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  1. #1
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    Aug 2012
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    Default Legal Fees for Denied Medical Requests After Settlement

    My workers compensation claim was made in the State of: disgust.

    Generally, if settling a case with medical included, how does the IW pay off legal counsel if WC denies medical requests? Who can afford medical treatment, monthly meds, living expenses AND nagging legal fees? If you win the medical refusal case, are we still stuck with paying court/legal costs EVERY time? What’s to stop IC's from refusing every time, to further beggar us by having to bear the brunt of actually settling even with medical included?? Are there court stop-gaps to keep this from continually happening?

    Are there any financial rewards for the lawyers involved so this doeesn't happen? I really wonder how many people are aware of this potentially catastrauphic problem. If there are no financial carrots for legal representation except our out of pocket expense, can these expenses be counted as officially deducted from the settlement or not? And when that's all gone, what next? IW poor farms?

    If we have to bear the costs without it being able to be deducted from the settlement amount, it truly shows what an absolute bloody sham this entire WC machine is, all to keep these parasites employed at the UN-employed IW's expense, no puns intended. How ironic that one is. No matter which way you turn everything seems to be so stacked against us! Ever consider how many people are employed because of YOUR injury?? Do you feel like some kind of planet with multiple satellites revolving around you?: doctors, lawyers, IC's, medical test companies, psych, court systems--as they become more financially healthy while feeding themselves off OUR INJURIES, yet watching us become weaker and powerless. If we ever banded together and organized they'd all be shaking in their boots. There ought to be a union for IW's! "Personal Injury United", instead of "WC Food Mill".

    How insane. To keep yourself in permanent employment, go work for WC. Just don't ever dare get hurt at work.
    Last edited by Grrrrrr; 09-25-2012 at 06:57 AM.

  2. #2
    Join Date
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    The 50 United States does not include "disgust"
    So...if you'd provide your state, as WC is state specific, possibly more info could be provided. Some states have legislated atty fee structures, others, IE Calif, have not (until 2013 with the new changes, specifically regarding future medical award enforcement)

    You have overlapping questions here... settlement, and award for future medical care.
    You are not entitled to cash in a settlement for medical reimbursement. Only benefits/medical treatment access.
    That is applicable to all states.

    If you require ongoing medical care...you should not contemplate cashing out the medical in your claim.
    Generally, if settling a case with medical included, how does the IW pay off legal counsel if WC denies medical requests?
    Depends on the STATE, most do not allow an IW paying cash out of pocket for atty fees.
    There ought to be a union for IW's! "Personal Injury United",
    Industrial/occupational injury are not "personal injury cases", unless there is a 3rd party involved.
    Sometimes I feel like some kind of planet with multiple satellites revolving around me: doctors, lawyers, IC's, medical test companies, psych, court systems--as they become more financially healthy while feeding themselves off MY injury, yet watching me become weaker and powerless.
    Other than volunteerism, what can you think of in todays world that is not based on a financial outcome...?
    Even when you worked, you did it for a wage/cash payment, certainly not out of the goodness of your heart...

  3. #3
    Join Date
    Aug 2012
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    26

    Default Re: Legal Fees of Denied Medical Requests After Settlement

    Well, from here the view holds nothing but a state of disgust is all I will say.

    There was no mention of getting "cash" through making WC uphold their end of the bargain by being forced to go to court in order to pry needed medical care out of their greedy, sticky hands. Was there? Whatever you are implying by your including that factoid is up to you. (I've noticed your posts tend to include obtuse info that at times only serves to confuse or subliminally affront by implication. Please try not to do that in the future? Left field doesn't help. In all fairness, you may be merely trying to helpfully touch all bases, or just reminding your own self of certain facts, but doing such things gets tedious to slog through. We're all on pain meds here, and just searching for honest answers sans snide comments or veiled judgmental attitudes. Try not to make the situation worse, friend. So at the same time, in doing so myself here, lets genially agree to both stop digressing.)

    There was no mention of "cashing out" any medical claim either.

    Yes, I did know that you cannot personally pay your atty BEFORE settlement. Most people do. But that also has nothing whasoever to do with my question. What most people don't know is, that "free" representation you had before you settled and payed off through part of that settlement? It disappears once you DO settle. Paying the lawyer is now your responsibility without any settlement to look forward to when it comes to disputed medical, no matter how many times WC digs in their heels. Surprise.

    What I asked is, do "most" states allow IW's to USE THEIR CASH SETTLEMENT to count toward their "care" by paying a lawyer to go to court to wrestle required authorization for medical care from WC? Or should I say does "Medicare" allow it? For instance:

    Settlement is $120,000, with lifetime medical.
    IW's doctor requests needed MRI 10 months post-settlement.
    WC refuses to pay for MRI.
    IW is forced to take WC to court for ruling. Possesses no money to pay post-settlement lawyer with other than through dipping into settlement cash.
    IW's lawyer wins MRI authorization. IW pays successful lawyer his $2000 fee from settlement amount (only).
    IW's settlement amount is now $2000 poorer. (Previously "free through WC" MRI via "lifetime medical" now costs IW in essence $2000.)
    IW battles WC in court to authorize various medical needs for next 5 years, paying lawyer from dwindling settlement monies.
    IW reaches retirement age and applies for SS.
    Medicare wants to know what happened to settlement money for the care of IW's medical condition?
    IW explains endless uphill battles with WC and having to pay lawyer from now exhausted settlement amount.
    Medicare replies..... Specifically, what?


    NON question-specific replies:
    If the whole self-serving WC industry was eliminiated, and IW's were allowed to sue employers who refuse to recognize their employees as valuable assets, and take responsibility for their employees injuries, it would once again be considered "personal injury". It would also cut out the enforced middlemen--WC insurance companies--who are the only ones who benefit from this whole farce called WC. I've found fear of the unknown generally makes people more careful in life, rather than a cold and heartless pre-determined formula slanted toward another's profit. But hey, everybody BUT the IW needs a job, right? Bottom line is hordes of support staff means.... jobs. We are on the bottom, being squeezed--by holding everyone else up.

    "Other than volunteerism, what can you think of in todays world that is not based on a financial outcome...?"

    Honor.

    "Even when you worked, you did it for a wage/cash payment, certainly not out of the goodness of your heart..."

    True, but it was from the goodness of my heart in agreeing to help my employer in a crisis that I was injured. They acknowledged this, and even thanked me for my dedication. Well, no good deed goes unpunished. Right? Those accolades quickly became empty words in now having to live a lifetime in pain and with endless fights over medical care, no job prospects in my condition, and being forced to sell off prized possessions to exist while waiting for their pitifully inadequate handout that is rapidly dwindling into something that fits inside a change purse, however. Should I now be "properly grateful"? Don't know about anyone else, but I will never refer to a WC settlement as being "won". Exactly what is "won" here? When WC takes the humane out of human, what exactly do they believe that leaves them with?

    So much for honor.

  4. #4
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    What I asked is, do "most" states allow IW's to USE THEIR CASH SETTLEMENT to count toward their "care" by paying a lawyer to go to court to wrestle required authorization for medical care from WC? Or should I say does "Medicare" allow it?
    NO ONE cares what you do with cash to take to close a claim. It's your money.

    And, apparently you don't understand the view Medicare takes here...
    IW reaches retirement age and applies for SS.
    Medicare wants to know what happened to settlement money for the care of IW's medical condition?
    IW explains endless uphill battles with WC and having to pay lawyer from now exhausted settlement amount.
    Medicare replies..... Specifically, what?
    Medicare doesn't care what you do with settlement money, IF you take a cash payment for PPD indemnity, with open medical... why should Medicare give a damn? The WC carrier is still liable for medical care. Not you, not Medicare.
    Settlement is $120,000, with lifetime medical.
    IW's doctor requests needed MRI 10 months post-settlement.
    WC refuses to pay for MRI.
    IW is forced to take WC to court for ruling. Possesses no money to pay post-settlement lawyer with other than through dipping into settlement cash.
    IW's lawyer wins MRI authorization. IW pays successful lawyer his $2000 fee from settlement amount (only).
    IW's settlement amount is now $2000 poorer. (Previously "free through WC" MRI via "lifetime medical" now costs IW in essence $2000.)
    IW battles WC in court to authorize various medical needs for next 5 years, paying lawyer from dwindling settlement monies.
    No one forces a IW to litigate a denial. Nearly all states provide for a dispute resolution process w/o or prior to actually taking the claim before a judge.
    Yes, I did know that you cannot personally pay your atty BEFORE settlement. Most people do. But that also has nothing whasoever to do with my question. What most people don't know is, that "free" representation you had before you settled and payed off through part of that settlement? It disappears once you DO settle. Paying the lawyer is now your responsibility without any settlement to look forward to when it comes to disputed medical, no matter how many times WC digs in their heels. Surprise.
    No... most people do not pay up front for atty fees. Don't know where you get that one.
    If you do opt to litigate a dispute over medical... there may be atty fees awarded by a WC court... what other "settlement" should you be awarded...? you get the medical care.
    Well, from here the view holds nothing but a state of disgust is all I will say.
    Well... I'll say it again... WC is STATE specific... what your state allows as AA fees is not going to be the same as the state next door.
    Other than volunteerism, what can you think of in todays world that is not based on a financial outcome...?"

    Honor.
    Get over it...Honor doesn't put a roof over your head, or food in your belly.
    "Even when you worked, you did it for a wage/cash payment, certainly not out of the goodness of your heart..."

    True, but it was from the goodness of my heart in agreeing to help my employer in a crisis that I was injured. They acknowledged this, and even thanked me for my dedication. Well, no good deed goes unpunished. Right?
    Every job whether in writing or understood is a contract between the EE and ER... ER provides the job, and agreed upon wage. EE agrees to perform those job duties, and "others as required", for the benefit of the ER. That's it. After your shift, go home... collect your wages on payday.
    Exactly what is "won" here? When WC takes the humane out of human, what exactly do they believe that leaves them with?
    There is no "win/lose" in WC... you are entitled to the benefits due, under the law. Nothing more, or less. There isn't anything "human" about the law.

  5. #5
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    Oct 1971
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    5,183

    Default Re: Legal Fees of Denied Medical Requests After Settlement

    Back on topic.
    The point you make is exactly what I've been complaining about for years.
    What good is lifetime medical if you have to fight for every procedure?
    Who pays the legal fees?

    This is why it's better to close the medical at settlement, lifetime medical is an illusion.
    You're better off setting up an MSA and be done with it.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  6. #6
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    It seems like paying for your MRI would be less expensive. Then you could send the receipt to IC for reimbursement.

  7. #7
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    "Life time medical" only means you have access to medical treatment, not entitlement. You are subject to all the same rules re PTP request, prior authorization, and UR process. As well as litigation to resolve a dispute. All of that subject to the state specific rules.

  8. #8
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    Aug 2012
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    MSA? Medical set aside?

    When settling w/o lifetime medical there IS no sending receipts for "reimbursement" to WC any longer. But there is no more WC or lawyers to deal with either. Those are something!

    I'm with Tony. What's the point in having lifetime medical when you have to fight tooth and nail for everything you supposedly were "awarded"? It only serves to further impoverish you while making yours and their lawyers richer, and IC workers earning what they consider honest pay. Lawyers have the pre-settlement payout to look forward to. When it's an MRI at stake, there will be NO monetary settlement to fund that lawyer. Just an MRI--or not, and a hefty legal bill, regardless. How many IW's realize THEY have to pay their lawyer for every round of authorization fights, whether you win the judgment or not? Not many. I didn't. And WC will see to it that there are many rounds to come, believe it. If they can't have what they consider their money, they will see to it you won't be able to keep it either. Not too far down the road insurance industry lobbyists are going to see to it that "lifetime medical awards" will become the open laughingstock practice that it is--behind those posh closed doors.

    Take the cash. Being rid of WC is worth any price. If there was a way to be rid of them AND refused their blood money, I would have done so.

    I'd still like someone knowledgeble to explain or point me in the direction of what happens with SS retirement Medicare when you DON'T accept lifetime medical. Call me a glutton for punishment.

    And BvIA? Again, NOBODY remotely mentioned anything about "entitlements" anywhere on here. Left field isn't helping. Is there any way for you to not be so harsh with us poor folks intead of instantly jumping down our throats? Ease up, will ya? Have a cold one, go blow bubbles outside then sit in that beautiful sunshine and laugh at nothing in particular. Does wonders. When you consider humans as being just that, doing so can change your tune as well as theirs.

    BTW, "won" was how the lawyer phrased the settlement. Decking your lawyer is not allowed in my state of disgust. Drat.
    Last edited by Grrrrrr; 09-26-2012 at 07:54 AM.

  9. #9
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    I'd still like someone knowledgeble to explain or point me in the direction of what happens with SS retirement Medicare when you DON'T accept lifetime medical. Call me a glutton for punishment.
    When you are Medicare eligible, and you cash out the medical in a claim, you must take Medicare interests into account, that may require a MSA...yes, Medicare Setaside Arrangement. You use that money to pay for treatment for your injury, when it's gone, including reasonable interest, Medicare will pay for treatment, you pay copays/deductibles just like regular Medicare.
    There are 100's of posts here regarding MSA's... I wont go into dupllicating that info here.
    What's the point in having lifetime medical when you have to fight tooth and nail for everything you supposedly were "awarded"?
    As I said...
    "Life time medical" only means you have access to medical treatment, not entitlement. You are subject to all the same rules re PTP request, prior authorization, and UR process. As well as litigation to resolve a dispute. All of that subject to the state specific rules.
    Future medical award is not "health insurance"... the ER/IC is still responsible for treatment, and still has the right to dispute.

    If you want to continue to rant... how about using that forum... this is for legal issues.

  10. #10
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    Default Re: Legal Fees of Denied Medical Requests After Settlement

    I'm unclear, do you or don't you have lifetime medical? The resolution process BvIA mentions would be the least expensive way to go before litigation. Everyone's circumstances are unique, however a serious complication or debilitating condition, caused by an original injury that will require treatment necessitates going through the process.

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