Should I Settle Out My Existing Medical Award for Cash?


Before accepting the insurance company’s offer to settle out your existing medical award for cash we recommend that you consult with the Law Offices of Marc Francis and its workers compensation attorneys serving injured workers in Santa Rosa, Sonoma County, and the greater north bay area.

We often receive calls from injured workers who have an existing medical treatment award in their workers compensation case and who have received communication from the insurance carrier offering them a sum of money in exchange for terminating their right to future medical treatment for their work injury. Sometimes such a settlement is in the best interest of the injured worker and sometimes it is not. Typically, the questions that should be addressed before proceeding to settle the medical award are: 1) what is the nature and extent of the expected medical treatment that will be required for the work injury in the foreseeable future? 2) is the amount being offered by the insurance company reasonable? 3) is the workers compensation case still within the time provided for by law to reopen the case for new and further disability and is the injured worker’s condition now worse than when the case was settled by stipulated award?

Before settling out your future medical award for cash is it best to determine what medical treatment is reasonably likely to be required in the foreseeable future. Some work injuries leave the injured worker with chronic conditions requiring expensive medication requirements. These can be cases of failed back or other spinal surgeries, for example, where the treating physician, often a pain management specialist, prescribes expensive pain medications for the work injury. Other examples are cases involving relatively young injured workers who have had knee or hip replacements that may need to be redone as the injured worker ages and the replacement parts become worn or require adjustment as the worker’s body ages. Still other examples are upper extremity injuries (shoulder, elbow, or wrist) where the injured worker has been advised by the treating surgeon that there may be a need for future surgeries for the work injury.

It is often difficult to determine whether the amount of money being offered by the insurance company in settlement of a future medical award is adequate to cover expected future medical needs. Oftentimes a consultation can be arranged with the treating surgeon or primary treating physician to get an updated opinion as to future treatment needs. This is a particularly good way to proceed if it has been a long time since the last office visit with the doctor. Not surprisingly, it can be risky to proceed in settling out a medical award without updated information from a physician. In cases where future surgeries are reasonably likely to be required, it is important to know what surgeries might be needed, the expected surgeon’s fee, the cost of the surgical facility, the cost of other related surgical needs such as anesthesia, the expected time off work for the future surgery, and other cost items. Another potential problem may be that the amount of money being offered by the insurance company may reflect only what the insurance company would have to pay for the future treatment within the workers compensation system, and that amount may be far less than what the injured worker would be charged by doctors and hospitals on a private-pay basis.

Another question that should be addressed before settling a future medical award for cash is whether the injured worker’s condition is worse now than it was at the time of settlement, and if so, whether the case is within the time limits for reopening the case for new and further disability benefits.

In many cases, therefore, it is necessary to obtain additional medical information to answer these important questions prior to settlement. It may also be necessary to conduct other medical-legal discovery before the Workers Compensation Appeals Board in order to address the needs of the injured worker.

The Law Offices of Marc Francis has workers compensation attorneys serving injured workers in Santa Rosa, Sonoma County, and the greater north bay area that can help you determine whether it is in your best interest to settle out an existing future medical award for cash and, if so, whether the amount being offered by the carrier is fair and reasonable. Please call today for a free consultation.

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