What is Your Impairment worth?

I received a comment on this from someone and I thought it deserved a posting on this Blog. First any impairment rating may or may not be correct. Any of the parties may be able to dispute the rating or number and this often happens for the claimant. Do not take the first impairment rating as the end of the story. It is often wrong and even a medical opinion you are at maximum medical improvement can be wrong. When you receive a rating consider questioning it (legally this is an involved process and best done by your attorney). In any event let's say that the rating you receive is a high one. Let's also assume you are not permanently and totally disabled (if you might think you are get with an attorney right away). Lastly let's assume it is truly a whole person rating as certain injuries are not. Even then if you receive say a valid 20% whole person impairment rating what is it worth? Believe it or not there are other variables to consider. There is an age variable. There is a variable for your wage. The lower your age the higher the worth of the impairment. The higher your wage the higher the worth of the impairment. These variables make it essential that the calculation be performed on a case by case basis. One person may get $1000 for every one percent whole person and another $4000 for each percent or even more. Colorado also puts limits or caps on how much you can get so there simply is no easy answer here. Finally if the insurer agrees with the rating they will file a Final Admission often seeking to close the case. Please realize you must also consider your future medical needs. Insurers will try to limit all benefits so take any Final Admission as an effort to end your claim or at least greatly restrict it. This means any Final Admission requires a very careful analysis to protect your interests. Do not accept it at face value without doing so. We almost always object to Final Admissions and take timely and appropriate legal action to advance the cause of the claimant.

Burden of Proof on modification

I previously posted on some statutory changes but overlooked one which on a second look seems pretty significant. This is stated effective for claims filed on or after August 5, 2009. SB 09-168 amends Colorado Revised Statutes 8-43-201 on hearings to say that the party seeking to modify an admission or order has the burden of proof when it wants to modify it. The best example of this is that under current law the Respondents can come in at a hearing and assert compensability (that is question coverage even after they admitted the claim). Common sense says fine but it should be their burden to prove it after they admitted the original injury was on the job. Well under the current law it was always the claimants burden when the other side raised this issue. Having the burden could mean that in a close call situation the claimant months later could lose his entire case. You can bet Respondents knew this and used it to their advantage at times. Now the law is that it becomes a Respondent burden. A Judge can now be permitted to question the other side's reasons so claimants have a bit more law on their side now. Click here to see the law changes.

Effective July 1, 2009 Maximum Rates

Just posted over at the Division of Workers Compensation website is a chart that sets forth the top dollars paid out on benefits. For example, the most you can receive in weekly temporary benefits is $807.24 and that only happens if you were making $1210.86 a week in wages or more. Few injured workers ever will be paid at that rate and if not they can be paid 2/3rds of what is determined to be their average weekly wage. Historically you do not pay taxes on the standard workers comp benefits so 2/3rds is close to your take home pay when you cannot return to work. Of course to obtain any benefits they must admit you were hurt on the job and are entitled to temporary total benefits. If your case is contested then as long as it is you are not paid such benefits. Moreover even if you are entitled to temporary benefits they will adjust them if they have you working part time. There are rules on all this but this post just lets you see what the top dollar figures can be. The rates are set each year and made effective every July 1st.

Statutory Law Changes for 2009

Here, from the Division of Workers Compensation website is an overview of recent Colorado legislation that affects injured workers, doctors, insurers and even Pinnacol Assurance (the largest quasi-public/private insurer in workers comp in Colorado. Also if you click here you can read the actual legislative changes. I notice that some of these legislative changes are because of cases that went against claimants. For example there is a change to allow psych impairments so as to get over the first statutory cap (yes there are caps limiting benefits). Another avoids the Division IME being attacked for not contacting the authorized treating physician so long as he has resolved certain differences with other doctors. These items have been ways for claimants not to receive adequate benefits. They allowed the other side to attack the claimants Division IME rating by saying the doctor did not contact some other doctor so his opinion could be overcome as not following the procedure in the AMA Guides. In another case the rating was kept under 25% and did not go higher because a psych rating was not added to make the rating higher. The difference can be many thousands of dollars. In any event the legislative changes are, by and large, helpful to claimants. Also Pinnacol has been in the news recently when it disputed the state effort to use some of its excess reserves towards the state budget. As I noted earlier Pinnacol is a hybrid mix of public and private elements. The state is going to seek more control over Pinnacol and some of this recent legislation seems to be setting up to do that. Lastly one change does seem unusual. An insurer IME must now be audio recorded which suggests that some of these IME's were misrepresenting what the claimant was saying during the examination. Regretably such matters often were so hostile that it led to making it mandatory to record the exam. These law changes are effective on different dates as indicated in the overview.

Adjuster's Guide in Workers Compensation

If you are interested in what the Division of Workers Compensation says is its guidance for adjuster's handling workers comp claims then click here for the guide. It may provide some insight for all of us. It gives us a basic understanding of the duties of the insurer. Many subjects are discussed and can help explain why a form has been filed and what are some of the deadlines. If the insurer or adjuster is taking some action or filing something you might want to check here for a better understanding of what and why it is taking place. Of course there is also a guide for employees which is also extremely useful in understanding the workers compensation claim process.