Settlement Plus Future Medical

[mlee19841]

My workers compensation claim was made in the State of: Pa. Long story shot I was injured on the job. Fast forward till today. I'm going to be setteling with the insurance company. My question is can I settle for a lump sum amount plus have them cover future chiropractor care and meds. Or is that out of the question.
Thanks

[BvIA]

Pretty much anything is negotiable in a C&R/Compromise and Release settlement.
However, there isn't much incentive for the carrier to cash you out and leave the medical open.

If your future medical care needs consist of Chiro and OTC medications... there isn't much value there. There is no 'entitlement' in a settlement of WC claim for cash reimbursement on medical going forward. If you need treatment, you should not close the claim.

[mlee19841]

Got ya. I talked to a orthopedic surgeon today. He thinks I should get surgery. Would the insurance company go for a settlement plus cover the surgery cost?

[Frank Lafferty]

Have to ask, what is the rush to settle? Settlement is not always the goal in a comp claim, especially when you may be looking at surgery. You could possibly get them to cover a surgery, but what if there are complications? The need for another surgery? The IC will want little or no future meds in most settlements. How long have you been out of work? Are you looking at a fusion or a microdiscetomy? As someone who represents injured workers, and has had two back surgeries myself, I have extra empathy for those with back injuries. Don't have anyone, IC or WC atty rush you into a settlement until you know where you stand medically. It may be appropriate to settle, but please make sure you have as much info as possible.

[mlee19841]

I've been out of work for a year and about 2 months and only minor surgery. Where they would make a small incision and cut away or remove the herniated part of the disc. Also how much would something like that cost if I did come to a settlement and have to pay for It out of pocket. Also health insurance wouldn't cover the cost right. Only reason why I ask is because when I make appointments for medical treatment for my back. I let them know it's a workmens comp case. But they also ask me if I have a secondary health insurance carrier?

[Frank Lafferty]

You should probably call a WC atty for a few different reasons. While I agree a microdiscetomy may be more "minor" than a fusion, it is still surgery and you may still face post-surgical complications, etc that you would possibly want covered if you do not have an alternate source of coverage. Speaking of alternate sources of coverage, do you have a spouse that may have insurance that would cover you? These are the types of things you should discuss with an atty. I have had clients insist they would never want surgery, then after suffering they decide they will. Its a personal decision, but you need it to be an informed one. Plus, if you are ever going to even consider resolving such a case, you should have effective, competent counsel helping you do so. Good luck!

[mlee19841]

So what your saying is that even though it's a work injury. I can use regular health insurance to cover some procedures.

[BvIA]

So what your saying is that even though it's a work injury. I can use regular health insurance to cover some procedures.

You need to have a clear understanding of what a GHP/Group Health Plan will/will not cover... nearly all GHP's expressly exclude coverage for treatment to a work related injury, this goes to liability, and the liability for treatment is your ER's....not you/GHP. Whether it's your wifes GHP or yours. Read the EOB/Explanstion Of Benefits covered usually toward the back of the actual policy.

[mlee19841]

Had another doctors appointment the other day. I'm looking at getting surgery, has anyone on this forum had any good results. after getting back surgery(herniated disc with a tear). Also does workers compensation see that as a permanent injury? Also has anyone received surgery and then came to a settlement agreement. If so is the money worth it. Reason I'm asking is because after this back surgery I cant go back to doing manual labor jobs and that's all I did all my life. Also trying to find a over min. wadge job with out a college degree is hard now a days.Also I don't want to stay on workers comp all my life and god forbid i need future surgery's which is always a possibility and I'm only 27 years of age. Also what was your recovery time and was it successful for you. I know every one is different in the way their body heals I just been reading a lot of negative things after back surgery. Some people need repeated surgeries, some don't really see the relief they were looking for and some are worse off months to years down the line. Thanks

[tiredofthiscrap]

I can only speak for myself when I say that back surgery should not be an option unless it becomes unbearable. I have had three back surgeries with negative results. For each surgery I was promised by the doctor that I would feel, "so much better". Horse-manure talk (at least in my case). Each surgery caused more pain and more complications. The last surgery that I had was a fusion with the placement of a titanium cage. What the doctor "forgot" to mention is that in a majority of cases, the cage and all of it's related parts, have to be removed a year later. In my case, workman's compensation fought the need for the removal of the metal parts. It took almost four years to resolve. Little did I know that during those four years, the cage and it's rigidity was causing problems above and below the surgery. Unfortunately, because of workman's compensation and the delay, I now have permanent damage resulting in me being bedridden on many days. You are only two years into this disaster called worker's compensation. You have a long way to go if your state has a "normal" workman's compensation board. The reason they want to settle is because they want to get rid of you before you cost them a chunk of money. I'd be surprised if they settle with you and keep any medical chambers open in the settlement. That is certainly not how they normally conclude with a settlement.
This is just my personal experience with back surgery and workman's compensation. There are many more stories in this forum similiar to mine.
As for your back surgery question itself, as I said earlier, I wouldn't have any surgery done unless you absolutely can't live with the pain anymore. I know some people that have had a successful first surgery. However, they're a minority. Before you do decide, do a lot of research (especially in this website forum). Oh, and as far as your question if the disk is a permanent injury, you'll have to look under your State's legal code. In my State, a back injury is not considered permanent and compensatory.