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  1. #1
    Join Date
    Jun 2012
    Posts
    2

    Default Insurance Company Challenges Medical Care After Settlement Preserving Future Medical

    My workers compensation claim was made in the State of: California

    My case was closed, at long last, with future medical in late 2011 to my tremendous relief.I knew that there might be struggles for treatment in the future. Imagine my surprise when I began to receive an onslaught of letters from a new insurance company demanding all of my medical records and a new QME along with all the details of the case. How could they put me through all of this again? I've been through the system for years on end and now it looks as if I am being called upon for a redo. How is this possible? Is it even legal? Isn't a judge likely to throw this out due to the prior settlement? I mean really...what next?
    Last edited by autumn leaf; 06-13-2012 at 08:40 PM.

  2. #2
    Join Date
    Oct 2006
    Posts
    9,073

    Default Re: Post Settlement Switcheroo

    if the new carrier was not a party to the claim it has no right to a QME.
    if it is a party to the claim, all the records are available from the other carrier or the comp court.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,938

    Default Re: Post Settlement Switcheroo

    There is no 'redo' here...you have a Stipulation w/Award and Order from the court. (the way you describe your settlement).
    There wouldn't be a reason for a PQME unless there is a disputed medical issue over your PTP request for treatment, and you dispute a UR denial.
    Can't go backwards on AOE/COE after an award & order. Not to mention the ER/IC ability to accept/deny a claim within the first 90 days.

    When you say a "new insurance company".... as SH said, if this carrier was not enjoined in the org claim, they have no legal interest at this point. Is your ER legally self insured, and this carrier is acting a TPA/Third Party Adm. ?

    Where is your attorney who handled the org claim ?

  4. #4
    Join Date
    Jun 2012
    Posts
    2

    Default Re: Post Settlement Switcheroo

    You people are terrific! Thank you for your responses.

    My attorney is ON it .

    To my knowledge there was not another IC enjoined in the claim and I would have known! Any disputed medical issues after settlement have been resolved (for the moment)

    I appreciate all your responses. I'll post w/the outcome or if I have other questions.
    Thanks

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