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  1. #1
    Join Date
    Apr 2012

    Default How Does a Settlement Effect My Future Health Insurance Payments

    If i accept a workers comp settlement, how does this effect any other payments from my health insurance or medicare...(for my back or neck) if i need treatment in the future?

  2. #2
    Join Date
    Feb 2007

    Default Re: How Does a Settlement Effect My Future Health Insurance Payments

    When you take a cash settlement for future medical, you are also agreeing to assume liability for treatment to your injury, out of your pocket.
    Your GHP/Group Health Plan carrier, in the EOC/Evidence Of Coverage pages expressly exempts coverage for work injury.
    Medicare doesn't cover work injury....and your settlement is now submitted to CMS/Medicare, tracked, and you'll have to prove you have exhausted any future medical cash you received in a C&R, if the allocations are not done properly....even though you are not Medicare eligible now, CMS can/will declare the entire amount of the settlement as medical...and you'll have to prove you spent it all, including reasonable interest before Medicare will begin to pay benefits.

  3. #3
    Join Date
    Feb 2007
    Charlotte, NC

    Default Re: How Does a Settlement Effect My Future Health Insurance Payments

    After a comp case is settled with closed medicals, health insurance will usually pay without an argument for new medicals, because there is no longer a work comp obligation to pay. But run all this by your own lawyer.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
    Join Date
    Mar 2007

    Default Re: How Does a Settlement Effect My Future Health Insurance Payments

    I was recently diagnosed as pre-diabetic. I DO have Medicare A, B, & D. My PCP wants me to do daily checks on my blood sugar and wrote me an Rx for a Blood Sugar Monitor/strips. When I took it to the pharmacy to have it filled, (Using my Medicare as this has absolutely NOTHING to do with my injury nor Indemnity Settled WC claim), the pharmacy tech told me that Medicare has a block on paying for anything for me until it IS first established that it is NOT in relation to my work injury. Be VERY cautious when deciding to attempt to use Medicare, or any other form of insurance for anything to do with a WC claim. Make darn good and sure IF you settle that ALL FM/Future Medical is provided for by the WC IC. Otherwise Medicare just might attempt to say any number of things don't pass the smell test. Can't speak to GHP as I do NOT have that kind of coverage any more. Good Luck to You.
    "He who is his own lawyer has a fool for a client"
    Abraham Lincoln

    Take Care and Be Well.

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