HOW WILL MY CASE RESOLVE?
There are three possible ways an injured worker’s case can resolve: 1.) Workers’ Compensation Administrative Judge’s Findings and Order/Award; 2.) Stipulation and Award; or 3.) Compromise and Release.
First, upon receiving a Maximum Medical Improvement (MMI report)* from either your Primary Treating Physician or an independent state doctor, also known as a Panel Qualified Medical Evaluator, the case is essentially at its final stages. At this time, the Injured Worker (through his/her attorney) can either come to an agreement with the WC Insurance Company regarding what to settle, or if no agreement can be reached, the parties can proceed to a Trial. Three thing can happen at this point:
1.) Workers’ Compensation Judge’s Findings and Order/Award: If the parties for any reason cannot come to an agreement, then the parties have to proceed to Trial, such that a Workers’ Compensation Judge can hear both sides’ arguments at Trial, and then issue a decision on all issues being presented to the Judge, including but not limited to the PD, TTD, and Future Medical Care. A Workers’ Compensation Administrative Judge’s decision is called a Findings and Order/Award. His/her Findings and Order/Award are binding, unless either party appeals.
2.) Compromise and Release: If the parties can come to an agreement as to the value of the Indemnity and the Future Medical Care, the parties can reach an agreement called a Compromise and Release. A Compromise and Release is essentially the only way Future Medical Care can be “bought out” by the Insurance Company/Defendants, meaning that once the parties enter into a Compromise and Release, and the Judge issues an Order which finalizes the Compromise and Release, the WC Insurance Company is no longer for the Injured Worker’s WC Case. This is accomplished by the Defendants paying a lump sum specified in the Compromise and Release. The lump sum is essentially a valuation of your WC Case. The valuation process can be difficult, as there are many components to consider. Thus, it is best that an Injured Worker obtains a Workers’ Compensation Attorney, such as our office, such that the Injured Worker gets a fair and reasonable valuation for their Compromise and Release settlement.
3.) Stipulation and Award: A Stipulation and Award settles out the Indemnity only. This means that the Future Medical Care is left open and the Injured Worker may continue to treat for his WC injuries, with the restriction that they have to treat within the WC Insurance Company’s Medical Provider Network (i.e. doctors that the Insurance Company authorize to treat the Injured Workers). For this reason, a lot of Injured Workers do not wish to settle via Stipulation and Award, as they wish to control their own medical treatment with the doctor of their choosing.
REAL CASE SCENARIO: Breadmaker injures his right knee at work and files a Workers’ Compensation claim. His left knee consequently begins to have problems, in response to his right knee being weakened by the injury. The PQME issues an MMI report which indicates that he is 23% PD ($26,245.00) and recommends that he have Future Medical Care of right knee surgery in the future. Because of the fact that the Injured Worker at this point unemployed because his Employer claims they could not accomodate the work restrictions given to him by the PQME, he has no source of income. Thus, he settles his case for a lump sum, which will include the “buy out” of his Future Medical Care. Consequently, we were able to get him a settlement via Compromise and Release for $60,000.00 with a SJDB voucher.