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 allows you to settle your accepted claim with the insurance company through an agreement called 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 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 elgible for medical benefits, and if you are not able to work, temporary total disability benefits. These benefits are paid when the claim is in "open" status. A claim remains open for as long as you require medical care for your accepted conditions. If you resolve your claim with a CDA, you will not lose any right you may have to medical care. However, there are no guarantees that you will be covered for all medical services. It still makes sense to consider where you are with medical treatment, because it affects the other benefit of an open claim, temporary total disability.
Temporary total disability or temporary partial disability are the wage replacement benefits in the workers' compensation system. If you resolve your case through a CDA, this is one of the benefits that you are selling to the insurance company. If you are in the middle of medical treatment, you need to consider how much of your settlemnet will cover future lost wages.
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.
You should also keep in mind that when you settle your case with a CDA, you are giving up not only the wage replacement benefits and permanent partial disability on the initial part of your claim, but also if your claim is re-opened in the future. Claims can be re-opened if there is a worsening of your accepted claim. So, if you settled your claim, and it is re-opened so you can have surgery on your accepted claim, your medical bill will be paid, but becuase you have resolved your case with a CDA, you will not be paid any wage replacement benefits while off work, and you will not be eligible for any additonal permanent partial disability you may experience from the worsening of your on the job injury.
Another potentially valuable benefit you give up with a CDA is the vocational services benefit. This benefit is available to an injured worker that is unable to return to their job becuase of the injury. Not many injured workers qualify for this benefit, but it is potentially valueable. The insurer must provide a vocational counselor who designs a training plan for the injured worker to learn a new skill. The injured worker receives time loss benefits while in the training program, and even gets help finding a job with the goal of returning to the wage level earned at the time of the injury.
This kind of benefit is valuable in two ways. First, it costs insurers a significant amount of money to provide. More important, by completing this program, the injured worker is making an investment in their ability to work and earn money for years to come.
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. You also need to have an idea of how to deal with an extended absence from work if you need treatment for your on the job injury in the future.
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.