“It has long been held that a C&R must provide fair compensation to the injured worker equivalent to what the injured worker would expect to receive from an award”
(Gaines, supra, at p. 17.)
“The purpose of an award is not to make the employee whole for the loss which he or she has suffered, but to prevent the employee and his or her dependents from becoming public charges during the period of disability.”
(Department of Rehabilitation v. Workers’ Comp. Appeals Bd. (2003) 30 Cal.4th 1281, 1286, as quoted in Gaines, supra, at p. 18.)
“Where benefits are due, they should be paid and the WCJ should ensure that payable benefits are not inappropriately shifted onto public systems, for example, Medicare, Medi-Cal, EDD, and Social Security. Adequacy review has the dual purpose of ensuring that an injured worker is appropriately paid benefits, which in turn benefits the public.”
(Gaines, supra, at p. 18.)
“If there is information in the record that indicates that an insurance company might be overvaluing a claim, that suggests that the settlement is adequate and that the WCJ should approve the settlement.”
(Gaines, supra, at p. 22.)
“To determine whether benefits are adequately paid, a WCJ requires information. The WCJ may not simply approve any settlement filed. The WCJ must independently review the settlement and determine that the settlement is adequate.”
(Gaines, supra, at p. 19.)
“(c) Agreements that provide for the payment of less than the full amount of compensation due or to become due and undertake to release the employer from all future liability will be approved only where it appears that a reasonable doubt exists as to the rights of the parties or that approval is in the best interest of the parties.”
(Cal. Code Regs., tit. 8, § 10700(c), as quoted in Gaines, supra, at p. 18.)
“Workers’ compensation was created, in part, to prevent an injured worker from becoming a public ward.”
(Gaines, supra, at p. 18.)
Cross-references: § 14.9 (what adequacy review is not for: protecting carriers from overpaying); § 19.5 (information bearing on adequacy).
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