Delays in Workers Comp cases

Previously I've mentioned about the delays to obtain a hearing in Social Security cases. But that situation is simply a matter of waiting for a hearing date and sprucing up the case for the hearing. In workers compensation the delays are varied depending on the case. Cases seldom proceed in a straight line or so it seems to me. One delay is when the claim is contested. This alone can take a hearing. Another delay can be with medical treatment. Sometimes the treatment is not thorough and yet unless there is a change of doctors (which also can lead to delay) the claimant has to go to a separate examination (called a DIME and mentioned previously). This also can take more then two months to arrange and even more time to wait for the results and still more time to await the insurers response. Sometimes further medical treatment is deemed needed and this is delayed until sometime after the DIME evaluation. Surgery adds still more months to the process and that is assuming it all goes smoothly. If the insurer disputes the need for surgery or other treatment it can take another hearing. Many cases often seem to take two years or more to wrap up if you are intent on protecting the rights of the claimant. I can say that most delays are based on medical issues or treatment. With medical care there is no certain timeline for recovery. Asking your lawyer when all this will be finished is often met with vague answers but the reason is simple: the legal matters cannot be finished until all appropriate medical treatment and conclusions are provided. If you wish to get it all over with sooner then you also must waive all further rights and benefits for a cash settlement. Such a settlement is seldom wise and often impossible to fairly analyze. While cases can be settled it is rare to try to do so until all the steps have been taken both medically and legally. Again this means delay. Imagine deciding you have to settle your case and move on with your life. You do so for quick cash and give up all your rights. Then you seek to return to work but find out you can no longer do your trade. You also find out that your back injury acts up on you but no one will pay for further treatment. By then you figure you made a mistake but its too late. By settling too soon there is no do over...its just done. So workers comp delays are terrible because your life is on hold but better to protect yourself before you are cut loose without anything further. In fact in some cases you are never finished. Your injury or complications from it can mean there is a need for lifetime medical care. From the time I take a case to the end of it usually takes from one to two years. There are exceptions where it is just a few months on the short side to well over two years on the long side.

Maximum permanent partial disability rate

Unless you are permanently and totally disabled the most you will be paid for having a permanent injury is based on specific state calculations and the medical rating (degree of impairment by either the authorized doctor, a Division IME doctor or by order). Your wage is often a factor in the calculations as is your age. But what I'd like to point out in this note is that the payment is biweekly until the amount is exhausted. A claimant can get an advance or even a lump sum but otherwise the amount is paid out every two weeks at a set rate. The highest rate for these biweekly checks changes each year but at present it is $413.95 a week. It can be less as it must be computed for each person. What this can mean is that you've been receiving temporary benefits of two-thirds your average wage which can drop down to the rate set for permanent benefits. The theory is that when permanency is determined you can return to work or find new work and receive the biweekly permanency checks anyway unlike temporary money where earnings are deducted. You or your attorney can get an advance if properly done so you might look into it. All this pertains to whole person impairments only. Scheduled extremity amounts are paid out differently. Here is the link for the maximum calculation:
http://www.coworkforce.com/DWC/FormsDeskAids/DESKAIDS/PDFDeskaids/Desk_Aid_4_Max_Rates.pdf

The Social Security Listings

Whether hurt at work or if your health is disabling there may come a point when you apply for Social Security disability. Even if the system is slow it still is an important safety net for those truly unable to sustain work. The listings are severe health problems that have made the list so that if you meet a listing it can mean you are truly disabled enough to deserve disability benefits. However this still requires that you meet other legal requirements but it is a big step to obtaining benefits. For example if you cannot ambulate effectively it may meet one of the listings. The Social Security Administration has very specific details on the listings and I have provided a link to them below.
http://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm

Can you return to work or are you totally disabled?

Often a person may not be able to return to his usual trade or occupation. This can occur because of restrictions or complications from the work injury as set forth by a doctor. Sometimes a person may have worked for many years and really enjoyed his trade but now is not sure what he can do. If you are only permanently and partially disabled or restricted you may receive compensation but not anything else. What then? Does the insurer have to retrain or put you into voc rehab? Not usually and you may wish to contact the state Vocational Rehabilitation office. There is an earlier blog post on this which I posted. But then if you think it is unfair and seek permanent total benefits (which can be substantial) it is your burden to prove it. Your attorney can apply for a hearing and line up his witnesses and evidence. He may also discuss a settlement. However if it goes to a hearing what will the other side say when you try to show you cannot work at all? Well, the other side can seek to show through its witnesses or evidence that you can work, even if just part time. Believe it or not if they show this and the Judge accepts it then you cannot get further benefits beyond what is allowed by an admission or the Judge. Just thinking it is unfair and no Judge would do this is a mistake. You must be ready to prove your viewpoint if it goes to a hearing. It is a true legal battle with high stakes. Here is a sample of some of the jobs that may be asserted through evidence you can do part time: "The claimant can work as a ticket seller, hotel desk clerk, restaurant host, pizza deliverer, customer service clerk, cashier, automobile salesperson, and sales clerk." This list does not end here...it can go on and on to include working at home! Decent pay comparable to your trade is not a legal consideration. This means it can be difficult to establish you can no longer work. Hard as it may seem it is quite possible to show this but it requires a solid effort. In this area your attorney may do the most good for you. There is caselaw to consider. There is vocational evidence to obtain. There may be further medical evidence to develop. Much can be done here so blindly accepting the insurance viewpoint is not wise.

Medical Transparency

Effective Jan. 1, 2008 a new law now requires more disclosure regarding doctors in the state of Colorado. This law has been signed and will apply after Jan 1st. It impacts workers comp in the sense that soon now you will be able to check further on any doctor to ascertain discipline or other adverse matters. In other words it will be harder to hide behind the traditional cloak of secrecy or nondisclosure that has been the case with the medical community in the past. Here is the link to the new law:

http://www.statebillinfo.com/sbi/index.cfm?fuseaction=Bills.View&session=07&mode=0&sortby=3&filter=b&srch=transparency&page=1&billnum=HB07-1331