I have been classified Catostrophic by GBWC and am totally disabled. Everyone concerned has no objections. My insurance Co. has said that they may want to settle. Medicare setaside has already benn set. What should I be looking for in a settlement. Is there an amount that I should be looking for . I am 55 and will not be able to work again. My claim is covered by the SITF. , but my Ins. Co. is in rehab. Thanks I look forward to your answers.
–James
Jodi Ginsberg responds: James, thank you for your email. Here are my thoughts.
I look at a number of issues when settling a catastrophic workers’ compensation claim. By the way, since some of those reading this blog entry may not be familiar with the term "catastrophic injury," I would like to briefly define the term. Under Georgia workers’ compensation law, the State Board has the power to designate a claimant’s injuries as catastrophic. This means that the Board recognizes that a claimant like James will not likely be able to return to work because of the severity of his injuries.
Most importantly, once a claim has been deemed catastrophic, the 400 week cap on benefits does not apply. In theory a catastrophic claimant could collect temporary total benefits for the rest of his life, as opposed to a maximum of 400 weeks for a non-catastrophic claim. Note, however, that just because a claim has been deemed catastrophic, there is no automatic right to 400 weeks. In theory a treating doctor could return a catastrophic claimant back to work.
That being said, catastrophic claims have a higher value for settlement purposes since the employer/insurer’s exposure is unlimited. Also, when a case is deemed catastrophic, a "rehabilitation supplier" is assigned to your case – these case workers are neutral in theory, but usually their interests lie more with the insurer.
Now, back to James’ question. I go through a checklist to evaluate the value of a catastrophic claim. My checklist includes factors like:
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what is the insurance company’s exposure for future temporary total disability – what do the actuarial tables say about your projected lifespan?
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how much future medical care will you require?
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what is the likelihood of needing future surgeries?
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will home modifications be required because of your injuries
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will vehicle modifications or a vehicle purchase be required
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will home health care services be needed?
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what are the provisions of the Medicare Set Aside
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since the Subsequent Injury Trust Fund (SITF) is involved, and your because the insurer is not fully solvent (the Insolvency pool is involved), timing would be an issue. My experience has been that the SITF complicates matters because there are layers of bureaucracy involved in getting an SITF case settled
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what future benefits will Social Security provide for post-settlement living costs
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would a structure settlement be in your best interest?
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should you settle in the first place? – sometimes your best bet is to maintain the status quo and continue to receive benefits for a period of months or years
These factors are among the ones that I consider when looking at a catastrophic case. I can’t really comment more without knowing about your specific case, but I think you get the idea. If I can be of service to you, please do not hesitate to call me.
[tags] catastrophic injury and georgia workers compensation, subsequent injury trust fund, medicare set aside, settling a catastrophic georgia workers’ compensation case [/tags]
Jodi, I am receiving TTD (temporary total disability) benefits and the authorized doctor told me that he is releasing me to return back to light duty work. Should I report to work immediately?
Jodi Ginsberg responds: No, you should not return to work right away. You should wait until you receive a form in the mail called the WC-240 form. The WC-240 form is completed by the insurance company and describes specifically a light duty job, the date and time that this light duty job will be available.
The WC-240 protects you, the injured worker. If you show up at your job site and your employer really does not have a light duty job that corresponds to the limitations on the WC-240, your refusal to try a job outside those limitations will not damage your case. Further, if you try the light duty job for up to 14 days and cannot perform it, your TTD benefits will resume immediately.
If you return to work without a WC-240, you risk the situation where the light duty job really is not light duty. If you cannot perform it and/or if your employer terminates you, your TTD will be cut off and, of course, your job is over as well. You then have to file for a hearing and wait two to three months to ask a judge to reinstate your benefits.
If you return to work with the WC-240, the burden falls on the employer/insurer to try to stop your benefits. If you return without this form, the burden may fall on you to try to get your benefits restarted. This is a big distinction and can determine whether you have money coming in every week while you recover. Further, if you have money coming in you will be less likely to be pressured into a cheap settlement.
Sometimes, an injured employee may be pressured to return to work immediately by his boss or even by a well meaning spouse or co-worker. Do not be manipulated in this manner. If you have been receiving benefits and your doctor tells you that he will be issuing a light duty release, wait for your WC-240.
As an aside, part of my job as a claimant’s lawyer is to review the WC-240 to make sure that the light duty description is consistent with the medical records, and to object if it is not. Further, if it turns out that my client cannot perform the light duty work, I will assert my client’s right to a resumption of TTD benefits.
[tags] WC-240, light duty return to work, georgia workers compensation claim, TTD benefits, temporary total disability [/tags]
Filed under Georgia Workers' Compensation, Income benefits, Returning to work by 
