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  1. #1
    Join Date
    Sep 2007

    Default Getting Health Insurance After Settlement

    I was injured (shoulder) on the job and the State of Oregon and SAIF have accepted my claim. I have done all the required therapy and gone to all the doctor appointments asked of me. The doctors have said that my shoulder is as good as it gets but it will never be 100% again. They have released me back to work with limitations. I have found other employment that better fits my abilities at this time. So no more disability checks will be issued.

    It looks like we are going to settle the claim somewhere between 20-25K.
    So now to my question. Am I going to have a hard time finding health insurance after I retire? This will be about ten years from now. I hear it is hard to get and can be very expensive if I could find any. Mostly because I will have a disability claim/judgment on my record.

    Tell me what you know,

    Thanks in advance,


  2. #2
    Join Date
    Oct 2006

    Default Re: Insurance after settlement

    Contacting a health insurer would provide more accurate information then getting it second hand from a stranger.

  3. #3
    Join Date
    May 2007

    Default Re: Insurance after settlement

    DMC: Roof's wife here----10 years down the road is a way off. Dependent upon the time of service with your employer it is possible that if you are vested then upon retirement your employer's health insurance would follow you.

    If you have private insurance now, keep it if at all possible...the reason I say this is an uninsured individual seeking health insurance is subject to underwriting and does not qualify for HIPPA protection.

    Any health insurance policy will take into account your work comp injury and their may be exclusions placed upon your work obtained health insurance when it is a new application. HIPPA affords you coverage no matter the circumstances and limits the time exclusions that an insurer can place upon you. Once you have settled your wc claim, and received monetary compensation your settlement should spell out what portion of the settlement is for medical, once those $ are exhausted then your private health insurance would be the primary source for benefits and you will be subject to that policies procedures, rules and regulations.

    Under HIPPA a health insurer cannot deny you coverage if you have had continous coverage for the last 18 months, and they will require proof in the form of a Certification of Coverage.

    If you currently have NO Health insurance and are looking to purchase as an individual, your premiums may be much higher, limited coverage or out right denials due to pre-existing medical conditions as you are viewed as an unacceptable risk. Your last resort would be HIGH RISK Medical Insurance, if offered by your State. In Calif. those who are turned down can apply however the premiums are outrageous and provide limited coverage ----they do however give you a rating of sort in that if you have the coverage and have no claims then your chances of moving to reqular insurance are improved.

    It is best to speak with your insurance agent about the types of health coverage available to you with your particular set of circumstances.

    Best of luck........

  4. #4
    Join Date
    Mar 2007

    Default Re: Insurance after settlement

    DMC, in addition to what Roof's wife gave you consider keeping your medical open with the WC claim. That way any future problems with the shoulder can be addressed by the WC IC that should have the responsibility.

    For the most part health insurance companies don't tend to hold that kind of pre-existing condition against you when issuing a policy any way. Pre-existing would be more along the lines of having diabetes or heart disease. A shoulder injury would be similar to a broken bone when pre-existing conditions come into play with medical insurance. It is an injury and once you are medically stable and released it really should have little to no bearing on getting health insurance in the future. Unlike say a back injury where more often than not they flare and cause further medical problems down the road most shoulder injuries don't.

    Certainly employer sponsored group health insurance polices don't usually preclude a body part that was previously injured and healed and HMO's CAN'T exclude pre-existing conditions even if they are not totally healed.. Also when you retire you should have entitlement to Medicare. 10 years after the fact they are not likely to exclude any treatment for a shoulder injury that has healed or been repaired. This would certainly be true if you did not require on going and regular care for your shoulder. If you do make sure your settlement is stipulated for future medical care then your concerns are a non-issue.

    Take Care and Be Well.

    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln

    Take Care and Be Well.

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