20 Year Anniversary Coming Up

[BvIA]

The only part Hartman language has here is the way the lump sum settlement on indemnity portion of your payment is provided. That just lets SSA know the indemnity is based on a weekly benefit payment as though you did not receive the lump sum.

But, I'm getting concerned here as you ARE a Medicare receipient and I haven't heard any discussion of a WC setaside arrangement. That is a requirement and should be addressed BEFORE any settlement that closes the medical in your claim.

However, even though you are going to trial, that is probably just the out of pocket medical you have received. Medicare is going to be reimbursed, and the judge cannot close the medical -any way.

[twomoons]

bvia,
my AA is working on the WCmsa set aside. she told me that last week.but she is trying to get a setllement with the IC i guess.i get confused as you do bvia, as my aa switches gears and mindsets when i send in 3 years of documented prescriptions, nerve block injections, and my pcp explainin several times, that i will need future medical treatment because of failed surgery's. that his statement on his letterheads
i really am happy that i have learned what to watch for,and listen for on this forum. so i at least know that my case is tracking an end,or trial, with the proper procedures.
My aa said the medicare set aside is put in a fund. if i dont use any of the money for a medical procedure ,the money goes to my estate. is that correct??

[BvIA]

My aa said the medicare set aside is put in a fund. if i dont use any of the money for a medical procedure ,the money goes to my estate. is that correct??

Yes... sometimes.

Your atty should/would not be doing the WCMSA on her own.. a MSA vendor does that... you have to sign a release of information of your SSA and CMD/Medicare records too. Your claim is TOO complicated for the atty to do a MSA... you first should handle the out of pocket medical costs for the last 3 years...including the MEdicare payments....
I don't remember who your IC is... (send me that in a PM please)

[twomoons]

For what it's worth,happy thanksgiving friends. I know it's hard being disabled,and with this tough economy to try and find any blessings.
But all of us do have some blessings somewhere.try and find them,if only for a day.
I will always be anyones friend,in prayers and advice.
Be safe dear friends

[InjuredGypsy]

Thank you twomoons

[twomoons]

bvia,
i got a phone call this morning.my aa is going to retire.
she is still going to keep my case though.can you believe that.she has sent all her current cases to to other lawyers,but is keeping mine.
bvia,at what point does the ama,or the the third party person who makes the IC and AA sit down and try and get a resolution.
what can i do to move this forward to an end.
my attorney has said thre is no money in it for me.
this nightmare just keeps going and going.
what can i do to end this.
i am ready to walk away with nothing ,just to have this nightmare end after 20 years.
i am ready to tell the IC ,you guys won,good job,now i want to try and live the rest of my life without a ic involvd
thanks for any advice

[BvIA]

my attorney has said thre is no money in it for me.

That's because the PD has been paid out.

There is nothing you can do to force a C&R to the medical in your claim. The IC is free to leave that open, and control the cost of treatment through use of MTUS/ACOEM treatment guides...and UR process.

Your AA didn't pass this on because the fees have been paid and another AA wouldn't be interested. The only thing left to settle out is the medical. And the IC isn't going to add money for that.

IF there is talk of closure to your medical/FMC... you need the WCMSA and the allocation in there for services Medicare does not normally pay for.

IMHO... keep getting the treatment you need for your injury as you are, and move on. IF...and that is a big IF, if you were to close the medical... you would be paying out of pocket for treatment, that's what the MSA money is for.

[1bigouch]

I truly understand your frustration. I am coming up on my 10th year of fighting for my medical procedures. I have been fortunate to have the same AA, but I have been P&Sed 3 times, then reversed, 5 hip surgeries, 2 back surgeries, and currently facing another hip surgery. Have had 5 claims adjusters, and its just keeps getting harder and harder to get treatment. I wish they would just say no, so I could use my private Ins. Keep your chin up, maybe one day Arnold will go away, and rules will change, AGAIN

[BvIA]

I wish they would just say no, so I could use my private Ins

Just because the IC for WC says no to a PTP request for surgery does not mean you can use your own coverage.

As 'you' are not liable for the treatment to your industrial injury, your IC won't pay because the IC is 'you' when it comes to paying the bills for treatment.
Any treatment directly related to an industrial injury will likely be denied by a private pay carrier. Otherwise, you could use that coverage from the beginning. Just like WC it's all about liability.

[twomoons]

bvia,
as youi know getting covreage in this i live in is impossible.
they have told me to go back to ca. for treatment.so bvia,
i called and talked to my IC adj yesterday. i do have a very good working relationship with him.
he said my AA has not answwered any requests form the IC in months.thats she is absolutely not interested in anything except retiring.
BVIA,is it possible, this case could go on forever.??
how can that be .??
i though their was a person who stepped in when thier were dueling wme's and wrote a settlement option or plan or agrement for a judge to follow
thanks bvia