might be right, as bad as it is here, some state's are even scarier. I know that many of us have to consider relocation after becoming permanently disabled, and yet it seems I might be trapped here because of all the complications that will come with WC billing from another state. I'd like to think if there was a single national system, it would garner more attention from those that might be able to effect a more fair system.

The reform a couple of years ago did only benefit the corporations. but here is the kick of it all. I have been paying into this system since I was 9. yep illegal but Ive been a tax paying citizen for that long. I never complained about it as it only gave me moore to add into ssi. but this is too much . It isn't taken into account my desire to work and feel like a contributing part of the world. only that the bottom line is satisfied. so if comp doesn't exist to make sure injured workers are cared for, or to make sure proper care is given to aid in the return to work.. whats the point.??? what is the point of it all? just to make sure others keep making money off my misfortune?? I am dis illusioned and loosing faith in it all.

the problem is that they don't really know the patient. and think that all patients are trying to cheat the system. what they need to do is see the dr,s notation. and if more than one dr is saying the same thing(including theirs) they should back off. and these separations between states. carriers such as comp and no fault that are governed should run by the same guide lines through the entire U.S. making it easier to get treatment. .Im pretty sure if this keeps up we will be saying ..I pledge allegiance to corporate america...
well I pray that an answer opens up for us all. be well and godspeed

This was not in a "no fault" state. Please don't jump to conclusions. And yes, I understand the general discussion here is WC.

I apologize if you took offense. none was intended. I was just stating that with this beast it should have been more. though I do understand how it could be less aggravating to settle for the long term of dealing with the NF/WC claims.
also I was making no judgement (I wouldn't. that would be too unfair to everybody that comes to this forum) many different ways this beast effects people making no two case the same.in regards to insurance, treatment, and pain. IN my YEARS I did a lot of professional medical billing , and I specialized in comp/nofault and liability . None of that matters on this end of the line. Its a fight no matter how you look at it. I wish you well. and days filled with less pain..

New addition to the rsd group
 

I was wondering if anyof you can give me some opinions on the SCS.
I am a 23 year old male with rsd of the right ankle and it is spreading up my right leg and is currently from my knee down... I was wondering how well the SCS works mainly because I have a beautiful one year old daughter and can't run around and play with her.... I would greatly appreciate it if y'all could give me a little input on the SCS and any other types of methods besides opids

RsDyork, there is a scs forum (link below) I would recommend posting this question to them for more answers.

http://neurotalk.psychcentral.com/fo...ysprune=&f=118