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The Road to Closing a Claim

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Denise Iannotti

on 12 November 2015

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Transcript of The Road to Closing a Claim

Evaluating the Facts
What is the injury?
Who is opposing counsel?
Is the Claimant
Pro Se
Is a surgery being recommended?
What additional issues are open for litigation?
Maintenance care only
Potential claim reopening
Permanent Total Disability Benefits
Medical Treatment
What additional medical treatment is being recommended, if any?
Who is the treating physician?
Is the Claimant at MMI?
Was a DIME performed?
Delayed recovery?
Psych issues?
Symptom magnification?
Waddell's signs
Subjective vs. Objective
Claimant's Employment
Is the Claimant still employed with the store?
Prior claims?
Claimant's job duties?
Store security camera footage?
How do Claimant's employment and job duties currently impact the exposure on the case?
Factors to consider:
Maintenance care being recommended
Reasonable expectation of receipt of benefits
Settlement amount
When is CMS approval required?
$250,000: If he/she is not on Medicare and does not have a reasonable expectation
$25,000: If he/she is on Medicare or has a reasonable expectation
Settlement Authority
How much authority is enough?
Take all factors into consideration
What are Claimant's expectations?
Is there a settlement demand?
Is opposing counsel involved?
Are other claims involved?
Does the Claimant have private health insurance?

If the Claimant is willing to settle, they likely do not want or need further maintenance care.
Negotiations: Let's Make a Deal!
How do you respond to a settlement demand?
How low is too low?

Considerations for working with Pro Se Claimant's
Remember: the ALJ must approve the settlement

When talking to opposing counsel, know who you are dealing with.

Know the value of your case before you make an offer!
It's a Deal! Now what?
What information is needed for the settlement documents?
Body parts involved in the claim
Date of injury
Prior claims to be included
Bad faith waiver
Medicare language and hold harmless clause
Contact information for the Claimant and his/her attorney
Settlement check deadline: 15 days from the date the settlement is approved
Payment of any outstanding medical bills
Approved settlement order
End of legal representation
Final legal bill

The Road to Closing a Claim
What to avoid so you don't crash
Claim Closure
Medicare Considerations
Mutual Mistake of Material Fact or Fraud are the only ways to reopen a settlement
No medical treatment after settlement is approved
No reopening in the future for a worsening of condition
Post-Settlement Issues
Full transcript