April 22, 2013

Oregon Workers' Compensation Settlements - What is a Disputed Claim Settlement (DCS)?

Disputed Claim Settlement (DCS)

A DCS is a type of Oregon workers' compensation settlement that is used to settle out a denied workers' compensation claim.  Essentially, a DCS means the injured worker (and their attorney) accepts a lump sum of money in exchange for the denial remaining final.  A DCS is most commonly used when the insurer has denied a workers' compensation claim and the denial has been appealed.  This creates the "disputed claim."

Unpaid Medical Bills

If there are unpaid medical bills at the time of settlement, they must be paid out of the settlement amount.  They are usually paid at an audited rate which reflects Oregon's maximum payments allowed under workers' compensation claims.  These amounts are lower than most physicians charge so it is to the worker's benefit to wait for the bills to be audited.

The insurer will not pay the unpaid medical bills out of the settlement unless they actually have the bills in their possession.  In other words, if there are unpaid medical bills and the insurer does not have them, they will not be taken out of the settlement and the worker will be responsible for them.

If, on the other hand, the insurer does have the medical bills in their possession and they simply fail to include them in the settlement, the insurer will remain responsible for the bills.

Any medical expenses or bills incurred after the time of the settlement will be the responsibility of the injured worker.  

Attorney Fees and Costs

Under Oregon law, attorney fees for injured workers in the Oregon workers' compensation system are capped.  The amount of the attorney fee for a disputed claim settlement is 25 percent of the first $50,000 and 10 percent of the remainder.  The attorney costs (usually incurred for obtaining medical opinion reports supporting the injured worker's claim) also come out of the settlement.

Do You Need and Attorney to Settle Your Workers' Compensation Claim?

Yes.  It is always a good idea to have an attorney help you settle your workers' compensation claim.  The attorney will help you get a better settlement and make sure you do not give up more rights than you should.

Will my Workers' Compensation Settlement be Taxed?

No, proceeds from your workers' compensation settlement will not be taxed.  Under Oregon law, it is not considered taxable income.

End Result

The final result of a DCS is that the injured worker's claim remains denied and, in exchange, they accept the lump sum settlement.

3 comments:

  1. Thanks for making it clear on who handles the medical bills in a certain situation. The blog contains very fruitful information as to the what comprises a Disputed claim. :)
    - Medval.com

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  2. What happens when you settle, but all medical bills have already been paid by your private health insurance? Will the insurance company ask to be reimbursed since the injured worker/insured received money from the workers' comp insurer via the settlement?

    ReplyDelete
    Replies
    1. The private insurance company will ask to be reimbursed from the settlement amount.

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