Wednesday, January 30, 2008

More VA disability concerns not helping injured soldiers

It never ceases to amaze me how a comp system can be cold blooded and almost hostile to injured people. This goes beyond bureaucratic delays. When laws, rules and paperwork become so complicated that they can be used to place obstacles in the path of the disabled and instead of easing their pain they add to it then it is time for change. Here the story in the link concerns veterans disability claims and apparently trying to find ways to save money on benefits. I have no problem with efforts to save money and make any system more efficient but when they say don't help them obtain all they are entitled to that is inhuman. Beyond the paperwork there is a human being with a disability or injury. If any system makes it easy to delay, deny and discourage a claim then that system should be changed.
To read more on this story go here.

Also you can visit this article for another story!

Thursday, January 24, 2008

So What Is a Full and Final Settlement?

Many times people come to see me and they say the insurance company wants to settle with me for a sum of money. I ask for more information and they show me a Final Admission of Liability which has a money figure on it. I then have to say what I have said many times before...a Final Admission is not a settlement at all. It is the Respondents (insurance, employer) saying they owe you some money but they also seek to close your case after 30 days. A Final Admission requires a swift response and usually we object and do much more to protect the claimants rights. A Final Admission is a very detailed document so never assume it is a settlement at all. It is what the insurer believes it owes you but it is often too low and leaves out benefits so once closed you are left only with limited rights, if any. A settlement is a contract which is agreed upon by both sides. It is also very negotiable or almost always negotiable. But do not drop the ball if a Final Admission is filed and you receive it. Do not think you can keep negotiating and pay no attention to the Final Admission. That is BIG MISTAKE. Closure of your case occurs if you think you can just keep negotiating after you receive a Final Admission. If you fail to properly act within 30 days of the date of the Final Admission your case will almost always be closed. Once closed trying to reopen is not easy although sometimes some benefits are left open by the language in the Final Admission. The point is act fast or you are at risk. A settlement is usually an agreed upon figure which can include many things. It can be much higher then any figure in the Final Admission and it can also address your future medical benefits and a host of other things. It is a complicated document but the two biggest points are the dollar figure you are to get and the medical situation. If represented by an attorney a claimant can rely on him to review all of the terms and negotiate a fair figure authorized by you. If you are doing this yourself historically it has required that you appear before a Judge so he can warn you it totally ends your case. There are no do overs and no way unless documented in the settlement to return for any more benefits. So if you think you can take the money and then reopen the case if your condition worsens or if you forgot to get all your meds before you settled...sorry you are out of luck. Full and Final means you are bound by all the terms of the settlement and so are they. If you get better you still keep all the money. If you get worse you still keep all the money but can't say I want more. If at all possible you should try to review your case with an attorney when either a settlement is possible or you receive a Final Admission. The fact is there are possible increases in the figures which are seldom mentioned to you by the insurer but which can dramatically increase the numbers or which can even lead to more benefits and treatment! In my last few cases the figures nearly doubled from what the insurer felt was due the client. NEVER accept at face value the insurers computations or analysis of your claim. We've even settled cases for large sums when the insurer never admitted to pay a dime! I always assume the insurer is minimizing as much as it can the benefits or amounts due. Frankly that is their job but you can often increase it. If it is a Full and Final Settlement or a Final Admission get help if at all possible. Your injury may last with you forever...make it count.

Wednesday, January 23, 2008

Workers Comp Claimant gets his minivan!

In an unpublished case (decided Jan 17, 2008) the Colorado Court of Appeals affirmed a decision that required the insurer to have to pay for a claimants minivan. Back in 1996 a wheelchair accessible van was denied to a quadriplegic claimant as not covered under the allowable medical benefits. Yet in this case the van was allowed not just the cost to modify the van for a wheelchair. In this area it is very much a case by case analysis and up to the Judge to determine if there was a therapeutic value. Really it boils down to how strong the medical opinions are on your need for any medical apparatus (in this case a van). So if the insurer claims it is not going to pay because of caselaw be aware that the cases vary and sometimes the insurer is mistaken. My caveat to all claimants is to let the claimant beware. Never assume the insurer is correct no matter how confident they sound to you. In the present case the van cost over $24000 and to modify it another $28000 plus. The insurer agreed to the cost of modifying the van but not for the van itself. The decision required them to pay for the van. However do not assume in all cases a van or other item needed to help you out shall be covered. Insurers can make you prove your case and may even then appeal. But it all depends on how medically needed the item is but you should know sometimes the claimant wins!

Tuesday, January 22, 2008

Guidance on Epidural Injections

Here is a link to a recent update at the Division of Workers Comp website that reviews epidural injections. Some are diagnostic and some are therapeutic. I do know that sometimes they are used to give the doctor a better clue on the situation so having one does not always mean the results will be good. In my experience injections do not seem to provide much relief and as noted in the link they do not last very long. Still when the treating doctor recommends it a claimant should go ahead unless he has a very good reason. I have had claimants try it and hate it so they dread trying again but then others have had some relief. Never ask your lawyer for advice on what to do as it is a medical question for your doctor. A good doctor will inform you so you understand the situation. It is natural to have concerns. If you have concerns and are not being listened to then take it to the next level. You can write your doctor and document your concerns by asking for more information. Always tell your lawyer.
Here is the guidance.

Monday, January 14, 2008

CBS Evening News on SSD Backlog

As reported at another site the CBS Evening News is to start a two part story on the SSD backlog. Here is the link:
And here is a link to the first part of the story on the CBS website:
And to further update you here is a link to the second and final part of the CBS story:

Saturday, January 05, 2008

Opposition to Proposed SSA Rules

The Social Security Administration is working on some new rules. Unfortunately its proposed rules are not being met with friendly comments. The concern is that the rules will make the hearing process even more technical and adversarial. I suspect that is the case. Over the years in my two areas of practice (Colorado Workers Comp and Social Security disability) my view is that claimants are having a tougher time. Laws and rules that are overly technical or costly to deal with simply work to the advantage of denials and reduced benefits. In the link below it is the House Ways and Means Committee (yes...our political leaders) who perhaps are waking up to this effort to reduce benefits and rights all in the name of efficiency. They put out a fact sheet showing displeasure with the proposed new rules:

Thursday, January 03, 2008

Rule 8 is new on authorized doctors

Effective now the new rule 8 for the Colorado Division of Workers Compensation sets forth the law that claimants should be provided with more than one doctor to treat the work injury and also with a right to easily switch. The prior law was that your employer simply had the first right to designate your treating doctor. Such a process has never been liked by claimants as often it meant treatment by a doctor handpicked by the employer/insurer. While some of such doctors are reasonable others are not or even hostile to a claimant (at least that is what I have been told). The new law eases up a bit but it is still permitting the employer to provide you with at least two doctors and one would then become your treating doctor. It also adds a new way to switch to the other doctor (provided you follow the rule). In the past the way to switch doctors would be to ask for a change or seek a change by order of a judge. Usually a sharp insurer would prevent that and force you to seek a hearing. At a hearing the Judge would not just grant you a change without some basis and all this took quite a bit of time to set up. The new law adds another option so it is a bit of an improvement. I still expect the two doctors you are offered to be handpicked by the employer/insurer. Here is the new rule:
Rule 8