How does the insurance company determine what my settlement amount will be, due to my work injury? 13 Answers as of January 24, 2013

My injuries are extensive and permanent due to a warehouse rollup door, which rolled down on my neck and shoulder escaping death by inches. I had become paralyze from my neck down. Worker’s compensation denied my neck surgery three times. They have denied every request except my biweekly checks and medications. My wife is very concern with my life, took me to our private insurance hospital- du to my sickly appearance and grave look. I had emergency surgery after eight hours, I now have two rods two plates, 8 screws and cadaver bone grafts. I'm looking at two more surgeries in a couple of years and I'm not able to walk. I have no control of my bowels. I have permanent spinal cord damage torn disc and six bulging disc up to 9mm. I need to know how I'm going to financially support my ten children and wife. Six children are still under the age of eighteen. Is my family and marriage doomed? Injury date was 11-11-11. I need somebody with experience in dollar amounts if I'm set for life or dead in the water.

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Edward J. Achrem & Associates
Edward J. Achrem & Associates | Ed Achrem
When your medical condition is stable your insurance must arrange for an evaluation by a rating physician to determine the degree of your permanent partial disability. The amount of this award depends on the date of injury, the result of the evaluation, your age, and your wage. You should consult with an attorney to make sure that your settlement amount is being properly evaluated/calculated.
Answer Applies to: Nevada
Replied: 1/24/2013
Shean Law
Shean Law | John Shean
I'm sorry to hear about your tragic injuries. However, with the right counsel you should be able to save your marriage and your finances. I recommend you immediately consult with a qualified worker's comp attorney.We are few and far between in Indiana. However, under Indiana law, you are entitled to free medical care, disability benefits, a permanent impairment rating, and future medical care. You can learn a lot about the value of your claim by going to the Indiana Worker's Compensation Board website: http://www.in.gov/wcb/. Again, I emphasize that you need to contact an attorney that specializes in these claims asap. You should be able to meet with that attorney free of charge.
Answer Applies to: Indiana
Replied: 1/11/2013
The Law Offices of Mark Wm. Hofgard, Esq.
The Law Offices of Mark Wm. Hofgard, Esq. | Mark William Hofgard
23-1045 includes several definitions for permanent disability. Among these is "[a]n injury to the spine resulting in permanent and complete paralysis of both legs or both arms, or one leg and one arm." When you are permanently disabled as the result of a work-related injury, you are entitled to compensation equal to 66.67% of your average monthly wage for life. This is in addition to medical and possibly rehabilitation benefits. Also, you want to file for a hearing on the insurance company's denial of surgical benefits within 90 days of their denial. Any time there is a determination of benefits, either by the insurance company or the Industrial Commission, and you disagree, you must request a hearing within 90 days or the decision becomes final.
Answer Applies to: Arizona
Replied: 1/11/2013
Lewis B. Kaplan | Lewis B. Kaplan
I am sorry about your severe injury. But I am compelled to ask why you apparently do not have a lawyer representing you in a work comp case and a Social Security disability claim.
Answer Applies to: Illinois
Replied: 1/9/2013
Law Offices of Ronald A. Steinberg & Associates | Ronald A. Steinberg, BA, MA, JD
In Michigan, they follow a schedule. Each "scheduled loss" is worth a certain number of weeks worth of benefits. Otherwise, you are entitled to wage loss benefits as long as you are unable to engage in any gainful employment. In most cases, the amounts are negotiated between the worker's comp lawyer and the insurance attorney.
Answer Applies to: Michigan
Replied: 1/9/2013
    Musilli Brennan Associates PLLC
    Musilli Brennan Associates PLLC | John F Brennan
    You should most certainly see an attorney, the damages which you have are extensive and if they are work-related will have to be covered by the Workmen's Comp. policy, whether they like it or not. Get aggressive attorney.
    Answer Applies to: Michigan
    Replied: 1/9/2013
    Paul Whitfield and Associates P.A.
    Paul Whitfield and Associates P.A. | Paul L. Whitfield
    If your injury is as serious as you say and it is all based on an accident in the course and scope of your employment you should get a lump sum or periodic payments based on the degree of permanency as set by the doctor why did the company not acknowledge your claim to begin with. What defenses do they have? You need the best worker comp lawyer you can find. And you need him now. Get him.
    Answer Applies to: North Carolina
    Replied: 1/9/2013
    The Law Office of Stephen R. Chesley, LLC
    The Law Office of Stephen R. Chesley, LLC | Stephen R. Chesley
    If this is a worker's compensation case by itself, there is no pain and suffering award. You are entitled to time lost from work, and medical benefits. You should contact an attorney to assist you.
    Answer Applies to: New York
    Replied: 1/9/2013
    Rags Beals Seigler Patterson & Gray
    Rags Beals Seigler Patterson & Gray | Ronald D. Reemsnyder
    Issues of this magnitude need an attorney to gather the facts and medical evidence. Workers Comp cases may be resolved with future covered or not. They may be resolved with or without a lump sum payment. You may have a claim against the door manufacturer or the building owner. In short in your condition you should not try to handle your claim without an attorney.
    Answer Applies to: Georgia
    Replied: 1/9/2013
    Steven Kalishman, P.A.
    Steven Kalishman, P.A. | Steven J Kalishman
    If you are determined to be permanently totally disabled from your on-the-job injury, you would be entitled to receive wage loss benefits for the rest of your work life, as well as medical benefits. Settlement is optional for you and the insurance company, but most cases are settled. The judge has no authority to order a lump sum settlement. Depending on your age, settlement value could be multiple six figures or more.
    Answer Applies to: Florida
    Replied: 1/9/2013
    Kram & Wooster, P.S. | Richard H. Wooster
    You should consult with a worker's compensation attorney if this injury happened while you were working. Depending on what caused the door to hit you, you may have product liability claims or other negligence claims against whomever caused the door to come down while you were under it.
    Answer Applies to: Washington
    Replied: 1/9/2013
    Andrew T. Velonis, P.C.
    Andrew T. Velonis, P.C. | Andrew Velonis
    Worker's comp covers medical expenses and time out of work. You cannot sue your employer for negligence and damages for "pain and suffering" is not available. Since you have a permanent injury, you are entitled to a "schedule award" which is based on a formula depending on the extent of your disability and your rate of pay, offset by payments that you have already received. But you should get some advice as to whether the schedule award is your best option. Depending on your situation, you may be better off getting disability payments and having your medical expenses taken care of. There may be another possibility, if there some party other than your employer who caused the accident, such as the manufacturer who installed the door, the warehouse owner, a janitorial company or repair service, you can pursue them. From what you describe, the difference between your comp pay and your actual wage loss is substantial, and the pain and suffering component is huge, though I'm not going to suggest any figures. You need an attorney experienced in these matters to pursue all prospective avenues for potential recovery.
    Answer Applies to: New York
    Replied: 1/9/2013
    Lombardi Law Firm
    Lombardi Law Firm | Steve Lombardi
    The answer to this one is simple, you need to hire a lawyer (contingent fee), your lawyer needs to file the claim, you need to hire the right doctors and this case needs to be litigated. You're getting screwed over by the adjuster or case manager. It's really that simple.
    Answer Applies to: Iowa
    Replied: 1/9/2013
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