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How Much Is My Case Worth?

At some point, your medical condition will be declared to have reached maximum medical improvement. This is also sometimes referred to as “permanent and stationary.” In essence, this is a statement that your condition is not expected to significantly improve or deteriorate in the foreseeable future. It also means that your workers’ compensation case is ready for a final resolution.

The value of a final medical report in workers’ compensation is based strictly on what the doctors have said in their conclusions about your impairment and the predicted medical treatment you may need in the future. The doctors are required to refer to the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition, to assess your degree of permanent impairment. Impairment is not the same as permanent disability but it provides the basis for calculating the permanent disability. Doctors who report in workers’ compensation cases have received special training to enable them to properly create a medical report that describes your permanent impairment in such a way that the parties can proceed to produce a permanent disability rating from it and conclude your case.

How Case Value Is Determined

Permanent disability in workers’ compensation is not the same as permanent disability in a civil case. In a civil case, you can get a recovery for inconvenience, pain, suffering and future loss of earnings. None of those factors are calculated in workers’ compensation. Attorneys and judges are bound by the limitations of the California Labor Code and must utilize the rating formulas in the labor code to calculate your permanent disability. The ratings begin with the doctor’s assessment of the type of injury involved and the calculated whole person impairment percentage for your injury. That number is then multiplied by 1.4 for cases where injury occurred on or after 2013. The result is then modified up or down for your occupation and age as of the date of injury, and your permanent disability rating is the result. The final permanent disability rating, expressed as a percentage, may be further modified down if the doctors feel some part of your disability is due to factors other than your work injury (this is called “apportionment”). The final number equates to a certain number of weeks of payments based on your average weekly earnings at time of injury but may not exceed certain maximum statutory limits on the weekly payment amount.

What Happens Now?

There are two ways to resolve a workers’ compensation case. One way to resolve the case is to agree to the permanent disability rating and accept an award of permanent disability in the amount stated. That award will come with a provision for lifetime medical care to cure and relieve from the effects of your industrial injury. If the doctors have said you cannot return to your usual and customary occupation, it will also come with a “voucher” that you can take to a certified school to learn a new occupation. The voucher is worth $6,000 that can be used for tuition, books, tools and in part for the assistance of a vocational specialist to help you find a new job based on that new training. Provision of the voucher will also allow you to access an additional $5,000 (not part of the permanent disability award) from a special fund that has been created to help people who have been displaced from their regular occupation due to injury.

Another way to resolve a workers’ compensation case is by settlement. A settlement in workers’ compensation is called a compromise and release (C&R). The C&R is a negotiated amount that takes into account your permanent disability and the estimated value of your future medical care. With a C&R, medical care is closed out. We recommend that our clients do not settle by C&R unless they have access to medical care from some means other than workers’ compensation. An insurance company will usually agree to a C&R if they believe it will be less costly for them to do so than to provide lifetime medical care for your injury. However, because the insurance company will have to pay all of the money out upfront in a lump sum, the calculated value of permanent disability and medical care will be discounted to “present value.” To put it another way, insurance companies make their money by not paying out any money on a case until they absolutely have to, so if the settlement demand is too high, the insurance company will usually decline to settle and will prefer to enter into an award.

Just as each client is unique, each case is unique and merits individual attention and analysis. We carefully evaluate the reports we receive and provide our clients with easy-to-understand explanations and recommendations for resolution of each case based on our many years of experience and special training.

Contact Us For Practical Guidance

Your workers’ compensation case will likely spark many questions about the process and require you to make vital decisions about your claim. You should not make these decisions until you know your options and the consequences of each choice.

Speak to our experienced attorney by calling Law Office of Howard J. Stevens, APC, at 619-880-4501. We are also available to schedule an appointment at our office, your home or your hospital room through our contact form. At your free consultation, we can advise you based on the specific factors of your injury.