Settling Your Workers’ Compensation Claim Through Compromise And Release

Not all workers’ compensation claims that are accepted and granted are settled in the same way. A common way of settling worker’s compensation claims is Compromise & Release, or C&R for short. Other types include Stipulation and Award and Commutation. We will provide an overview of the basic considerations when it comes to Compromise and Release.

How does Compromise and Release differ from other types of settlements?

Compromise and Release is a one-time lump sum payment made to the injured worker by the employer’s workers’ compensation insurance carrier. This lump sum monetary settlement buys out any and all issues and benefits in the worker’s case. When the settlement is final, the case cannot be reopened. The idea is that the insurance company will make a projection of future medical care costs and cover them in the payment. If the worker’s injury or condition worsens in the future, the worker cannot ask for any more benefits to pay for medical care. If the worker sustains another, unrelated injury, they can file a different work comp claim, but they cannot reopen the claim that was settled through Compromise and Release.

What are the advantages of C&R for the worker?

Many injured workers prefer this settlement over other types, such as Stipulation and Award, in which the payments are spread out over a period of time and the claim can be reopened if the condition worsens. Some of the advantages of Compromise and Release are:

  • The employee is in control of how the money is spent.
  • They can make investments with the settlement money.
  • They can choose doctors, rather than visit those that are in the insurance carrier’s Medical Provider Network (as is the case with Stipulation and Award).
  • They don’t have to worry that doctor’s decision could cost them benefits (which can happen in Stipulation and Award).
  • They don’t have to make treatment requests that go through Utilization Review and/or Independent Medical Review, since the injured worker is no longer in the system of workers’ compensation.
  • They can finance further education or retrain to work in another industry.
  • They can leave some of the settlement money to their heirs, should the injuries ultimately prove fatal.

What are the advantages of C&R for the employer/insurance company?

Compromise and Release holds some advantages for the employer and their insurance carrier as well. Their biggest interest lies in the fact that they assume this lump sum payment would prove less than payments on a schedule in the long run. Next, they also get to put a fixed value on the claim, which facilitates their accounting. This type of settlement is also preferred when the issues in the case are highly disputed.

Don’t risk it – get the help of experienced workers’ compensation lawyer!

Even when the settlement offer seems to be in your favor, you should always seek the services of a reliable, trustworthy and experienced work comp attorney. What appears like a good offer now, may be insufficient to cover your future medical expenses, since you are unable to predict with certainty the amount of medical care you’ll need in the future. Don’t risk accepting a settlement that is lower than what you deserve. Reach out to an aggressive, ethical and experienced work injury lawyer and protect your rights. Bear in mind that a large number of these professionals work on a no-win, no-fee basis, so you really have nothing to lose if you retain their services. You can only gain by hiring a skilled workers’ compensation attorney!

Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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6 days ago  ·  

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