Tennessee Worker's Compensation - Help For Injured Tennessee Workers

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

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

Results 1 to 7 of 7
  1. #1
    Join Date
    Jun 2012
    Posts
    2

    Default Proposed Medical Buyout

    First let me say I do not have an attorney. I am 42 yr olds and had a seriouS back injury at work in June 2008. In July 2009 I received a MMI settlement. Then in 2010 I reinsured my back at work and found out I would not receive benefits for missed work. I am now no longer able to work and have filed for disability. I have been denied twice and I am waiting for my hearing.

    Now my IC is talking about a medical buyout where they will no longer be responsible for my medical treatment. I am suppose to receive a offer amount soon but I don't know what to do. My doctor and I have been trying to get WC to approve a second surgery for over a year and they keep denying it. They sent me for a IME and they say that doctor said I didn't need another surgery. My medical care over the last 3 yrs has averaged $7200/yr and they say my life expectancy is 35.4 yrs.

    I have a wife and 4 kids to consider and I am in constant pain. What is my magic number that I should take? Is the buyout money I will get to pay for my medical care or will it be put n a trust? What do I do if it's not enough can I negotiate or is it too late to get a lawyer? Should I get the department of labor involved can they help me get a fair settlement? Can I negotiate that the IC first pay for surgery then do a buyout? I feel like I am going to get snowed by a large amount waived in my face then I'll realize it won't be enough and me and my family will suffer tremendously.

  2. #2
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    350

    Default Re: Proposed Medical Buyout

    No one can force you to take a settlement and it is not too late to talk to wc atty, which is free, and you should. At the very least you should speak with the wc state ombudsman listed in the phone or google for your state. You will never be offered enough to cover medical.

  3. #3
    Join Date
    Jun 2012
    Posts
    2

    Default Re: Proposed Medical Buyout

    [QUOTE=Leslie;174889]No one can force you to take a settlement and it is not too late to talk to wc atty, which is free, and you should. At the very least you should speak with the wc state ombudsman listed in the phone or google for your state. You will never be offered enough to cover

    Thank you for your feedback. I have another question. My wife has insurance and they have no preexisting condition clause so since WC has been denying this surgery they say they will pay it. Is this should I should do? Will it effect an offer that WC might make to me. I just feel I am compromising my health fighting with WC.

    - - - Updated - - -

    Also if I take the settlement and get medical bought out will my wife's insurance still pay since they have no pre existing condition clause?

  4. #4
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: Proposed Medical Buyout

    Quote Quoting Shavone25 View Post
    First let me say I do not have an attorney. I am 42 yr olds and had a seriouS back injury at work in June 2008. In July 2009 I received a MMI settlement. Then in 2010 I reinsured my back at work and found out I would not receive benefits for missed work. I am now no longer able to work and have filed for disability. I have been denied twice and I am waiting for my hearing.

    Now my IC is talking about a medical buyout where they will no longer be responsible for my medical treatment. I am suppose to receive a offer amount soon but I don't know what to do. My doctor and I have been trying to get WC to approve a second surgery for over a year and they keep denying it. They sent me for a IME and they say that doctor said I didn't need another surgery. My medical care over the last 3 yrs has averaged $7200/yr and they say my life expectancy is 35.4 yrs.

    I have a wife and 4 kids to consider and I am in constant pain. What is my magic number that I should take? Is the buyout money I will get to pay for my medical care or will it be put n a trust? What do I do if it's not enough can I negotiate or is it too late to get a lawyer? Should I get the department of labor involved can they help me get a fair settlement? Can I negotiate that the IC first pay for surgery then do a buyout? I feel like I am going to get snowed by a large amount waived in my face then I'll realize it won't be enough and me and my family will suffer tremendously.
    the number you will take and number they will offer are two different things.
    your number will be based on what you lost and what you think you will loose.
    their number will be based on what they think they will owe in benefits if the case does not settle.
    obviously two different starting points

    you want benefits and not a settlement. make sure that is also what your atty wants for you.

    yes, take the care that is available- let the two carriers fight out the liability while you recover.
    whether it will change the settlement amount it depends on if the health carrier has or will file a lien. if so, it will have to be delt with in the settlement.

    if you think you can wait and win treatment thru the comp court, then don't settle. if you think the amount is similar to what they would pay if the case doesn't settle, then take it.

  5. #5
    Join Date
    Apr 2012
    Location
    Oregon
    Posts
    350

    Default Re: Proposed Medical Buyout

    SH is right about taking the care that is available and it will be better care with better prescriptions and therapy. Your wife's carrier will probably contact you about adjudicating the claim, that means they get the money back from wc carrier when you, or if you, win your hearings. That is what I am going through now.
    Also you refer to the carrier as your IC but as our expert BvIA is constantly reminding us they are the ER's IC and that makes a difference to how we are treated. Adversarial process is what complwyr (Bob) calls it.
    Last edited by Leslie; 06-17-2012 at 12:11 AM.

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

    Default Re: Proposed Medical Buyout

    Because you have applied for SSDI and even though waiting for a hearing...you have triggered the potential need for a MSA...setaside trust account.

    Your wife GHP/Group Health Plan may have a pre exisiting clause... but this isn't about pre existing, it's about your ER liability. GHP expressly exempts work related injury/illness.
    If anyone tells you they will cover... GET IT IN WRITING or it does not exist.

  7. #7
    Join Date
    Jun 2011
    Posts
    208

    Default Re: Proposed Medical Buyout

    Do what ever you can to get better by all means. Let the insurance companies duke out. I was lucky and had the same option otherwise I probably would be just getting back to work now. Instead I was back to work last September. Had I know this earlier would have been back at work even sooner. If I had known that I would have been out only a couple months for surgery vs 7 months for PT that the doctor and PT said would not work in my case would not work, but play the WC game. Would have jumped on the surgery and gotten back to work and not gotten behind on bills. Would have been over and done with before IME got to look at me and would not have screwed up my neck that they ended up not covering. Good thing for a good chiropractor that works for jelly and bread

Similar Threads

  1. How Long Does It Take to Receive Future Medical Buyout Payment
    By yaris in forum Insurance Company Practices
    Replies: 3
    Last Post: 11-19-2011, 11:54 AM
  2. Medical Buyout
    By gotcha in forum Tennessee
    Replies: 4
    Last Post: 06-02-2011, 03:49 PM
  3. What is a Proposed Order
    By oldlady in forum Georgia
    Replies: 2
    Last Post: 06-08-2010, 10:31 AM
  4. Can You Be Forced to Take a Buyout for Medical
    By asantullo in forum Kentucky
    Replies: 0
    Last Post: 01-17-2010, 01:11 PM
  5. Buyout of Future Medical Care
    By sunshine1 in forum California
    Replies: 12
    Last Post: 12-10-2008, 03:32 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