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  1. #1
    Join Date
    Jun 2011
    Posts
    4

    Default Future Medical

    I have finally reached MMI, the doctor has rated my injuries (to arms and hands) with a 21 % whole body impairment rating, permanent and stationary. He is also recommending additional surgeries in the future. Due to the injuries, he does not want to perform the additional surgeries now. I have already had four surgeries on both arms. The insurance company wants to settle and I am wondering how future medical, i.e. surgeries, medications, physical therapy will be covered. I am not receiving Medicaid or SSDI at this time. Since the additional surgeries may not happen for another 6 months to a year, is money set a side or is it paid to me in the impairment settlement and it is up to me to cover the cost? Thanks for any information
    Last edited by Idinjured; 06-11-2011 at 07:11 AM. Reason: misspelling

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Future Medical

    Future medical care reimbursement is not an 'entitlement' in settlement of a comp claim... ppd indemnity is.
    FMC is a negotiated item, and carriers are not apt to pay for treatment/surgeries you may or may not seek post settlement.
    Nor would you receive the full value of "usual and customary" fees for any surgery... not a good option for you.

    C&R to a claim where the IW is likely to require siginificant treatment in the future is not in the best interests of the IW.

    You don't have to accept a cash settlement... you can stipulate to the body parts accepted/covered, take the ppd indemnity in weekly payments, and leave access to medical open. There is no money "set aside" for you to use for medical care.

    WC is all about paying benefits...medical care, wage replacement and ppd indemnity. Cash settlement is always in the best interests of hte ER/IC...not the IW.

  3. #3
    Join Date
    Jun 2011
    Posts
    4

    Default Re: Future Medical

    Thank you for the information. This has been going on for three years now and it is really getting on my nerves. I have no income, I have been released for modified work but no longer have a job but have been told by 6 doctors I can no longer do what I was doing as a living. I know there is talk of work rehab, but while everyone drags this out with possible future surgeries, additional rehab for the injuries, etc. I am going to loose my house and end up living on the street. One bad day at work ends up costing me everything...I know there is no pain and suffering payment but there should be. I have to decide if I want the additional surgeries since there is a chance it could make the condition worse.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Future Medical

    If you have returned to work, even in a light duty or modified job... and the ER cannot make the accommodation, or you can't perform the job functions...and, you have not been released at MMI, you should return to a TTD status.

    If you are MMI, and your ER cannot provide a job for you ...you should be eligible for UI benefits. Have you applied for UI ?
    What is your attorney advising you on these issues...?

  5. #5
    Join Date
    Jun 2011
    Posts
    4

    Default Re: Future Medical

    I guess I should provide some additional backround. The original attending doctor that performed the surgeries waited 6 months after the last surgery and then reported I had reached MMI, and that he felt that I could no longer perform the work I was orignally doing at the time of the injury, he further stated he "wasn't sure" how to rate the injury(s) and gave me a impairment rating of 0, that was five months ago and all TTD payments stopped at that time. Since the injuries continued to worsen my attorney recommended a specialist that specialized in injuries that I endured. It was this specialist, after several test and a lengthly examination determined that the original surgeries did not resolve the problem and handed down the Whole Body Impairment rating of 21% with the recommendation for future surgeries. I have not returned to work for two simple reasons, one, the restrictions set at MMI and the ongoing problems restrict me from doing the type of work I was doing and I was "laid off" shortly after being injured three years ago. I am now getting unemployment but it is not enough to handle the bills and it will only last another 6 weeks. My attorney keeps saying "just hang on"

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Future Medical

    If the ER/IC accepted the 21% PPD, you should be receiving those indemnity benefits.
    And, accesst further medical care.
    As I said... in a settlement, medical reimbursement for those services you may need down the line is not an automatic payment based on full value of the medical. At the very least, you would receive an amount discounted to "todays value''. And not the full calculation of what you may or maynot seek post settlement.

    I understand what you are thinking, and what your doctors are advising you... but just because a panel of Dr anticipates future medical needs doesn't mean they will pay for it in a cash buyout.

    WC is about paying benefits...not cash settlements.

    As your Dr has said you won't be able to return to your pre injury job functions...you should be eligible for VR services if provided in your state.

  7. #7
    Join Date
    Jun 2011
    Posts
    4

    Default Re: Future Medical

    Thank you for all the information you have provided, it has been helpful. My attorney has been great, but sometimes he explains things in a manner a laymen cannot comprehend. There are times I really feel like smacking him (if I could get my arms to work right) when he says just hang on, he isn't the one trying to figure out where the next meal is coming from or where he is going to live if he looses his house.

    Idaho does provide for VR not to exceed 52 weeks. I am just not 100 percent sure what they can retrain me to do and still make the money I was making prior to getting hurt. I understand WC is about paying benefits and not settlements, it just gets really frustrating and scary when one day you are fine and have a great job and income and the next you are left with nothing.

    Again, thank you for your help. As a side note, we have not heard from the IC as to if they will accept the 21% PPD or not. My attorney said he thinks they won't and he said he actually hopes they won't cause he wants to take them to court. He said he will try everything he can to avoid court but he said I need to be prepard for that aspect.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Future Medical

    Well... your attorney remains the best source of infor on how your claim is proceeding... we don't have access to the file, or know what may be involved in resolving your disputed issues... it may well be necessary to take the carrier to court to enforce any benefits you may be due...

    As to VR... that will help identify any transferrable job skills you posses, an attempt to retrain to some capacity of gainful employment, not necessarily to your pre injury wage standard. There may be some wage differential benefits paid...that will depend on your ID WC Act and how those benefits are defined.

    When you can't grasp what your atty is saying... just restate the question, that's what the atty is for...to explain what the issues are in your claim, represent you in resolution of any disputes, and help guide you through the settlement process if that is how the claim is to be resolved.

    Good luck to you...

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