Long story short. I had a work injury a while back, had surgery a few months ago and I’m still in physical therapy. Everything’s been going okay, I’m progressing nicely, my day to day dealings with the insurance company have been fine and most of the bumps in the road (WRT the insurance company) I’ve dealt with on my own.
Yesterday I was assigned a Nurse Case Manager. She’s going to accompany me to my next doctor’s appointment. She’ll stay in the waiting room during the visit and then come in afterwards to discuss, um, stuff with myself and the doctor. Regardless of what she says, my understanding from reading about NCMs is that they step in when the insurance company feels it’s time to start moving things along and getting the case wrapped up.
So there’s that, and there’s still the settlement that comes at the end of all this. My understanding is that the doctor will assign me a disability rating and my settlement will be based on that. However, it seems that the settlement the give me (based on the doc’s number) can be considered a first offer and that a lawyer can get you considerably more.
I often read accounts of people saying that the initial settlement was for $7000 but the lawyer got it up to $20,000 or $50,000 or $100,000. Now, I’d like to be realistic and not think I’m going to turn $7,000 into $100,000. But if a lawyer can turn $7000 into $20,000 plus all future medical expenses, that would be nice.
Also, I wouldn’t mind having someone as my go between for all my day to day stuff so I don’t stick my foot in my mouth, especially now that I have an NCM to deal with. From what I’ve read, you’re not to say a word to these people other then to answer exactly what they ask as it pertains to your injury.
On the one hand, I’d hate to forfeit 20% of my settlement, on the other hand, if they can get me more, then it’s still worth it.
Also, one last question. Today I got a request in the mail from her to release all my medical information to her (pertaining to the injury). However, it also said I don’t have to sign it since they have access to it anyways. I want to sign it just to keep playing ball with them, but since I have the option of not signing it, why bother. Also, they put my name on it slightly incorrectly.
I know if happens to me, I’ll get a lawyer. My step-Dad lost all of the fingers on his right hand to a saw blade. He got a $3,000 workers comp settlement. I kept telling my mom and step-dad to get a lawyer, but they wouldn’t listen to me.
He was a carpenter by trade, and that accident ended his working days.
I don’t think speaking to a lawyer could hurt. Would their pay come out of the settlement as a percentage? So, the more they get you, the more they make?
In Wisconsin they can only have a maximum of 20% of the settlement. The settlement checks are sent to them, they take their cut and send the rest to you. So it’s in their best interest to get you as much money as possible.
One (official) cite I came across does say “An attorney retained by a worker is entitled to legal fees of up to 20% of the amount of benefits in dispute or, if there is no net gain over the amount the employer offered, the attorney is entitled to up to $250 as determined by the ALJ.”
That doesn’t totally make sense to me. The only way that makes sense to me is to keep lawyers from hopping onto cases where they know there isn’t anything to gain (the settlement is fair or more than fair already) just to get the 20%. In effect, making it worse for the employee.
I’m planning to meet with my insurance broker (also a family friend) to get his opinion. I’m assuming he’ll tell me to get a lawyer, and probably to not sign that release. When I first read it, I understood it to be saying ‘we already have access to this stuff, we pay the bills so we get to read the info, but we want your permission anyways, it just makes it easier’. But what I think it’s actually saying is that it’ll give them permission to see medical charts that aren’t related to the injury as well. I can’t think of anything in my history that would play into this, but who knows.
Another pro for getting a lawyer involved is that this stuff is all normal for them. They don’t have to hem and haw about this form or that meeting or what to say to who. It’s all standard ‘Release form? Throw it out’, ‘NCM wants to meet with you, we can do it at my office’ etc.
My original plan was to find out what the settlement would be and then go from there. If it was low I would hire a lawyer if it was fair/high I would accept it and walk away. But now that I’ve got this NCM I think I’d rather get someone experienced to help.
Hi Joey, I am in a similar situation. Seven weeks ago I hurt my knee at work and had surgery. And for good measure, I am also in the Milwaukee area.
Two weeks after the injury I received those medical release forms. I called the claim rep who was handling my case, and she said to ignore them, since my claim had already been approved.
I also have a nurse case manager assigned, but aside from the call where she introduced herself, I haven’t heard from her since.
As for an attorney, I don’t have one, though I have been thinking about it.
I guess I’ve been waiting to see if the insurance company starts hassling me.
My husband was injured on the job 2+ years ago, and has had a nurse case manager since the beginning, even before he left the hospital. In his case, the case manager has actually made things much easier - arranging specialized transportation when he needed it, coordinating the appointments, etc. After 27 months, the insurance company is now talking about a settlement (we don’t officially know that, but, when one becomes good friends with the doctors and other medical professionals, one is allowed to peek at certain emails…) We’re in Georgia, but have the same sort of questions you do - I’m following this thread with interest.