NLW, is this normal?

[mbird]

What is the name of your state (only U.S. law)? NH
What is the name of your state (only U.S. law)? NH
Hi, how are you? Hope you and yours are fine.

NLW, the reason for this post is to ask you if :

Since the beggining of my claim, my insurance adjuster treat me like nobody.
No answers to my phone calls ( I don't have an attorney), say that ( when I choose to be redirect and for lucky he get the phone without seeing my number) will call later or that specific day and then call a week later.

Ok, I can take that. (did it for more than 1 year) But, since I got my impairment rating (13%, you're just right about that) they stopped sending my weekly checks. I call, left n messages, no answers. Then, when I finally got to speak with him, he told me that he was going to send me the check for the impairment rating and the case would be close and i could have future medical expenses , if necessary, paid.
Question: In NH that's no settlement for future medical expenses, right? So he lied to me?
That have said, I asked him about diminished earning capacity and that I needed a vocational rehabilitation counselor to check my earning potential and, I felt that he got very nervous like, "how he knows that" ? Then told me that he could pay me the money instead paying the counselor. After that, told me that he would be calling next week (that was last week) and , nothing. I called this Monday and he told me that he was going to call me today(friday) , it's 03:00 pm and nothing.
What should I do? Is that normal?
Thank you for your time.

 

[NLW]

How very frustrating for you. I've worked with claims adjusters from other companies, and even have some on my staff that have come from other companies and I could tell you horror stories. Many claims adjusters with other companies have case loads of well over 200! They are simply put into situations where they cannot take care of anything proactively, and are essentially putting out fires every day. I can't say whether this adjuster is in this scenario, but if he is - despite your frustration - understanding this and showing a little compassion may get you more of what you want. Using honey instead of vinegar, so to speak.

Then, when I finally got to speak with him, he told me that he was going to send me the check for the impairment rating and the case would be close and i could have future medical expenses , if necessary, paid.

You're right - future medical cannot be closed. I think what the adjuster meant was that if you still need to see the doctor, he would pay those bills.

As far as voc, you need to stay on the adjuster. If unresponsive, you can call the personnel in the office of the Vocational Rehabilitation Coordinator at the Department of Labor. This office may be reached directly by dialing 271-3328. The NH in-state toll free number is 1-800-272-4353. I'm not sure if you can hire your own counselor - you might try asking the Department of Labor.

 

[mbird]

Thank You, NLW!

Yes I do understand that he could be very buzzy. I have been very patient and I'll keep that way.
Just one more question: Should they stop sending my weekly cheks after the impairment rating done?

Thank you, thank you, thank you!

 

[NLW]

There are rules about how benefits can be stopped. As you have permanent work restrictions and have not returned to work, no they shouldn't. Here is the rule:

Lab 510.02 Rules Governing Review.
(a) No carrier shall reduce or terminate benefit payments for reasons other than provided by statute, Lab 506.02 (o), or Lab 510.04 without obtaining prior approval of the commissioner pursuant to (c) and (d) below.
(b) A carrier seeking approval to reduce or terminate benefit payments shall take the following action:

(1) File a written petition with the commissioner setting out in detail the reasons why it believes it should be allowed to take such action;

(2) Attach to the petition copies of all medical reports and other documents it is relying upon to support the granting of its petition; and

(3) Simultaneously send a copy of the petition and supporting documents to the opposing party, together with a notice that if the party objects to the petition, a written objection together with all documentation supporting the objection is required to be sent to the commissioner and the moving party within 10 days.

(c) Upon receipt of the petition and any objection to the petition, the commissioner shall:

(1) Review the medical reports issued since the date of the last decision by the commissioner or commissioner's representative to determine if there has been a revision of any full-time, light or full duty work release applicable to the employee;

(2) Review the limitation and restrictions placed upon the employee by the treating physician;

(3) Review the documentation indicating the availability of work for the employee;

(4) Review the employee's involvement in an approved vocational rehabilitation program; and

(5) Review such other facts noted by the parties in their filings that might restrict the employee from returning to work.

(d) Based upon the evidence presented and the review pursuant to (c) above, the commissioner shall grant or deny the petition to reduce or terminate the employee's benefits.
(e) If the petition to terminate benefits is denied, the commissioner shall schedule a hearing in accordance with RSA 281-A:43 if a hearing has been requested.

 

[mbird]

What should I do?

In this case, what should I do?

 

[NLW]

You need to get your adjuster on the phone - or maybe even his supervisor if you cannot get through to him. Advise the insurance company that you are aware of your rights -
1.) Benefits need to continue as you have been unable to return to gainful employment as a result of your work injury and permanent work restrictions
2.) You are entitled to a vocational counselor and vocational services as you have been unable to return to gainful employment as a result of your work injury and permanent work restrictions

You should demand benefits be reinstated and a vocational counselor be assigned immediately. If they refuse or try to stall, you should further advise that failure to comply with the laws will result in you filing a formal complaint against the adjuster and the company with the Department of Labor.

Your adjuster mentioned settling out these rights - if they have an offer, let's hear it. If they have a number, we can talk about it more - an offer doesn't mean you have to accept it.

 

[mbird]

Can't thank you enough!

I'll do it.

NLW, I don't now what this was going to be without your help...

Thank you!

 

[NLW]

Sure thing. Let me know how it turns out.

 

[mbird]

They called!

Good Morning, NLW

They finally called and gave me a figure of 30.000 for settlement.
Based on the numbers you gave me, it should be, at least, 16.000 for the impairment rating plus 48.000 for the diminished earning capacity in a totoal of 64.000.
I told them that wasn't a fair amount and will wait for a better one.
He told me that if we go to a comissioner to settle, the amount could be more or could be less, and they are trying to do without having to go in front of the comissioner.
I also told them that, by law, they shouldn't stop sending my weekly checks, and they will issue one for that time.
So, what you think?

Thank you!

 

[NLW]

Not a bad start, mbird!

On the impairment, I'm coming up with $19,100 (350 x 13% x 420), so it looks like they are factoring $10,900 in wage loss over 262 weeks. This would be a wage loss benefit of $41.60 per week. I'm not familiar with your work history or educational background, but these will be factors that will impact your ability to find gainful employment within your restrictions - which are pretty tough.

You can always counter their offer with a demand of your own. For the sake of compromise you'll want to demand more than what you really want. So, the numbers we put together previously were assuming you returned to work making $10/hr for 40/hr weeks. Maybe for your demand, you should assume that you'll return to work making $7/hr for 35/hr weeks. This would give you a weekly benefit rate of $273 for 262 weeks - or $71,526. This, combined with the impairment rating is $90,636.

Hopefully they will then counter with something closer to $50,000-$60,000, which I think is reasonable value for your case. Keep in mind, that they can still get a medical opinion of their own to dispute your restrictions. Also, it is presumed that through promotions and raises, that your wage loss benefit would likely decrease over time as you are earning more money.

 

[mbird]

Thank you Again!

Yes, that is the amount I said I was expecting : 50.000 to 60.000 and he said he will talk with his supervisor.

Quick question: for the impairment amount should the 52 weeks (1 year) be taken from the 350 weeks for the time that was already paid?

THANK YOU!

 

[NLW]

Oh, very good question - very smart of you to bring up what you've been paid in the past. The number of weeks of benefits you were previously paid is not deducted from the impairment rating. The award is what it is and per NH website: "The award is a separate and distinct benefit and is in addition to any other benefit being paid such as weekly compensation, medical benefits and vocational rehabilitation."

The number of weeks of benefitspaid is actually deducted from the wage loss benefit. Have you been paid 52 weeks of benefits? So the numbers would look a little more like this:

Earn $7/hr at 35 hrs/week = $273 x 210 weeks = 57,330
Earn $10/hr at 40 hrs/week = $180 x 210 weeks = 37,800

Combine these numbers with your impairment rating and you are in the range of $56,910 and $76,440. Of course this will change dependent upon how many weeks of benefits you have already received.

 

[mbird]

Thank You!

Great. He also told me about paying me instead of the rehabilitation counselour.
How much would that be?

Thank You, NLW.

 

[NLW]

Probably somewhere around $5000. It of course depends on the level & length of services provided. A year worth of services to include a skills assessment, job placement, and assistance with resume, etc. is about $10,000 (on average). Assuming you return to employment in 6 months, the insurance company could reasonably expect to pay $5000 to a vocational counselor.

 

[mbird]

What if...

Good Morning NLW,

What if they don't want to settle for more than 30.000?
Should I go in front of the comissioner? Do I need a lawyer?
By whos side the comissioner usually goes? For the fair amount?
Can they (insurance company) choose not to settle?

Too many questions...I know...thank you in advance.