Workers’ Comp Settlement is second largest ever – $3.9 Million Settlement

Claimant is a 42-year-old quadriplegic as a result of a fall from a second story balcony. Claimant lives at home by himself in a rental house. He has no contact with any family members and requires 24/7 home health care which was being provided by the carrier. Because the claimant has relocated out of state, in order to facilitate settlement on this large file, claimant’s counsel was able to convince the carrier to agree to split the cost of flying a Deputy Commissioner from the Virginia Workers’ Compensation Commission to the mediation. Commission approval was also required. Including the mediator, fifteen people attended the mediation. At that mediation, the parties were able to successfully resolve the case for a total upfront cost of $3.9M. The claimant is not eligible for Social Security Disability (SSDI) or Medicare because he has insufficient deposits paid into the Social Security system. Because of his ongoing weekly compensation checks, he was also ineligible for Supplemental Security Insurance (SSI) and Medicaid. The settlement proceeds will be placed in a Special Needs Trust (SNT). An attorney practicing where the claimant lives was hired to advise on Medicaid issues and assisted with setting up the SNT on behalf of the claimant. The SNT is a pooled trust which reduces the cost of management of the claimant’s money. Because of the SNT, he will become eligible for both SSI and Medicaid. With upfront settlement monies, he will purchase a home and a handicap van which will be exempt resources not disqualifying him from receiving SSI and Medicaid. As a result of his Medicaid eligibility post settlement, Medicaid will pay for his hospital bills, doctor bills and prescriptions as well as 40 hours per week of his home health care at no cost to him. An annuity which is sufficient to cover the additional cost of his home health care needs for the remainder of his lifetime will be funded by the settlement. The claimant will become the employer of his home health care aides through an inexpensive payroll service paid out of the SNT. As a result of this change, the cost of his home health care aids is much lower than the amount being paid pre-settlement by the carrier to an agency. In addition, an annuity was set up to cover the cost of a nurse case manager to help handle his significant medical needs and arrange treatment and appointments.  Additional annuities will fund his ongoing living expenses.  Claimant may potentially qualify for Medicare and SSDI upon reaching his full retirement age. An opinion was obtained from a Medicare expert lawyer that a Medicare Set Aside was not needed.

Type of action: Workers’ Compensation

Injuries alleged: Quadriplegic

Name of case: John Doe v. Confidential

Tried before: Mediation

Date resolved: 2018

Special damages: Expected Permanent Total Disability and entitlement to lifetime indemnity benefits and lifetime medical benefits including home health care benefits

Verdict or settlement: Settlement

Amount: $3,900,000

Attorneys for plaintiff: Andrew Reinhardt, Stephen Harper, Craig Davis, Richmond