Kentucky Worker's Compensation - Help For Injured Kentucky Workers

• Kentucky Worker's Compensation - Quick facts about worker's compensation law, benefits and lawyer fees.

• Kentucky Worker's Compensation Resources - Links and resources for injured workers.

Results 1 to 5 of 5
  1. #1
    Join Date
    Apr 2010
    Posts
    3

    Default Workmans Comp Wants Second Opinon After 5 Years

    Hello all, I hurt my back at work, had to have two back surgeries, case was settled, I got life time medical from workmans comp and I am on disability due to nerve damage, I have to go to a pain specialist every month and I take several different meds for pain and inflammation, I have been doing this for 5 years and every year the workmans comp adjuster tries to get me to sell my life time medical and I refuse, today I get a call from the adjuster saying they have me an appointment with there doctor for a second opinion and I was told it was just to see if they could do something different than the doctor I have been seeing for 5 straight years. This doctor they have made me an appointment with is the same one who was not so nice when I got my impairment ratting. Is this normal behavior from workmans comp? Can they try and make me change my doctor or change my meds that have been working? I am a little shook up by all this and I am not sure what to think. If I had a choice I would refuse to go to there doctor at all, he really is not a nice man and just a hired gun for workmans comp, not to mention I have to drive 1 1/12 hours to get there and it hurts so bad when I have to ride that long.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Workmans Comp Wants Second Opinon After 5 Years

    Yes, the carrier can request a medical examination/evaluation at any time. They are paying the bills for your treatment, they have the right to know what they are paying for, and from what Dr provides that information.
    If you refuse the exam... your benefits could be stopped until you submit, or a judge could compel you to the exam. They are entitled to name any Dr they choose.

    If their Dr/IME says the medications you are currently being Rx'd are not medically necessary, your Dr will have to provide the medical reasoning to support that treatment plan. Your state laws would determine whether or not you might have to change treating physician... depends. Not usual though after the length of time here.

    If your Dr says you cannot drive that length of time, the carrier may have to provide transportation. At the very least, your Dr may say to stop at reasonable intervals and rest. That 1.5 hour trip may become 3 hours. That's not unreasonable.

    I am on disability due to nerve damage,...every year the workmans comp adjuster tries to get me to sell my life time medical
    If you are receiving SSDI, and are Medicare eligible, you will have to address and protect Medicare interests in any settlement that changes/closes the medical coverage in your claim.
    A proposal for WCMSA/setaside arrangement will have to be sent to CMS/Medicare for review.
    There are several steps to be taken before this should/can happen.

  3. #3
    Join Date
    Apr 2010
    Posts
    3

    Default Re: Workmans Comp Wants Second Opinon After 5 Years

    Thank you for the reply, Would it be beneficial to me in any way to take a WCMSA? My doctor says my back will get worse as I get older ( 41 now ) but I am not a candidate for a third surgery but I do take several meds and go to see a pain specialist once a month, but on the other had I would be done with workmans comp and not have to put up with there tactics on denials and constant aggravation and yes I am on SSDI and are Medicare. again thank you for your help.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: Workmans Comp Wants Second Opinon After 5 Years

    To tell ya the truth, I'm not so sure it's ever a good idea or beneficial to close out the medical in a comp claim. It's always a good deal for the carrier. They no longer carry any liability for your injury, they no longer are paying a claims adjuster to administer your claim/benefits. They no longer have the expense of denying you treatment. Good deal for them.

    On the other hand, when you cash out the medical, you are agreeing to ''administer'' your own claim...that doesn't cost you anything, you aren't doing anything else. But you will be paying out of you pocket, with their money of course, for all of your future medical care. And, regardless of what you may read/hear, there is much more to self administering a WCMSA than what appears on the surface. If there weren't, MSA vendors wouldn't get a 10K fee up front to administer for you. And, the carrier wouldn't object so much to paying that fee.

    Medicare Secondary Payor Act says the parties must take the necessary steps to protect Medicare/taxpayer interests when a IW closes out the medical by cash payment. So you don't spend all that money and become a ward of Medicare, a WCMSA is the recommended tool to do that protection.

    WC is about liability of the ER for you injury. Medical is one of the benefits provided under the law. That's why there are denials and tactics etc. WC isn't health coverage for the EE in the event of injury.
    When/IF you settle out the medical, and have a MSA, you can only use that money for services Medicare would normally be responsible for. There are a lot of those services, and medications, Medicare denies.

    In any FMC settlement there must be money allocated for the WCMSA and non Medicare services. If you have significant injury and future needs... IC are reluctant to pay out that kind of cash... unless it is really in their favor.

    I wouldn't do anything until... 1) you have signed a release of information form for SSA and CMS/Medicare status. 2) a determination to the need for a WCMSA has been made, and proposal submitted to CMS for review/approval. And you have the letter back. 3) a negotiated amount of money for FMC has been completed, and you know exactly what is entailed in keeping up your end of the arrangement.

  5. #5
    Join Date
    Apr 2010
    Posts
    3

    Default Re: Workmans Comp Wants Second Opinon After 5 Years

    Thank you so much for taking the time to answer my questions, it has helped ease my concerns and for that I am very grateful.

Similar Threads

  1. Replies: 4
    Last Post: 03-26-2010, 07:29 PM
  2. Workers Comp Settlemnt After 9 Years
    By tazsdaisy in forum Arkansas
    Replies: 10
    Last Post: 10-25-2009, 12:25 PM
  3. WI Workman's Comp Claim Taking Years,
    By siberiancat1 in forum Wisconsin
    Replies: 2
    Last Post: 01-24-2009, 07:11 PM
  4. Nine Years of Comp
    By NOEZRD4ME in forum North Carolina
    Replies: 6
    Last Post: 07-09-2007, 09:56 PM
  5. On Comp For Seven Years
    By shirley in forum Disability Benefits
    Replies: 8
    Last Post: 04-13-2006, 02:36 PM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer