I prevailed at the conference stage and insurer appealed and requested I see an Impartial State Dr. Report from state Dr. supports my Drs. findings and recommends surgery. I have certain losses of function and curious when they are paid out to me?
Jeffrey A. YoungWorkers' Compensation LawyerLowell, MAMA licensed ·
You do have to reach maximum medical improvement. Massachusetts does rely on the A.M.A. Guides to the Evaluation of Permanent Impairment in determining loss of function benefits. One suggestion I would make is that you do NOT have your treating surgeon do the impairment evaluation. In my years of doing these claims I find that doctors who perform surgery on you do not tend to want to maximize the impairment rating. The inference being that the more impairment you have, the less successful the surgery may have been. Even though the surgery might have been very successful, but there was no way to avoid a permanent impairment. You want an evaluation done by a doctor who knows the Guides and can apply them correctly. Many doctors do not really understand the Guides, especially the new 6th edition.
You may want to speak to an experienced Massachusetts workers' compensation attorney. Most do not charge for a consultation and if they file a claim on your behalf and prevail, most if not all of the attorney fees and expenses are paid by the insurer. The state has specific charts and formulas for converting the impairment percentage into your dollar benefits. Consulting an attorney will also help you determine what your benefit amount will be.
Lastly, the insurer will probably send you for an IME (Independent Medical Exam or what I like to call an Insurance Medical Exam). DO NOT go by any impairment percentage in an IME report alone. Given the amount of money most IME doctors make from the insurers on these exams, their obvious bias is going to result in a low percentage or no impairment finding at all.
Mr. Ranone is correct, in my opinion. The only thing I might add is that in some instances, your attorney may want to obtain a loss of use rating from your treatment provider in accordance with the American Medical Association Guide, 5th or 6th Edition.
Either by agreement or when so order upon a judgment.
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George A MalliarosCar / Auto Accident LawyerDracut, MA ·
You sound like someone who is not represented by counsel. Big mistake. unless you are able to resume your employment with the same employer. If not, you'll want to lump sum settle your comp claim. You will get taken advantage of without able counsel. An attorney would take 20 % 0f the gross settlement minus the loss of function benefit. You will probably need to file a claim for section 36, loss of function benefits.
J. Eric ChisholmWorkers' Compensation LawyerBoston, MAMA licensed ·
Loss of function claims can be filed at any point in the litigation. However, if you are post-Conference, and pending a Hearing, your lawyer should file a claim and/or motion to join a claim for a loss of function benefit, which will be dealt with at the Hearing. If the lawyers can agree as to a dollar figure, then the benefit can be paid at any time. However, if you are already in litigation, and the figure is disputed, which it generally is, then would be paid by way of a Hearing decision, or a Conference Order. If you opt to have the surgery as recommended by the impartial doctor, and your own treating doctor, then having an assessment as to loss of function is premature. You want to wait until six (6) months post surgery. Loss of function claims, per G.L. Ch 152 Section 36, are filed using a physician's report which details an individuals permanent impairment pursuant to the A.M.A. Guidelines. If you had a surgery, as previously suggested, I generally try and avoid having the surgeon who performed the surgery, conduct the impairment assessment. You would want the evaluation to be performed by an independent board certified doctor who knows and understands the AMA Guidelines, and ensure that its six (6) months following your presumed surgery/fracture which caused the presumed loss of function.
teven H. KantrovitzWorkers' Compensation LawyerBoston, MAMA licensed ·
In order to qualify for your Section 36 Loss of Function or Disfigurement benefits, you first must reach what is called a maximum medical improvement. MMI. Basically your doctor must be of the opinion that you have reached an end result. The doctor must quantify the loss of function in percentage terms under American Medical Association Guidelines. If you qualify for a disfigurement benefit, the doctor should be descriptive of the disfigurement. To qualify, the disfigurement must be either on the hands, face or neck, or case be disfigurement other than scarring, such as a permanent limp. Most insurer's require that you wait at least 6 months post surgery before they will consider a disfigurement award. In light of the fact that the Impartial Doctor appointed by the court was supportive, the insurer will not likely not fight the 36 claim to any great degree.
Hope this helps
