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Settlements - Bummer Knees - 08-16-2008 06:49 PM
Do you remember my friend, the injured nurse?
Her mother is in town visiting, Eva recently retired as district manager for a large insurance company. In the past she has been an insurance adjuster, and yes she has delt with work comp claims.
I explained to her I noticed a trend when several injured workers are involved in the settlement process at the some time and I asked her about this.
This is how she explained it to me; when a worker is injured the insurance company is required to set a certian amount of money aside.
For example $100,000. this is money that can not be invested.
If the insurance company needs to free up some money and the injured worker has reached MMI they can make settlement offer.
Say the injured worker has medical bill of $25,000.00 and they offer the worker $40,000, then the insurance company keeps the remainder $35,000.
This is a simple example that Eva gave me. I welcome information anyone has to add to this.
RE: Settlements - Bad Boy Bad Boy - 08-16-2008 07:03 PM
I'm not evil, and I don't want this to sound evil.
I would like you to ask her, when the IC denies a claim, and lets say it made total no sense to deny it, because all the makings of the injury were truely done at work, and being no fault. Had she ever been confronted say by upper management to deny claims for awhile.
I also would like to ask her, just what does an Adjustor or the IC truely consider Reasonably medical care. I had read in the last few days, reasonable med care is a cost matter. Say doctor X wants to give treatment for $300.00, and IME said it could be done for $250.00. But yet many States have now in place a Fee Schedule of what a doctor can charge, and what the IC has to pay. Being that is now true, then how can they now say reasonable medical care, for if your State does have a set fee schedule medical Billing and or payments would be the same as coded.
Thanks for allowing to ask questions.
RE: Settlements - Bummer Knees - 08-16-2008 08:20 PM
Eva is only in town for one more day, I will try and visit with her tomorrow.
I will print your question and see what she says.