Legal Question in Workers Comp in California

I am settling my own workers comp claim, C&R. The QME said I may need lumbar surgery in the future (not definitely, just might). The Claims Examiner said she would give me a portion of the fee for surgery in my future medical settlement. I realize that might be 25% of the total cost. Question: Is there an amount in California that Claims Examiners use for the cost of a laminectomy or fusion? In other words, 25% of how much? I want to make sure I am prepared to demand the proper amount. Thank you.


Asked on 4/13/10, 12:05 pm

1 Answer from Attorneys
George Shers Law Offices of Georges H. Shers

I believe there are general guidelines as to what is the reasonable range for medical treatment; you should ask the adjuster what is the basis of the figure she is using. But remember that medical costs are going up so if there is a 25% chance that you might need in 10 years something that would cost $20,000 now, you need currrently a sum that would match, with growth from reasonable investing, what that surgery would cost then. Since medical costs rise faster than general inflation, whta costs $20,000 now might cost $50-60,000 in ten years. You also have to take into account whether your medical insurance will cover you; if not, you are making a big gamble that you will not need surgery.

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Answered on 4/20/10, 11:22 am


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