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

By the end of the year the DWC plans to have a new 12 point plan in order to control medical costs.  This is directly correlated with adjusting what will be submitted to Utilization Review.  Many of the treatment requests submitted to UR include MRIs, CAT scans, and physical therapy.  Occasionally if a doctor is not around to respond to UR, they automatically deny the treatment request.  This adds additional money and costs that could be avoided with the 12 point system.

The idea is only unreasonable requests will go through Utilization Review.  In the end costs will go down and UR will become a streamlined process unlike the difficult and costly system is it currently.

For more info go to:https://www.workcompcentral.com/members/index.php?fa=news&id=6c2ccbfa15185dfa068be4fe0d05c411g&state=CA&CFID=17580966&CFTOKEN=89730080