Future medical question...

[ksgirl]

I have a question about future medical. I finally hired an attorney and we decided to leave medical open (I am in KS). I spoke with my husbands insurance the other day and they told me that even with me just having surgery, that as soon as I settle they will take care of any further problems with my back , no pre-existing condition applies. My husband plans on staying with this company for a long time. Here's the question, should I settle medical or not? I will ask my attorney on Monday, but I was wondering what you all thought.
My injuries are herniated L4-L5 (laminectomy, discectomy done on 6-11-07) bulging L4-L3 & L5-S1.
Thanks as always for all of the knowledge you all have!

[Sithie]

I am sorry but I am totally out of the loop on back stuff KS, I pray you get the guidance you need.
Sithie

[ksgirl]

Thanks for your support Sithie. Prayers help us all!

[capricorn]

ksgirl...I am totally out of the loop with any IC offering to pay for future medical on a WC claim that's already been paid on and settled. I know there is a difference in all state's but this seems to be really out of the norm. Be careful.

CAP

[Still in Limbo]

Ks. I want to make sure I've got this correct. You were injured, and settled with Medical left open, correct? And Your Husbands ins. co. has stated they will take care of your back in the Future, with the exception of pre-existing problems. If I'm correct in what I posted, what your Husbands Ins. stated is usually the Norm, and you need to keep Your w/c Med. Open, because your surgery or any complications thereof are pre-existing due to your ailment. I think what the ins. co. meant is that if you have any other Future back problems, not caused from your injury they will cover, but the workplace injury will always be pre-existing, and any complications from that surgery only, will be linked to the pre existing condition. My opinion only, but I would leave Medical Open for that reason. I hope this Helped and made sense, and Have a Great Day!!

[capricorn]

I'm sorry ksgirl. I don't know if it's my eyes or the worry but if Limbo is interpreting this right I am sorry. I read your post over and am still understanding that your husband's insurance has said they will waive the pre-existing clause and that as soon as you settle they WILL pay for any costs pertaining to your back even though WC has already settled this claim. Am I understanding you right???? If so this is a first for me. I have never hears of any IC paying for an injury that has already been accepted and paid on by WC. Please clarify for Limbo and I.


CAP

[ksgirl]

Sorry guys, I guess I wasn't very clear. I have not settled anything yet. I haven't reached MMI. In my first visit with the attorney we discussed leaving medical open instead of settling it when the time comes for settlement.
I actually was speaking to my personal health insurance about something else and just thought I would ask them about my back. She said that since I have had this insurance for so long that as soon as I am finished with wc, they will cover anything else that happens to my back. Even the three discs I am currently having problems with. I asked her, do you mean that when all of this is setteled, if I find out six months later that I need to have the same surgery again it will be covered, and she said yes. I t really surprised me.
I hope this is clearer.

[capricorn]

ksgirl.....yes a little clearer BUT after my first back injury my PCP told me that somewhere down the road if I was done with WC that my personal insurance would pay for treatment on my back. Please, please be careful. He was speaking of me going back to work with no settlement. I honestly am really afraid of this for you. I have never heard of any IC paying for an injury that has already been paid on and settled on by a WC IC. The purpose of a settlement or medical set aside is exactly for that reason that IC's won't pay for something that has already been accepted as work related. Please talk to an attorney about this. Maybe it's different in different states but I have never heard of any such thing happening. When my husband settled, the Judge was very clear about the difference in what each insuance would pay for. Maybe it's my state but I would be real careful.

CAP