On May 10, 2018, Associate Attorney Scott Ashby (DGC San Diego) ended newly-ignited medical spending (averaging over $21,754 per year in medications alone) by way of OAC&R from the San Diego WCAB on a 2015 stipulated case of a now 47 year-old applicant, who had filed a timely Petition to Reopen due to a worsening of her psyche condition.
The applicant had been a stocker and was struck on the back of the head and neck by a falling box containing a microwave. Early symptoms were documented as nausea and dizziness, severe headaches as well as neck and shoulder pain, momentary loss of consciousness with posttraumatic amnesia. Anxiety, sleep disturbance, panic attacks, domestic disputes, repeated cutting behaviors, major depression, nightmares, and borderline personality disorder crept into the applicant’s work injury complaints and history.
Post-award, the parties returned to the AMEs in psychiatry and neurology. By this time, the picture included multiple suicide attempts and psychiatric hospital admissions as well as very expensive migraine and psychiatric medications based on the medical reports and UR decisions. Approved medications included Diazepam, Chlorpromaz, Chlopromazine, Effexor XR, Propronolol, Sumavel DosePro Injections, Relpax, Eletriptam, Zonisamide, and Latuda. Valium was not approved, but applicant paid for it out-of-pocket. Documented marijuana use was also a part of her medical history.
To promote resolution of the claim and reduce the risk of tragedy for all parties, Mr. Ashby assisted the claims examiner in developing a plan to consult with a medical expert and obtain his opinion about the use of the extensive neurological and psychiatric medications. The respected specialist who was consulted confirmed the reasonableness of the current treatment, and advised that it was “…very likely…” to continue for life, given all comorbidities and home life stressors.
With $229,972 in medical payments already (TD and PD were only $8,226 and $24,035 respectively), the consultant’s opinion laid to rest any doubt that the claims examiner’s Future Medical Outstanding Reserve of $1,032,789 would most probably be spent, given the applicant’s relatively young age. The risk of her possible death also hovered.
Again for the benefit of all parties involved, Mr. Ashby and the claims examiner were steadfast in their persistence with the applicant attorney that the legal guarantees and closure provided by a structured settlement (as opposed to continued litigation) could at the very least ameliorate one lingering stressor in the applicant’s life and hopefully provide a boost to her psychiatric condition. Mr. Ashby worked collaboratively with the applicant attorney to make sure the settlement offer was communicated clearly and in the right vein.
The following Structured Compromise and Release agreement was reached: $205,000, guaranteed in the form of $1,110.02 payable monthly to applicant for the next 20 years of life beginning on 07/01/2018; $60,000 up-front cash payable to the applicant; and $35,000 up-front cash payable to applicant attorney.
OAC&R and Walk Through Appearance Sheet: Click here
Structured Annuity Settlement Addendum – Paragraph 9: Click here
Outstanding Medical Reserves and Settlement Evaluation: Click here
Compromise and Release Document – WCAB SDO: Click here