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

The Director of the DIR John Duncan announced that there needs to be a change in PD rates from the reform in 2004.  Although the reform did decrease the amount of money owed in the worker’s compensation system by billions, it also decreased the amount of money an injured worker was payed in regards to his/her permanent disability rating.  The idea for a change is to reform other parts of the system by controlling costs, thus allowing a larger PD rating to the injured worker.  Duncan has until Jan 1, 2010 in order to update this PD rating schedule.

When an applicant is incarcerated after suffering an injury prior to being sent to jail, what happens to any temporary disability (TD) and/or permanent disability (PD) benefits that the applicant is entitled to? Labor Code Section 3370 addresses the area of state penal or correctional inmates and the treatment of such benefits. Subdivision (a) paragraph (2) says that no inmate shall be entitled to TD indemnity benefits while incarcerated in state prison. Paragraph (3) tells us that no benefits are to be paid to an inmate while they are incarcerated and that the benefits shall commence upon release. It goes on to point out that if the person is released and begins to receive benefits and is subsequently reincarcerated in a city or county jail or state penal or correctional facility, those benefits will immediately cease and will not be paid for the duration of the reincarceration.

Subdivision (d) of Section 3370 says that the above paragraphs of subdivision (a) are applicable to inmates of state penal or correctional institutions who are otherwise entitled to workers’ compensation benefits based on an injury prior to their incarceration. However, if the inmate has dependents, the TD and/or PD that the inmate would be entitled to if not for being incarcerated is paid to them. If the inmate has no dependents, then the TD goes to the State Treasury to the credit of the Uninsured Employers Fund and any PD is held in trust for the inmate while he is incarcerated by the Department of Corrections.