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Thread: Future Medical

  1. #1
    Join Date
    Jan 2008
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    12

    Question Future Medical

    I am at the point in my case where I can either accept a settlement or proceed to the trial scheduled for next month. If I take the settlement after I pay for the past medical bills and my attorneys fees I walk away with half of that amount. NOTHING FOR FUTURE MEDICAL! My attorney said future medical is not payed...Really?!
    Since I am near eviction I am not sure I can wait this out any longer...Just what the other party wanted. They also have scheduled my THIRD medical exam, just two weeks before the trial date...Stalling?? So I expect the trial to be delayed. I have been in litigation for a year and a half.
    Although my lawyer is supposed to be "wonderful", I am less then impressed. If MI WC law is supposed to cover future medical, is it not usually done as my lawyer has told me? Is that typically the case with settling? I more likely to get future medical if I do go to trial?
    I am so sick of this!!!!

  2. #2
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    Feb 2007
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    Default Re: Future Medical

    Here is what MI law provides to treatment for a work related/industrial injury
    http://www.state.mi.us/orr/emi/admin...Dpt=LG&RngHigh

    Where there is an offer to settle a claim by C&R, the ER/IC will come up with a figure they feel will compensate you for all of the issues in your claim....PD indemnity, which is 'wage loss' for your inability to compete in the open job market due to your injury, any TTD that may be due, and the anticipated treatment as outlined by your PTP/QME/IME as the case may be.
    Your state may not provide for what is ''future medical'' spelled out that way. Usually there is some sort of defination though.

    If MI WC law is supposed to cover future medical, is it not usually done as my lawyer has told me? Is that typically the case with settling? I more likely to get future medical if I do go to trial?
    Where you see people speaking of "Future Medical'' or "Permenant Disability indemnity" when refering to a settlement...that probably should be refered as ''additional medical treatment'' you MAY be in need of. Those are just terms used to describe what would be included in a lump sum payment. If the FM isn't spelled out, your entire lump sum could be determined as being for 'medical treatment' you may need.
    Also, IF there is a payment for FM, it would be reduced to ''todays dollars''...the presumption is that you could deposit that money in a interest bearing account the same as the IC could, and there would be more money in time to cover the FM treatment you ''may'' have. IC's don't like paying for something you may or may not avail yourself of later on.
    Depending on how MI provides for settlements, either by a ''Stipulation w/Award'', or a ''Finding w/Award'', both of those would provide for periodic payments for the PD and medical remaining open. In a Stipulation, the parties agree to the terms of the settlement, but there is usually no lump sum. You retain medical benefits as to what is ''reasonable, and necessary'' to your injury.
    Your AA would naturally like to see a C&R that includes ALL issues, PD/FM/etc as the fee would be calculated on the whole award, vs just the PD indemnity in a Stipulated award.

    Where your AA has advised you that "NOTHING FOR FUTURE MEDICAL", maybe there is no future treatment anticipated in your case....(?)

  3. #3
    Join Date
    Feb 2007
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    550

    Default Re: Future Medical

    Karrie,

    I have READ YOUR PRIOR POSTS. It appears you have an attorney who IS AN IDIOT, who is looking out for his pocket!! If he is telling you to take the cash first, and tell medical providers, later, i WOULD RUN TO THE STATE BAR, and fire his ass!!

    You say Medicare has been PAYING YOUR MEDICAL BILLS???? (BVIA JUMP IN HERE)
    1) Are you on Social Security?

    2) Is your atty talking about a "REDEMPTION" in your case, where you close out EVERYTHING, INCLUDING FUTURE MEDICAL?

    3) Has the term "MEDICARE SET ASIDE" COME UP?

    BVIA is the expert here on MSA's, so i defer to him for the particulars. HOWEVER, KARRIE, it appears to me IF MEDICARE IS PAYING YOUR MEDICAL BILLS you CANNOT SETTLE YOUR CLAIM BY REDEMPTION, UNLESS AND UNTIL a MEDI-CARE SET ASIDE is drawn up, and SUBMITTED FOR THEIR APPROVAL. This process, all told can take up to a year. Take a look at this: www.michbar.org/workerscomp/pdfs/WCwinter06.pdf It is from the Mich State Bar.


    LA

  4. #4
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    Default Re: Future Medical

    It appears you weren't clear in your questions in this post.

    You need to go to the MI state web site and find the laws governing the provision of WC benefits in your state.
    In most states the IW cannot be billed for medical treatment UNLESS it is first determined to be 'unnecessary' per the guidelines to what is ''reasonable'' to your injury. IF the treatment is determined to be ''self procured'' and not a liability of the ER/IC...then yes, you can be held liable for the charges...and for what is ''usual and customary''...but as I said, you need to get the authority per the MI WC Act/Law. on how medical treatment is handled.
    I don't believe your attorney is advising you in your best interest in saying not to tell the providers that a settlement is/may be pending... and, the providers may have placed a lien against a potential settlement.

    As to your Medicare/Medicade... WHY are you receiving Medicade...?
    Is this because you receive SSI benefits from SSA...?
    If so, then as pLA has provided, you MUST protect SSA/SSI/Medicade interests BEFORE you enter into any agreement to settle you case. Where Medicare/Medicade has been providing advance/conditional payments for your treatment/Rx's, they must be reimbursed for those charges BEFORE you can receive ANY funds from any settlement. The treatment costs are as a rule to come from the ER/IC, not from the settlement proceeds in your agreement.
    But, as I said, you need to get the authority for this from the MI WC ACT...WHO is liable for treatment provided by someone else...like yourself, or Medicade. I wouldn't go by what your attorney is telling you at this point...it certainly doesn't sound right from what you provide.

  5. #5
    Join Date
    Jan 2008
    Posts
    12

    Default Re: Future Medical

    I will try to clear some of this up... First of all, my wc case was denied three months after my injury. That was now close to two years ago and I am on medicaid because I am poor and have a child, so I qualify. I did sign a agreement with medicaid that they will be payed back. By law my attorney said he must pay them and that comes off the top.
    Now, earlier there was the issue of my attorney wanting me to "stay quiet" about my case to providers. That clearly rubbed me the wrong way, so I contacted the director of workers comp for MI...What a nice guy that Mr. Nolish is! He instructed me that outstanding medical should be handled prior to settling my case by my lawyer (as opposed to hiding it).
    Also this would be a redemption settlement, so I guess that answers that question about future medical. A month ago I agreed to accept the settlement offer because I am broke and was unable to wait until the end of May for a trial. My lawyer did tell me it would be much better if I did take it to trial. Well, here I am still waiting with nothing scheduled to settle. So at this point should I try to wait it out since I am not sure when I will settle? But then will the trial date get pushed back?....I have been through so much stress with this wc case it is unreal. I don't even know what to do at this point!

  6. #6
    Join Date
    Feb 2007
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    550

    Default Re: Future Medical

    Hi Carrie,

    You CANNOT DO A REDEMPTION if you need to have it approved by Medicare/Medicaid. Go to the CMS web site, and have your atty research this. He can be held LIABLE if he settles your case without taking MC's interest into account.

    Why HAVE YOU GONE TWO YEARS with a DENIED case, Carrie????? Have you not had a hearing on this?

    I am so happy that you had the courage to question your atty's unethical behavior. Many IW"s are so beaten down and scaredm they won't question their atty, even when they know something is wrong. You did the right thing. I applaud your courage, Carrie!!!

    Hopefully BV will chime in here, further. I trust his opinion.

    Best of Wishes, Carrie.

    LA

  7. #7
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    Calif
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    Default Re: Future Medical

    Why HAVE YOU GONE TWO YEARS with a DENIED case, Carrie????? Have you not had a hearing on this?
    I think the injury was over 2 years ago... initially denied for 3 months, and subsequently accepted ''over 2 years ago''...

    I did sign a agreement with medicaid that they will be payed back. By law my attorney said he must pay them and that comes off the top.
    States may differ in how medical treatment is handled...but I have never seen one that requires that the IW be liable for the cost of medical, and the funds come from a settlement. The ER/IC is liable for your treatment costs to the injury.
    If there are reimbursements to be made to Medicare/Medicade those monies should be paid by the ER/IC.
    Medicare/Medicade provided 'conditional payments' for treatment while your claim was being denied, the IC should reimburse..not you.

    That does NOT however relieve you/attorney/ER/IC from the duty to evaluate the need for a WCMSA (setaside account).
    Medicare/Medicade are one in the same...the only difference is that the SSI/Medicade is administered by the state.
    That is why the web site says..."Centers for Medicare/Medicade Services'' www.CMS.gov

    A month ago I agreed to accept the settlement offer because I am broke and was unable to wait until the end of May for a trial.
    It is sad for the condition you find yourself in... waiting for a trial should be something you discuss with your attorney. He may have a strategy in mind that you are unaware of.
    But... IF you receive a lump sum payment for settlement of your claim, you cannot just use the "future medical'' monies to pay bills...you/ER/IC cannot attempt to shift the future medical costs to Medicade. That is why there must by the evaluation done for a WCMSA.

    IF you receive money for additional treatment by settleing this claim by a C&R CMS/Medicare/Medicade won't pay for your treatment until you can prove the money is completely exhausted... out of your pocket.
    And, IF the settlement agreement is not worded properly, SSA/CMS can declare the ENTIRE amount you receive to be ALL for Future Medical.

    These are issues where you are dealing with the federal government...they can and will come after your AA, the ER/IC, CA/DA and possibly you.
    IF a WCMSA is not considered there can be fines up to $1,000/day plus three times the amount Medicare/Medicade has provided.

  8. #8
    Join Date
    Jan 2008
    Posts
    12

    Default Re: Future Medical

    I hope I am properly explaining my situation...You seem to really know your stuff.
    Let me include more details to be sure-- The IC payed for my medical for just more than three mths and I worked w/restrictions for about two and a half. So I never received lost wages. The IC sent me a copy of dispute so the next month I hired my attorney and 3mths later the mediation took place. Then four mths later the first hearing date was setup. It did not take place because they had not done the deposition w/my doctor. Then it was rescheduled two mths later. Well, the problem that time was that the other party’s attorney, he had not met w/ their people (something to do w/ being self-employed). At the next hearing, the current amount of medical to be paid back to medicaid was incorrect. This sort of thing has continued until now 8mths later....So that has been my nightmare
    Now with the medical, I have Priority Health Medicaid. Does that make a difference? I had to sign what they call a subrogation agreement. Under the agreement they have the right to be reimbursed out of any recovery I get in my WC case. Does that sound right?? Now with the amount of the settlement. First my attorney pays medicaid off the top. So beyond that I am stuck with paying for any other medical care needed. I do understand no other IC will pay for this injury.
    With all of this said, do I still need to be worried? Thank you so much for you feedback!

  9. #9
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    Calif
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    Default Re: Future Medical

    Now with the medical, I have Priority Health Medicaid. Does that make a difference? I had to sign what they call a subrogation agreement. Under the agreement they have the right to be reimbursed out of any recovery I get in my WC case. Does that sound right?? Now with the amount of the settlement. First my attorney pays medicaid off the top. So beyond that I am stuck with paying for any other medical care needed. I do understand no other IC will pay for this injury.
    What it would boil down to is this... IF Medicade paid for any treatment that was to your work injury, the IC should be the one to reimburse, you/IW would not be liable to the work injury treatment.
    On the other hand, IF this treatment/Medicade was for other medical issues for you and/or your family, then yes, it would be paid from your settlement funds. Medicare/Medicade has to right to recovery from any monies advanced to you because, Medicade/SSI is asset based.

    So it that a little easier ...? There are or could be TWO medical/Medicade issues in your case...one work related, the other being ''personal'' medical... that would have to be addressed seperately.
    Maybe that is something that wasn't clear in your posts...(?)

  10. #10
    Join Date
    Feb 2007
    Posts
    550

    Default Re: Future Medical

    "The IC payed for my medical for just more than three mths "

    WHY did they only pay for 3 months??????????????????????


    LA

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