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 Part Two, we talk about settling an accepted Oregon Workers' Compensation 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 is a lot to consider when 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 eligible for medical benefits, and if you cannot 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 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 benefit that you are selling to the insurance company. If you are in medical treatment, you must consider how much of your settlement will cover future lost wages.
If your claim disabled you from work, you may qualify for permanent partial disability (also called "PPD"). PPD 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 sign a CDA before you know the long term effects of your injury, you may be giving away significant money settling your claim early.
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 . 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 because you have resolved your case with a CDA, you will be paid no wage replacement benefits while off work, and you will not be eligible for any additional 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 cannot return to their job because of the injury. Few injured workers qualify for this benefit, but it is potentially valuable. 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 to return to the wage level earned during the injury.
This benefit is valuable in two ways. First, it costs insurers significant 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 must answer this question when you consider a CDA. Sometimes, these settlements are attractive, but that money will only last so long. If you cannot go back to your old job, you must figure out what you will do to earn a living after the money runs out. You also must know how to deal with an extended absence from work if you need treatment for your on the job injury.
Will My Medical Bills Really Be Covered?
After a CDA, the insurance adjuster may tell you have have "medical coverage for life." Although there is truth to the statement, the insurance company must 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 remember that future medical care is not guaranteed, whether you resolve your case or not.
What is A Global Settlement?
This term, "global settlement," appears nowhere in the rules, but it is often used to describe a claim where both accepted and denied conditions are resolved simultaneously 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. The insurance company will ask you to agree that any current medical problems from the injury are not work related, and agree to a denial of all 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.
Sometimes, 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 you will leave your job, not re-apply, and give up any claims you may have against your employer. Often, these agreements are not a big deal because you may have moved on from your old job, and you may have no 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.
If you are looking at the possibility of any workers' compensation settlement, and have questions, contact us. We deal with these issues every day.