Fist of all, if you’re at this point in your workers’ compensation claim where you have to answer this question, congratulations!  You have most likely already had your deposition taken and have been to multiple medical evaluations.  You are now at the settlement stage.  However, there are 2 types of settlement: Stipulations with a Request for Award (Stips) and Compromise and Release (C&R).

Stipulations (a fancy word for “agreements”) with a Request for Award is a settlement that allows for the future medical care associated with your work injuries to remain open.  In other words, the workers’ compensation insurance carrier still has to pay for your medical after you sign the settlement.  In fact, they will be on the hook for it as long as you need it (it’s lifetime medical, but only on the work injury).  However, they can still send treatment requests from your doctor through Utilization Review (UR), which is where they determine to reject or deny a particular treatment based on their determination of the treatment’s “medical necessity.”  In other words, even though the medical care is left open, they can still review it and deny it if they don’t think it’s necessary.  Also, with a Stip settlement you can re-open your case within 5 years from the date of injury if you feel that your work injury has gotten worse and has resulted in new and further disability since the settlement.

The Compromise and Release (C&R) is where the insurance company issues you a tax free lump sum check in exchange for being relieved of liability (taken off the hook) for future medical care associated with the work injury.  In other words, the benefit to you is that you receive all of the settlement money at once, while the benefit to the insurance company is that they no longer have to worry about paying your doctors.  The lump sum check often takes into account the benefits associated with your permanent disability, the estimated cost of your future medical care, and the value of giving up the right to reopen your case.  Lastly, if you are still working at the job you got injured at, the employer most likely will not be agreeable to settling by way of C&R.  The reason is because of you settle by C&R and go to work the next and injure the same body part, they are on the hook again for medical treatment of that body part.  It defeats the purpose of them agreeing to enter into that type of settlement; not having to be liable for the medical care in the future.

Which one you choose is of course ultimately your decision to make.  If you know that you are going to require a lot of medical treatment because of the injury and do not have any other type of insurance, you will probably lean toward leaving the future medical open.  If you do not get a lot of treatment or are getting by without it and don’t anticipate it being a problem in the future, you might want to settle with a C&R.

By RODMAN J MARTIN, esq

Workin’ 9 to 5…and then some

It is not uncommon these days to be employed at more than workplace.  After all, the cost of living is high in the Bay Area, and supporting a family on one income is not an easy task.  These issues make it even more difficult when someone suffers a work-related injury that renders them Temporarily Totally Disabled, unable to earn the money that he or she so desperately needs.  The person is not only usually precluded from being able to perform the job that is related to the injury, but also is prevented from returning to work at the other job(s).  When this happens, it is important to make sure that the Workers’ Compensation Insurance Carrier is paying you the right Temporary Disability rate.

If you are injured at work and you are temporarily unable to return to work right away because of that injury, you will receive Temporary Disability (TD) benefits.  These are calculated per the Labor Code of California to be 2/3 of your average weekly wage.  You should receive TD payments every two weeks.

However, if you have more than one job, those wages should be included in calculating your TD benefit amount as well!  Let’s say you work at 2 different retailers.  If you are injured on the first job and cannot immediately return to work, you most likely cannot return to the second job either.  The first job alone does not reflect your average weekly earnings, so it is important to make sure the insurance company is including the earnings from the second job as well!

The downside is that if you were getting paid more at the second job (where you weren’t injured), that hourly rate does not apply in determining the TD amount, only the rate of pay at the job you were injured.  The hours from the second job will be added at the hourly rate of the first job.    The big thing to remember is that if you were working more than one job when you were injured, be sure to let the adjuster on your claim (if you don’t have an attorney) or your attorney know, and provide them with the pay-stub/tax-information that can help them determine what the TD rate should be.

Rodman J Martin