Comp insurance/ injury settlement question

[Robert_in_NY]

I had a friend call me yesterday asking me if she should accept a settlement from Comp for her back injury. She said they offered her $132k to close her case (this wasn't a lawsuit). She would still be covered by her own insurance she told me and if the disc failed it would be replaced for free in her back. So it seemed like it made sense for her to take the deal as she said she is past any treatments or surgery now. However this got me thinking about my own case.

I still have some serious problems and Comp is still taking care of everything. I am actually happy with how they have treated me as they have never questioned any of the medications or treatments my doctors have ordered. But I am no where near healthy and none of my doctors can even guess when I will be anywhere near as healthy as I was before I fell. So right now I do not expect any type of settlement offer from Comp but I do not have a lawyer and do not want one either unless I am left no choice. I have had a few lawyers begging me to let them jump in and sue the insurance company which I have refused because I fell because of my own mistake. I had no one to blame but myself and the insurance company has been treating me well. I would not feel good about suing because I was stupid and made a mistake. I know they just want to sue to make some easy money (which is why they all offer "free" consultations for personal injury cases).

So now that I have bored you guys this long here is what I am concerned about. I have insurance and have had it from before I was hurt so they will cover me even if comp didn't any longer. But if I had to change insurance companies I am not sure if they would cover a pre-existing injury. So what do you guys think? I am not looking for an answer as I don't really know the question but I am looking for anyone who has been thru this before. If Comp offers me a settlement and closes my case what happens if I have a problem in the future (I am only 30 so I hope to live a few more years). So any and all thoughts or experiences on this topic would be appreciated.

I will say I know my uncle refused his settlement when he hurt his back when he was 19. Instead he has Comp paying for all his back treatments for the rest of his life (chiropractors, massage therapist and so on) so I know I don't have to accept a settlement if one is offered but I just don't understand enough of this to be comfortable making a decision. My doctors have been great so I would ask them for advice also before making a decision. I just don't want to make the wrong decision if the time comes.

I do apologize for such a vague post but this stuff has been bouncing through my head the last 24 hours and I still have no idea what all of the possible pros and cons are. Thanks for everyone who has read all this.

 

[gsganzer]

I had a workers comp injury 20 years ago and settled with the insurance company. In my case, the compensation (settlement) was for loss of function and scarring and future lost wages for any lost time for the injury. Any future medical procedures for the injury WILL ALWAYS be covered and cannot be waved. I would not be able to claim lost wages while recuperating if I underwent surgery in the future.

There are typically tables that are used to determine the compensation for scarring and lost of function. The insurance companies "independent" medical evaluation will typically evaluate you and provide compensation at the lowest end of the scale. Your attorneys "independent" medical evaluation will put you at the top end of the scale. The two groups haggle it out and you land in the middle (where you probably should have been in the first place).

Mine wasn't for much money. I had our family attorney evaluate the offer, and he determined I probably would been shorted if I accepted the insurance companies offer. i forget what his fee was, but it wasn't much. I believe there may even be laws that regulate the attorney fee's for workers comp cases.

 

[Robert_in_NY]

That makes sense then. I have been trying to figure all of this out before I ever have to worry about it (if I have to worry about it). Ever since my friend told me about her offer I have been nervous about my case as I don't know enough currently to feel comfortable making a decision. I know if I did get an offer I would be able to review the offer and understand things better after reading it myself but I would most likely have a lawyer look it over if I didn't feel comfortable after reading it.

My friends lawyer charged 10% of the settlement which confused me some. If it wasn't a lawsuit like she told me then did he really charge $13k just to read a paper and tell her to sign it? I know another guy who was hurt on the job and he sued everyone. His wife who is friends with my mom told us their lawyer charged 30% but I am not sure if that was a comp case or if it was a lawsuit against the truck drivers insurance company as his plow truck was hit by a tractor trailer while he was plowing the I-90.

I do hope I just heal up and my doctors tell me I never have to worry again. Right now I can't even begin to guess what my future medical bills are going to cost

 

[MossRoad]

If your insurance is treating you well and you are satisfied with the way it is going, just stay the course. Don't worry about a settlement until it is offered to you and yes, by all means, if a settlement is offered to you, have your attorney look it over. Your attorney. One you trust.

 

[Robert_in_NY]

Hi Moss, I am not so much worried about any possible settlement. I am just trying to learn more about this system so I will be prepared if need be. Right now I know so little I am uncomfortable making decisions. I am not a fan of lawyers as with this case they all kept trying to talk me into doing things I didn't want to do (sue). I wasn't even talking to them about the injury, it was a different issue but as soon as they heard "injured on the job" they start drooling and figuring out how much money they can make off my case I felt they cared about getting me as much money as possible just because they would get more money but I have trouble trusting them to represent all of my interest in this.

I don't like gambling with my life anymore which is why I am looking for others with similar experiences so I can hopefully learn from them.

 

[MarkV]

Now it just makes sense to me that an insurance company is a business and as such they want to make as much money for their stock holders as possible. I just have to think that if they offered your friend $xxx it is because they thought it was in their best interest. They just don’t present their best offer because “she is such a nice person”.

As said above you can count on the opening offer being the lowest on their pre set scale of standards. Not many are going to settle without having professional legal help to look out for them so they have to leave room to up their settlement offer.

Shoot I can hardly understand my homeowners insurance contract when I read it. There is no way I would settle without having an attorney represent me.

Good luck with that back Robert.

MarkV

 

[MossRoad]

Hi Moss, I am not so much worried about any possible settlement. I am just trying to learn more about this system so I will be prepared if need be. Right now I know so little I am uncomfortable making decisions. I am not a fan of lawyers as with this case they all kept trying to talk me into doing things I didn't want to do (sue). I wasn't even talking to them about the injury, it was a different issue but as soon as they heard "injured on the job" they start drooling and figuring out how much money they can make off my case I felt they cared about getting me as much money as possible just because they would get more money but I have trouble trusting them to represent all of my interest in this.

I don't like gambling with my life anymore which is why I am looking for others with similar experiences so I can hopefully learn from them.

I understand about them wanting to make money off of you. I guess it depends on the attorney. We have an attorney that we use for family business, like wills, trusts, etc... he is not the suing type; he is the "help you with the legal stuff look out for your interests first type".

 

[salopez]

don't settle! and get a comp lawyer!

if you settle its done...no more treatment and you might not be covered as pre-existing... if left open they will treat you for ever.

the difference with the 2 lawyers fees are as follows...1 they had diffrent contracts. 2. the first lawyer most likely didnt go to court...if they had it would have been 30 or 40 percent. so yes they got 13k for not too much.

however with my comp my lawyer for 400 for months and months of work.

 

[kthompson]

Robert, I am an insurance agent and at one time our business did sell W/C. No expert here but some things to know: you will find much of this affected by your STATE laws. So what would happens in my state or any other state may be just conversation for you and might prove hurtful to your thoughts or plans. More than likely one of the best low cost sources for you is the NY State Dept of Insurance. They should have toll free number and web site. Look there and ask questions. For the most part they are there to give free information and should be right down the law but are there to look out for the insured.

As to the pre existing condition limit you asked about, very possible. Again talk with your department of insurance. NY has some very different insurance laws. It is very possible you would not face pre existing limits. In my state it would depend on where the new coverage came from a group policy no problem but individual policy problem. Then there are time limits with different issues that come into play. Just too much to cover all here but then NY probably has different laws and regulations than my state.

It is my opinion if you accept a settlement, they are fully released from any future claim. That is why they want the settlement. At same time many people do not realize at least in my state there is a dollar cap on what the W/C insurance company coverage is. Also many don't realize in some settlements any claims paid by your health insurance company, they may be eligible to recover those from you. Again, check your state's laws.

Hope you have a good recovery.

 

[MarkV]

Robert, I am an insurance agent and at one time our business did sell W/C. No expert here but some things to know: you will find much of this affected by your STATE laws. So what would happens in my state or any other state may be just conversation for you and might prove hurtful to your thoughts or plans. More than likely one of the best low cost sources for you is the NY State Dept of Insurance. They should have toll free number and web site. Look there and ask questions. For the most part they are there to give free information and should be right down the law but are there to look out for the insured.

As to the pre existing condition limit you asked about, very possible. Again talk with your department of insurance. NY has some very different insurance laws. It is very possible you would not face pre existing limits. In my state it would depend on where the new coverage came from a group policy no problem but individual policy problem. Then there are time limits with different issues that come into play. Just too much to cover all here but then NY probably has different laws and regulations than my state.

It is my opinion if you accept a settlement, they are fully released from any future claim. That is why they want the settlement. At same time many people do not realize at least in my state there is a dollar cap on what the W/C insurance company coverage is. Also many don't realize in some settlements any claims paid by your health insurance company, they may be eligible to recover those from you. Again, check your state's laws.

Hope you have a good recovery.

Now that is some good advice! Great post.

MarkV