Planning to Settle. Advice Needed.

[AxisEdwards]

What is the name of your state? Missouri.

I'll try to cover all the details right away to save a ton of questions.

In September of 2002 I was injured at my job at Spencer Gifts, formerly owned by Vivendi Universal. I fell backwards into the edge of a metal desk causing misalignment of 3 vertebrae and knocking a rib out of place. I had just started seeing a chiropractor once a week for general discomfort and had X-rays taken 3 weeks prior. New X-rays showed the injuries and the injuries were confirmed to be the result of a fall at work. I was 16 at the time of the accident.

I started seeing my chiropractor 2-3 times a week for several months, until the first problem came - WC did not want to pay my chiropractor. I was then left un-treated for 3 months, 3 months which was full of pain left to nothing but over-the-counter pain meds (I was never allowed to have real pain meds - not sure why, but WC didn't feel they would be necesarry). Finally got back to treatment for 2 weeks when another outstanding bill arose and again, I went nearly 3 months without treatment. My chiropractor had enough and decided to see me anyway and allowed the bills to pile up.

After a year and a half there was a 5-figure bill left to be payed which Vivendi's insurance company refused to pay because "I no longer needed treatment". This was a decision reached WITHOUT ever requesting my medical records for review. I continued to see my doctor and the bill continued to grow. 4 months ago we (me and my parents) had our first meeting with a judge & VIC's (Vivendi's Insurance Company) lawyer. They finally agreed to pay the outstanding bill, as well as begin to pay for more visits until the case was closed.

Time passed and nearly better, me and my doctor were getting ready to close up my case. Damn my luck, I got in a car accident, but luckily it wasn't my fault. I had new injuries to upper back as well as knocking loose one of the same corrected vertebrae. New doctor's report showed that the injuries to my lower back from the initial fall were more serious than originally stated by VIC's doctors. However, I'm fed up with all VIC's bull****, I just want to close the case and let the guy who caused the car accident pick up the bill from here.

Now that that is out of the way, here are my questions -

1- What kind of settlement offer would be fair (both for me to offer and or accept)?

2- Should I get my lawyer involved?

3- What other options do I have?

My back is progressively getting better and I'm close to closing the car accident case out right now - no surgery or anything fancy needed.

Thanks in advance.

 

[Arcari]

Some Answers

CA.
Now that that is out of the way, here are my questions -

1- What kind of settlement offer would be fair (both for me to offer and or accept)?
Your settlement will be based on the percentage of disability resulting from your work related injury, your PTP (Primary Treating Physician) sends his final report to the Ins Co, and this one has the right to send you to an QME (qualified medical evaluator), etc, etc. ( also, there are 2 ways to settle your claim... 1.- C & R (compromise and release) getting a lump sum on your settlement and waiving your rights to future med treatment, surgeries, etc.
2.- by "Stips" - weekly payments till the whole sum is paid off or until you die, whichever comes first (much less than TDB - temporary disability benefits), right to reopen your case if you re-injure, right to med treatment, etc.

2- Should I get my lawyer involved?
Do you have a Workers' Comp Attorney? well, unless you fire your attorney before the settlement, there's no way you deal with the Ins Co. about your settlement without getting your attorney involved. If you fire him, you still have to pay him for the services rendered

3- What other options do I have?
Your Workman Comp Attorney should tell you about the benefits you as an injured worker are entitled to, ie: temporary ( $ ) disability benefits, medical treatment, vocational rehab, etc. Good luck....if you don't have a W.C. attorney you should get one asap, they don't charge you the finitial consultation, and get paid when your case is settled.

 

[Arcari]

PS.- The Ins Co will not cover nor will compensate you for your injuries in the car accident, regardless of whose fault it was, if you're asked of any other injuries before or after your work related injury and you lie about it, and the Ins Co later finds out , you might end up in troubles and your lieing about it may be considered a fraud.

 

[AxisEdwards]

We have a family attourney that is already aware of the case and situation and should be stepping in soon to handle the out-of-court matters that are currently coming up.

I only missed 2 days of work which would have equaled about $60 in lost wages, so I'm not sure if that means I'm only entitled to such a low sum. My big problem and reason for considering pursuing a lawsuit is for the time I was denied treatment based on them "not thinking I needed it" WITHOUT having seen my medical records. I ended up being in my chiropractic rehab program for a year and a half longer than I should have, which is the fault of the insurance company.

My back still is and never will be more than 80% or 85% due to my fall at work, if that is the type of disability percentage you are referring to. I am not sure if the time I was denied treatment made that percentage any lower or not.

With the C&R, does this mean FOR THIS CASE I can't go back to it for any reason at all or ALL future cases I may have involving my back?

For my car accident - none of this is in reference to that. However, his insurance company IS paying my current medical bills and up until my release in 2 months, they will continue to pay. That is the ONE thing they have been decent about. My car is worth $5,200 by Blue Book, I'm asking for $4,000, they are offering my $800 since the car was in "such poor shape", which is a lie. *sigh*