Strokes are brain attacks. They occur when the blood supply to the brain becomes blocked. Stroke is the fifth-leading cause of death in the United States. Nearly 800,000 people have a stroke each year.
When a client has a stroke, the disability in the workers' compensation system can be difficult to assess. The current system requires use of a book called the AMA Guides which rates "medical impairment." Medical impairment often does not take into account functional loss. Functional loss is essentially how you are limited in your daily life and work. Medical impairment often times will not take into account the stroke impact.
A stroke can include cognitive problems, functional problems as for use of the body in activity, and as well as psychiatric issues.
Depending on the type of stroke, the acute treatment when someone is rushed to the hospital is administered until the problem is stable. Usually, workers' compensation becomes involved after this event.
Treatment shifts to preventing future strokes and other problems and to your recovery.
The injured worker may need a number of medicines to control conditions that put you at risk for stroke. These conditions include high blood pressure and atrial fibrillation. Some people need to have surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).
A stroke rehabilitation (rehab) program can help you regain skills you lost or it can help you make the most of your remaining abilities.
Social Security / Medicare
In many catastrophic claims, the injured worker is eligible for Social Security Disability. Although that is not an area of law we handle, it's important for a workers' compensation attorney to understand the impact of Social Security with the workers' compensation claim; special paperwork needs to be done.
Additionally, Medicare is a critical benefit especially if the injured worker has other health conditions. A workers' compensation settlement can impact Medicare rights, therefore, your attorney must understand how to prepare the proper paperwork that Medicare will approve.
Structured Settlements / Medicare Set Aside Trusts
If you are on Social Security Disability and/or you are a Medicare beneficiary, then a Medicare Set-Aside Trust (MSA) would be required before you settle your case by Compromise and Release. The workers' compensation insurance company would obtain a MSA from a company who prepares them. Then that MSA would need to be submitted to CMS (the third-party agency that Medicare uses to address these issues). The MSA company would need all medical records from your workers' compensation case in the last two years, a prescription list from all pharmacies for the last two years, and a Social Security Administration release.
Special Needs Trusts
If a client is on Medi-Cal, public assistance, welfare, or any other benefit which is dependent on income and assets, a Special Needs Trust may need to be setup in order to properly settle a workers' compensation case.
Pre-Existing Conditions Combined With Limitations following a Stroke Event
If a client has limited function following a stroke, that injury alone may not limit them from having a productive future at work. However, in some cases, the injured worker has pre-existing injuries, health conditions, anxiety, depression, and other disabling conditions that the worker could manage before the stroke. However, the stroke injury has put the client "over the edge" as far as ability to work in the market.
Basically, from a practical point of view when you combine the pre-existing problems following a stroke, the client cannot function in the open labor market. This doesn't mean that they can't live their life; it means they cannot compete in a competitive job market. There is a special type of workers' compensation claim called a Subsequent Injuries Benefit Trust Fund (SIBTF) claim and that type of claim is one that your attorney should understand and consider in these situations.