Workers' Compensation Discussion Forums

jayne Wrote:I settled closed medical but.......I have an insurance that will pick up and go on....I wanted them out of my life out of all medical decisions.....I did not expect a million dollar settlement but I did get more than what I would have settled for.
  you must know in advance what you need and that is your bottom amount...just to put you lad and lassies in propespective...after the lawyer takes his share it will be LESS than the 6 figure amount that so many expect....and I had 1 cervical to be fused and 3 lower back discs to be fused.
   WC contracts with so many docs and hospitals for a lower fee to cut you and maybe fix you.....to try and call a hospital and get a charge to get yourself fixed is unrealistic......IE:2 cervical fusion in a hospital may cost you 100 thousand but cost wc only 65 thousand so they will give you only 30 thousand for it.....not fair you say but it is realistic and its what they will do.....for the 2 surgeries I would have got thru them I was given 65 thousand dollars plus my back pay and disablity........back pay and disabilty the lawyer got his pound of flesh but without him I would have got nothing...THEY WILL NOT PAY YOU MILLIONS Cooks family after all they messed with him and left him wheelchair bound got around 600 thousand (I believe)and then in an annunity where they could only get so much a month.If you are gonna settle without your surgeries you better be willing to do without them.

Hey, Jayne.
How did your attorney go about figuring the total future costs of your Future Medicals (closed medicals)?  Did he use a Nurse Consultant who specializes in projecting all possible costs relating to your injuries (not just the surgeries you would have had)?

he figured in the two I needed and down time......their was nothing figured in for if they went bad.......or if I needed more....they wonnt let them do that Its a risk I took my opting out

jayne Wrote:he figured in the two I needed and down time......their was nothing figured in for if they went bad.......or if I needed more....they wonnt let them do that Its a risk I took my opting out

Jayne~
I'm just trying to grasp a general understanding for Cost Projections when closing out and lump summing the Future Medicals part of the award.  It must be different in your state, but in South Carolina I have the option of bringing onboard a Nurse Consultant that will prepare a Disability Cost Projection, which can be described as a mini-life care plan.  This calculation considers the current treatment, including physician visits, diagnostics typical for injury diagnoses, medications, and probable surgeries coming up.  Yearly costs are multiplied over the normal life expectancy.  The total cost can be quite surprising.  Even if the injured worker  is only on a couple of prescription medications, they add up significantly.  For an example in this, find http://www.drugstore.com and type in Celebrex, which is a common medication prescribed for orthopedic injuries.  Taken 3 times a day, the cost quickly adds up to almost $500 per month, which is $6000 yearly, and $180,000 over a 30 year life expectancy.

Now lets say for example (my lawyer's crude example): My total future medical adds up to $900,000.00  He would then negotiate and we would land somewhere in the ballpark of 2/3rds of that amount = $600,000.00, standfastly settling very close to that.

It's up to me if I want to use the Nurse Consultant, and the cost of her expertise will come out of my settlement, of course, but my lawyer is strongly advising that we use her to maximize, sunstantially, that part of the settlement--proclaiming this was his experience with former clients.

Wink..I use to do the cost analysis of our referred admissions prior to admission to our home. Of course the goal here was to decide if this patient was going to be cost effective or not. Was there an expected return or a cost to admit. It is rather easy to do when you have all the services working with you to complete the analysis.

You are on the right track with your example of Celebrex. That would be fine for a home who may only have the patient for a month or so, but in your case, there would be price changes in the medications and medication changes due to changes in your needs. Right now, Celebrex is a rather new drug so it is more expensive until the pharmacy pays for the research money it spent to find the drug. Then the original pharmacy looses it patton and a generic will be created by anther company and its price goes way down.

We could create a medical needs assessment...same as a care plan that the nurse consultant would do for you if you want too. I will not be as good as the nurse consultant but it would not cost you anything either. For us to be successful though we would have to go through all your medications, physician recommendations for now and what your prognosis is. Then we would have to net work with a pharmacy, rehab, miniminally. We would need to know the cost of you last surgery if there is any projected surgeries in the future. Then we would add an inflation cost to that amount and come up with a projected cost for another surgery. If no surgery, it is really easy. What about DME's. Are you using any braces, extenders or other medically neccessary equipment. Then we would want to add the ware and tear and replacement value for this. So saying all this..we would begin with the following on an analysis sheet.
1. Medications...cost to day..and projected cost base on historical trends.
2. Rehab....cost based on freguency allowing for inflation cost here also.
3. Hospital cost...what sort of side effects may you encounter that may lead you back to the hospital? If a surgery is possible in the future consider its cost as well.
4. DME Cost now and future replacement cost.
5. Out patient appointments for PCP, consultants etc.
6. Cost of travel to and from Outpatient visits, rehab, etc.

Does this give you some more ideas on how to do this. Let me know if you want my help. Best of luck in what ever you decide.

red1030 Wrote:So saying all this..we would begin with the following on an analysis sheet.  
1.  Medications...cost to day..and projected cost base on historical trends.
2.  Rehab....cost based on freguency allowing for inflation cost here also.
3.  Hospital cost...what sort of side effects may you encounter that may lead you back to the hospital?  If a surgery is possible in the future consider its cost as well.
4.  DME Cost now and future replacement cost.
5.  Out patient appointments for PCP, consultants etc.  
6.  Cost of travel to and from Outpatient visits, rehab, etc.

Does this give you some more ideas on how to do this.  Let me know if you want my help.  Best of luck in what ever you decide.

Thanks, anyway, Red.  I had already given the go-ahead to my lawyer before reading your post--and just last evening the Nurse Consultant telephoned me with my medical file before her.  She's doing all of the above you that you described...and more, to my surprise!  For instance, she's even figuring in the laxitives I'm taking to counter the constipation the opioids cause.  Even the OTC Prilosec I use for stomach problems caused by the prescriptions and over-the-counter stuff, etc, etc.  Regarding the laxitives, though, I asked her how did she know that I was taking them, that no one knew except me and my wife.  She laughed and said it was common knowlwedge within her circles.  LOL!!

Hi Wink, she sounds like a very good consultant. When I said the medications that did not mean just the prescription medication, it would mean the OTC's also. Best of luck.

good luck my friend

Good luck Wink I hope everything turns out for you the way you want it to.