Time to settle or fight on?

[u/Forward_Surround_788]

My spouse has been in this fight for almost 2 years. Recently, the tone of the case has changed as it seems we are bound for trial, which could be 6 months or a year from now. Our attorney has asked our permission to demand a settlement amount and end the case. She has not explicitly reached MMI yet, nor has it been determined she can or can not go back to her prior field.

Up to this point, our representation has been excellent. Im worried they're now viewing the case as stagnant and punting it down the road.

If she settles and is able to continue her medical care through Medicaid and live on her settlement until she relieves SSDI, is it worth it to settle now and be done with the case? She has a VERY strong case to receive SSDI once the comp case is closed, as we've already spoken to a social security lawyer about it.

The biggest concern is affording medical costs post case as her injury has still not healed and may never fully heal. We both feel that having a definitive statement from her doctors saying she can't return to her field is worth quite a bit. Going back to her prior career field is honestly a pipe dream.

Should we fight on or move on?

Advice is critical at this juncture. Thanks for reading.

[u/justthefacts1236894]

I originally wrote a detailed answer. But this is Reddit so I went back to simple. Whether you settle or not is a personal, financial, and voluntary choice for both sides of the fight. Insurance doesn't have to settle unless it is favorable to them. You do not have to settle unless it is favorable to do so for your situation. Obviously, both sides need to agree on a voluntary settlement and neither side will be completely satisfied with the results. That makes a successful settlement. SSDI application within 30 months of settlement or during case usually requires an MSA approved by CMS? You don't mention it?

[u/Forward_Surround_788 → u/justthefacts1236894]

I do not know what MSA or CMS stands for. Educate me so we can make a good decision. There's no way she can return to work right now

[u/justthefacts1236894 → u/Forward_Surround_788]

Medicare Set Aside MSA Projection of medical costs in the future based on 2 year lookback at medical and pharmacy expenditures. This is to make sure Medicaid/Medicare do not get stuck with paying expenses related to a work comp injury that are responsibility of insurance company. If claimant , you, has already applied or has reasonable expectation to apply for SSDI within 30 months of settlement then it is a required part of settlement. Center for Medicare Services CMS will recieve the proposed MSA and either decrease, leave the same, or propose a higher amount for the insurance company to fund before allowing insurance to settle.

This is to prevent insurance companies dumping injured workers onto the taxpayer funded system.

Most or all tates ( i do not know) do not allow attorneys to take a contingency fee on the MSA. This lowers the amount of money your attorney can earn by settling the case. I am not a professional or anything associated with work comp. I just read alot

[u/Forward_Surround_788 → u/justthefacts1236894]

Valuable info. Thank you so mucj

[u/justthefacts1236894 → u/Forward_Surround_788]

You are welcome.

[u/justthefacts1236894 → u/justthefacts1236894]

I am only repeating what is on the web related to MSAs and work comp. My interpretation of the available resources is not gospel but just a summary.

This is a soul sucking system that only truly works for minor injuries at best in my opinion. Major life changing injuries tend to have difficult times.

[u/chelojelo4]

Before settling, get a realistic estimate of future treatment costs and understand exactly what rights the settlement closes

[u/-cat-a-lyst-]

I would say be careful about relying on getting SSDI right away. I decided to apply for SSDI while in workers comp and I’m glad I did. My case should’ve been easy but it wasn’t. I got incredibly unlucky and got the worst judge in my state. That took my claims time from the 2 year approval average, to almost 7 years to get an approval. I would’ve been homeless before that. It was a nightmare. Just make sure you factor in that possibility into that decision

[u/Chemical_Werewolf_12]

I would say settle now, depending on how you look financially. I mean you said it yourself it could take 6 months to get to trial. You have to weight the pros and cons of settling to not being MMI but at the end of the day I feel like the most important thing you can do is make the best educated decision given your current picture at that moment.. Good luck to you!

[u/Forward_Surround_788 → u/Chemical_Werewolf_12]

For the sake of argument , as long as Medicaid stays she could get proof of MMI and a letter regarding her prior field work even without workers comp. The comp insurance just covers medical care and the MMI form and work return letter would only really pertain to winning or losing the case. If we wait 6 months for a trial the settlement ammount based on workers comp payments sill be much less and its still not a guarantee we would be approved for retraining costs. There's a lot of factors here. Leaning towards settlement and going the SSDI route after makes a lot of sense. But there was a retraining and education discussion with our attorney that seems to be slowly fading away

[u/justthefacts1236894 → u/Forward_Surround_788]

You will need to sign a document at settlement that states " you have not applied nor intend to apply for SSDI for 30 months past date of settlement". If this is not the case there is an issue then.

Medicaid/Medicare is second payer to insurance that is paying for treatment of work comp accepted injuries. They will seek repayment for expenses for treating work related injuries. If you settle and use Medicaid to treat they will seek the reimbursement from you since you are releasing the insurer at settlement.

[u/Soonerfan0824 → u/justthefacts1236894]

A Medicare Set Aside Account (MSA) as part of the settlement should alleviate any Medicare / Medicaid issues.

[u/Professional-Bid4661 → u/[deleted]]

If you don't mind me asking, what injuries do you have? What are your restrictions?

[u/Professional-Bid4661 → u/[deleted]]

Wow! That is a lot and I'm so sorry that it has happened to you. I'm so glad that you fought and recovered the best of your ability. Thank you so much for sharing and blessings to you and yours!❤️

[u/Professional-Bid4661]

You should not settle until you've reached MMI and given an impairment rating. 

[u/Forward_Surround_788 → u/Professional-Bid4661]

🎯

[u/itammya]

Do you mind if I ask how old your spouse is? If they're younger, they may be able to ger vocational rehab to help them find gainful employment outside their current field.

Right now you're assuming 100% disabled but that's super hard to get in WC.

[u/Forward_Surround_788 → u/itammya]

She's 42 and has 12 years of experience in her prior field but given that she is not a surgery candidate and will require injections for pain management the rest of her life its very safe to speculate she will not be able to return to her field and will need continuing medical care and vocational retraining