In Part One of this series, we discussed the Disputed Claims Settlement, or the DCS. A DCS is the settlement of a denied claim. In this part of the article, we talk about settling on the accepted part of a claim.
The Oregon Workers' Compensation system will let you settle with the insurance company on your accepted claim with a Claims Disposition Agreement, or a CDA. Under this agreement, you are "selling" the insurance company all of your claim benefits, except for the right to request medical services. There are a lot of things to consider in deciding whether it makes sense to resolve your case with a CDA.
What Benefits Do I Still Have, And What Are They Worth?
Timing is everything. When your claim is open, you are getting medical benefits, and if you are not able to work, temporary total disability benefits.
If your claim disabled you from work, you may qualify for permanent partial disability (also called "PPD"). This is a cash benefit that compensates you for your lost earning capacity. PPD benefits can add up to a lot of money, but it depends on what kind of recovery you make from your injury. So, if you enter into a CDA before you know the long term effects of your injury, you may be giving away a significant amount of money settling your claim early.
What is My Plan?
You need to answer this question when you consider a CDA. Sometimes, these settlements are attractive, but that money will only last so long. If you are not able to go back to your old job, you need to figure out what you are going to do to earn a living after the money runs out.
There is a Vocational Services benefit that you also give up with a CDA. This benefit could include a training program, which trains you for a job with close to your earnings when you were injured. Not only does the benefit pay for the training, but you get time loss payments while you are learning the new job. This benefit is like an investment. If you train for a new job, the insurance company may even help you find work. You have to think about all the potential for future earnings that re-training provides.
Will My Medical Bills Really Be Covered?
After a CDA, the insurance adjuster may tell you have still have "medical coverage for life." Although there is some truth to the statement, the insurance company has to approve medical care. It's not automatic. Nothing in Oregon Workers' Compensation is. The insurance company can deny medical care for many reasons. You can appeal medical treatment denials. Just keep in mind that future medical care is not guaranteed, whether or not you resolve your case.
What is A Global Settlement?
This term, "global settlement," does not appear anywhere in the rules, but it is often used to describe a claim where both accepted and denied conditions are resolved at the same time with both agreements. You will see this when the insurance company accepts responsibility for some of your medical problems following an on the job injury, but not others.
Watch out for this loophole: Some insurance companies will include a "current condition" denial into the part of the settlement that resolves the denied claim, and cut off all possible future medical benefits. In other words, the insurance company will ask you to agree that any current medical problems you have from the injury are not work related, and agree to a denial of all current medical problems. Not only that, but the agreement also says you are agreeing to let that denial stand. The bottom line? No future medical benefits, at all.
In some cases, an insurance company will also insist that the injured worker sign an "employment release." This is not a settlement of Workers' Compensation benefits, but instead an agreement that you will leave your job, not re-apply, and give up any claims you may have against your employer. Many times, these agreements are not a big deal because you may have moved on from your old job, and you may not have any claims against your employer. But that is not always true.
When we see possible claims against the employer with our workers' compensation clients, we will often get an employment lawyer on the team to protect our client.
The Bottom Line
With any settlement, you need to know what you are giving away, and how much it is worth. A plan for the future can't hurt either. Call us at 888-306-6910 to learn how we can help.