5 years into this W/C claim and NOW they want to say not work related injury.

[bagpussinamerica]

Hi there, from Montana. Been treated from Tarlovs Disease which resulted from a workplace injury back in 2007. At first w/c did not accept this was related, that it was congenital, then they sent off my records to their own independent medical reviewer who said it was, in his opinion, work related. At the same time my own neurosurgeon had been in contact with an expert on Tarlovs and they both agreed it was injury related. So WC sent me off to Kansas City for a consult, and then later for surgery. Now this surgeon does not like to take w/c patients because of all of the hassle, but he took this case. Now w/c are claiming that this neurosurgeon never really STATED that it was work place related, never mind the fact that they never asked, just accepted the consult report and the surgeons rept here in Montana. So Now they want to have me re- reviewed, here I am just just a few days from having a spinal cord implant, which they approved, but now say they don't have to pay for it and they want this medical review in two days time. I only got the letter today. My attorney is saying yet again I should settle, and decide at a sum since w.c. will not agree to medical within the settlement. And that if I keep fighting I could lose benefits, and everything. I don't understand. Didn't they set the precident by agreeing to the surgery for Tarlovs in the first place? And how on earth do I find a settlement sum? Why do they keep forking out money for me to go to a pain clinic in FLORIDA, which failed, and now I am in a care facility at $250 a day, I've been here 7 weeks now. Why do this if they never believed it was injury related? Are they that stupid?

Being in the care facility has actually helped my case by reporting the symptoms which make my life very difficult to live with without assistance. So that much is finally clear. I don't get it. Does anyone have any advice? If I settle, it won't cover medical, they will just hand me a sum of money and I can hope it will cover things. Do I settle and just pay off my mortgage and pray I don't get any worse and hope I can afford some vocational rehab too to be able to maybe get a part time job that won't cause my symptoms to arise. What have others done? That is of course if they do settle instead of trying to kick me off the system completely.

[hurt back]

Sounds to me like they see you as an "expensive" risk.. I personally have never heard sending someone out of state for treatment, but I guess there is a first time for everything. First off, sorry that you are in so much pain and I pray that somehow you can get the treatment / respect from the w/c ins. company you deserve. Second if you do decide to settle, what I would do is sit down and get an estimate figure of what the current cost they've paid and find the avg lifespan of your gender and multiply it time that. I mean you can tell them a number and they will ALWAYS counteroffer if they think is too low, but if you short yourself then thats on you! Personally I believe I would consult with my attorney on this. If you feel he is giving you the run around then inform him you are going to seek another opinion. Keep in mind attorney only get paid if you settle so he/she may not be looking out for you but yet their firm. There are some decent lawyers out there ( like mine ) but I've also know there are some bad ones.

And yes the current place confirming your pain will help you. Keep in mind most want to settle out of court due to a jury that sees someone in alot of pain will most always go with the injured and not the ins. company.

Good luck and God bless!

[bagpussinamerica]

Oh the definitely see me as an expensive risk, because I am one. Tarlovs is really rare, but it is symptomatically activated by a traumatic accident, ie auto accident, heaving lifting etc. My fell into that catagory. It was accepted as such.

Now they have spent ALOT sending me here there and everywhere over the last 5 years, so if I even took the last year....the expense wo
uld be enormous and then multiplying that by my life expectancy....

Now my atty is concerned that w/c is hoping to stop this all by saying that a legal loop hole allows them to disclaim this whole thing and if they win, I lose everything. Not a single penny. On the other hand this disease can be progressive and no one knows the odds of if or when this will happen to me, of if it has already happened. What I do know is that I know have a double disability. One the pain from the Tarlovs, and also the severe spasms and contractions, without notice, and for at least two to three hours at a time followed by extreme exhausted, as documented by this care facility. These later symptoms were caused by some smart guy in w/c thinking they would send me off to another state for pain therapy and intensive PT and OT. Which is now proved to be the cause of the secondary disability. So what do I go for? Do I settle on the grounds that this is going to get worse, and who do I go to for an opinion on that? My Neruo from yet another state? Or leave it to my atty?

I also read today that any medical cash settlement is handed directly over to Medicare. And they actually charge higher fees for other medical interventions. Is this the case?

I already suspect that this disease has progressed given the nature of the spasms now. This case being so rare is a boggle and my atty is tired of it and told me he wants to settle because he said he can see w/c throwing every single independent medical reviewer they have in their personal arsenal at me and I will end up with nothing. We already had one reviewer in Jan who came back completely against me saying I had a lumbar strain and nothing else was related, so no, I should not be on workers comp. Fortunately for me I ended up in ER for a related medical problem and they started to ball back into my court all over again.

Honestly, I've learned to roll with things. But deep inside I am scared to death that I will just give up...completely. There are times when I really just want to lie down and go to sleep forever. The confidence is a huge cover.

[1171]

no it's not given to medicare.
it's put in a set aside account to pay for your work comp treatment.
when it runs out medicare starts paying.

here the link again to the medicare set aside website:
https://www.cms.gov/Medicare/Coordinatio...taside.asp

[bagpussinamerica]

What about if I have not enough "unit" of work within the US to get Medicare? I worked in England for 36 years. I need 5 more units or credits in this country to qualify for benefits including ssdi.

[1171]

the link I posted lists all the criteria for a set aside agreement. there are a number of conditions that have to be met before one is needed.

of course eligibility for medicare is primary; there are many settlements done without a set aside because they don't meet the criteria.