California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Jul 2010
    Posts
    5

    Default What is Future Medical Worth

    I have a knee injury from 2002, and the QME has requested Future Medical. I am curious as to what that would be worth in a dollar amount. The QME, and my personal doctor have both stated in my medical file that I would probably be a candidate for a total knee replacement in the future.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: What is Future Medical Worth

    your doctor is probably a good resource for medical costs.

  3. #3
    Join Date
    Jul 2010
    Posts
    5

    Default Re: What is Future Medical Worth

    I'm not talking about the cost of the actual procedure. I'm interested in knowing the relative worth of a knee replacement in negotiating a buyout of my Future Medical. I believe it's called "Compromise and Release". I'm looking for some ideas or actual numbers regarding the worth of it in that aspect. That would also be including the hospital stay, therapy, durable medical equipment, and so on...

    As in, if they say it's worth 20K, I would say no it's not. It's worth much more than that, like maybe 50K.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: What is Future Medical Worth

    One, you will never receive the full value of a potential knee replacement. IC's dont pay for treatment you may or may not seek post settlement'

    Two, you are not going to pay for FMC per the OFMS/Official Medical Fee Schedule.
    \
    Three, if you require FMC/Future Medical Care, you should not sell those benefits by a lump sum payment. YOu are agreeing to pay out of your pocket, with the money you receive for FMC, for any/all future medical necessary to your injured body part.

    No one on a message board can give you figures such as you are seeking. Just not possible. There are no "averages", what you receive would not be similar to comparable to what another IW might receive.

    Negotiate this on your own. go to the OMFS if you like, and expect to be paid in "todays dollars"... again, NOT enough to pay for one TKR, let alone a second.

  5. #5
    Join Date
    Jul 2010
    Posts
    12

    Default Re: What is Future Medical Worth

    Has anyone had an attorney ask you to come up with an amount for a C and R? Isn't that up to counsel to advise so one gets an appropriate amount ( I know it will not equal potential costs)??? Sounds like if future med is needed, keep it..right? But I would love an answer to my question..

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: What is Future Medical Worth

    Atty will always ask the IW what it would take to close the claim... there isn't any way to determine the value however until you are MMI and rated for PD/WPI... that is the basis for indemnity due.

    If you require ongoing medical care, no, you should not close the medical. That is the single most valuable asset in a WC claim.
    To step back a post or so...
    I'm not talking about the cost of the actual procedure. I'm interested in knowing the relative worth of a knee replacement in negotiating a buyout of my Future Medical.
    What do you think an estimate of FMC would consist of...? You statement makes no sense...

  7. #7
    Join Date
    Jul 2010
    Posts
    5

    Default Re: What is Future Medical Worth

    What do you mean it makes no sense? it's just a question posed to whoever has an idea to comment on it. It's not a critical, life or death, got to have the precisely correct answer, the only one true answer... Get over it dude!

    You seem to have an answer for all questions, and some of those questions are as cloudy and vague as some of your answers...

    Perhaps, I just stumped you, little fella!!! Let me enlighten you and the others, further...


    I understand the importance of having, and trying to keep FM, but I keep getting denied by the claims adjuster / med review panel for procedures (knee scoping and cleanout) that my doctor wants to do to keep me employed and my knee stable. I have great medical insurance through my employer right now. I'm looking at settling, and trying to close this case (it's been going on for over 8 years without settlement), taking the buyout on the FM, and just using my med insurance to deal with the procedures... I need to work for another 10+ years until retirement, and feel that a TKR now would probably hinder my ability to last another 10 years. I could get the TKR further down the road after retirement, and covered by my med insurance also.

    I hope that makes sense to anybody that needs more sense...

  8. #8
    Join Date
    Jun 2009
    Posts
    196

    Default Re: What is Future Medical Worth

    Blue,
    The problem is WC just won't pay very much for future medical on a knee injury. By the time you C and R it probably would'nt be worth it. If you are treating now and the doctor is saying you need a knee replacement ,that would put you in a better position.

    The system is pretty much a joke.They won't pay anything to close medical and then they fight requested treatment or try to shift liability.The Ic is not obligated to buy out your medical if they don't want to. Start treating and give them a reason .If you are not repped that could be why you are getting denied. Talk to a lawyer . One would jump at the chance to negotiate for you .

    I recently got a letter/offer from an IC to buy my medical and it wasn't even worthy of consideration.

    Are you certain you private insurance will cover it? Most do not cover a WC claim/ preexisting condition.

    Interceptor
    Last edited by Interceptor; 07-16-2010 at 08:38 PM.

  9. #9
    Join Date
    Jul 2010
    Posts
    12

    Default Re: What is Future Medical Worth

    --------------------------------------------------------------------------------
    What do you mean it makes no sense? it's just a question posed to whoever has an idea to comment on it. It's not a critical, life or death, got to have the precisely correct answer, the only one true answer... Get over it dude!

    You seem to have an answer for all questions, and some of those questions are as cloudy and vague as some of your answers...

    Perhaps, I just stumped you, little fella!!! Let me enlighten you and the others, further...

    Hey, Blue...we are all beyond frustrated with this system and it sounds like you have really been through it..with 8 years in...but these folks who post here, especially those who post regularly, do so out of a great spirit of generosity and with lots of knowledge..Let's be respectful of their experiences and time!

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: What is Future Medical Worth

    ...taking the buyout on the FM, and just using my med insurance to deal with the procedures...
    Get out your EOC/evidence of coverage on your own health insurance plan. Industrial injury/illness is SPECIFICALLY denied coverage. You cannot use your own health plan, they will deny the bills.

    IF you take a cash payment for the FMC, and you knowlingly allow another carrier to pay for treatment to your injury it would be double dipping, and a attempt to defraud an insurance company.
    I could get the TKR further down the road after retirement, and covered by my med insurance also.
    No...you can't. Your IC is liable for medical care to your injury/hip for the rest of your life. Unless you take that cash out, then YOU are responsible out of your pocket. That is what you are agreeing to in a C&R.
    Perhaps, I just stumped you, little fella!!! Let me enlighten you
    You didn't stump me...or anyone else here... you SAID...I'm not talking about the cost of the actual procedure. I'm interested in knowing the relative worth of a knee replacement...How would you define the difference in the cost of a procedure, and the TKR...?
    As to you using your own health coverage, OR Medicare for that matter, as you are only about 10 years from retirement, and as one would have to presume you have had GHP for some time in your life, we'd have to also presume you are familiar enough with those coverages you'd go to the EOC first before stumbleing around a message board with these remarks. So, to put your response back at ya... "Get over it dude!", and yourself if you can step that high.

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