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At what point does an injury no longer become WC responsibility
#1
I have having a difficult time understanding if WC has not accepted a particular definition of injury but has accepted a body part as injured, when are they no longer responsible for treatment. I was injured in MVA - work related some injuries accepted in full others just as sprain. I am not MMI. If I settle and give up medical then I will be responsible for anything that occurs to that body part or what? My medical records are now well documented as to nature of injuries so in the future a pvt IC can access records and say oh no you were in a work related auto accident and we will not cover that. If I was in a non work related auto accident and had a back injury for instance an IC would cover treatment as long as case was settled right? I mean I would not then be the sole responsibility fro any future medical care if it was a pvt accident so how can someone be on the hook for treatments after a WC settlement? How can feel comfortable to settle a claim with this type of confusion.
 
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#2
if you were in a non-work related auto accident a health insurer would not care about a prior work injury settled or not.
you can't.
you can't ever guarentee a future event.
you can't do anything now that will guarentee the decision of a future health coverage determination.
if you have medical problems in the future there will have to be a medical opinion as to it's cause-whether a past industrial injury or something else.
that opinion can be disputed by another medical opinion. whether that's resolved in your favor can't be guarenteed now in your comp settlement.
if you have some guarantees as to what's going to happen in the future, please list them. I'n very curious as to how you've come to expect them with your comp injury.
generally trying to get as close as you can to reducing the risk is about all anyone can expect.
unless I've misunderstood your point.

I'm trying to understand your reasoning. somewhere you've missed a step or have made a false assumption.

workers comp is the employers insurance not yours. it only covers the employer's liability for a particular event.
for comp purposes an injury is a specific incident or series of events that happened to an employee.
an injury is not a body part; you could injure multiple body parts in a single injury. you could have a series of injuries to the same body part.
you could have 10 injuries to your back. if the 5th one happened on the job that's the only one comp would cover.
these decisions are based on medical evidence.

have we made any progress?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(02-20-2014, 05:02 PM)1171 Wrote: if you were in a non-work related auto accident a health insurer would not care about a prior work injury settled or not.
you can't.
you can't ever guarentee a future event.
you can't do anything now that will guarentee the decision of a future health coverage determination.
if you have medical problems in the future there will have to be a medical opinion as to it's cause-whether a past industrial injury or something else.
that opinion can be disputed by another medical opinion. whether that's resolved in your favor can't be guarenteed now in your comp settlement.
if you have some guarantees as to what's going to happen in the future, please list them. I'n very curious as to how you've come to expect them with your comp injury.
generally trying to get as close as you can to reducing the risk is about all anyone can expect.
unless I've misunderstood your point.

I'm trying to understand your reasoning. somewhere you've missed a step or have made a false assumption.

workers comp is the employers insurance not yours. it only covers the employer's liability for a particular event.
for comp purposes an injury is a specific incident or series of events that happened to an employee.
an injury is not a body part; you could injure multiple body parts in a single injury. you could have a series of injuries to the same body part.
you could have 10 injuries to your back. if the 5th one happened on the job that's the only one comp would cover.
these decisions are based on medical evidence.

have we made any progress?

I know you are trying to answer my ??? but maybe there is no answer. Bottom line is I have injuries I currently treat for . WC has accepted some as sprain even though I have gone through spine surgery - others were accepted as full even though i continue with pain. 1 was not accepted - PVT IC is paying on everything WC has not but ER is self insured so essentially ER has paid for everything. I no longer will have pvt ins in a short while so since WC has not been willing to pay anything more except scripts I dont know what I will do - I cant afford to pay with no income. So if I get a job with ins to resume treatment for the same injuries etc they will know these were related to Work injury and then I will have to hope for the best. I can understand that if you have a broken leg - you get it casted and then it heals and essentially its done - if you break it again that would be a separate event. In the case of continued pain and possible additional level surgery from spinal fusion - how does this get handled.
 
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#4
(02-20-2014, 07:09 PM)vinga Wrote:
(02-20-2014, 05:02 PM)1171 Wrote: if you were in a non-work related auto accident a health insurer would not care about a prior work injury settled or not.
you can't.
you can't ever guarentee a future event.
you can't do anything now that will guarentee the decision of a future health coverage determination.
if you have medical problems in the future there will have to be a medical opinion as to it's cause-whether a past industrial injury or something else.
that opinion can be disputed by another medical opinion. whether that's resolved in your favor can't be guarenteed now in your comp settlement.
if you have some guarantees as to what's going to happen in the future, please list them. I'n very curious as to how you've come to expect them with your comp injury.
generally trying to get as close as you can to reducing the risk is about all anyone can expect.
unless I've misunderstood your point.

I'm trying to understand your reasoning. somewhere you've missed a step or have made a false assumption.

workers comp is the employers insurance not yours. it only covers the employer's liability for a particular event.
for comp purposes an injury is a specific incident or series of events that happened to an employee.
an injury is not a body part; you could injure multiple body parts in a single injury. you could have a series of injuries to the same body part.
you could have 10 injuries to your back. if the 5th one happened on the job that's the only one comp would cover.
these decisions are based on medical evidence.

have we made any progress?

I know you are trying to answer my ??? but maybe there is no answer. Bottom line is I have injuries I currently treat for . WC has accepted some as sprain even though I have gone through spine surgery - others were accepted as full even though i continue with pain. 1 was not accepted - PVT IC is paying on everything WC has not but ER is self insured so essentially ER has paid for everything. I no longer will have pvt ins in a short while so since WC has not been willing to pay anything more except scripts I dont know what I will do - I cant afford to pay with no income. So if I get a job with ins to resume treatment for the same injuries etc they will know these were related to Work injury and then I will have to hope for the best. I can understand that if you have a broken leg - you get it casted and then it heals and essentially its done - if you break it again that would be a separate event. In the case of continued pain and possible additional level surgery from spinal fusion - how does this get handled.

Every state has different laws. Are you from California?

If you are from California, work comp should have been paying for everything UNLESS your claim was denied. It is not the same thing using your private insurance as your employer is self insured, because they are completely two different entities, and work comp treatment is free. Using private insurance usually has co-pays etc. I would recommend saving those receipts and requesting reimbursement from your work comp carrier if you have out of pocket expenses.

Whatever state you are from, it sounds like it would benefit you to hire a work comp attorney ASAP.

I think what you are asking is if you compromise and release your work comp claim, and do not leave your medical open, can you go and purchase private insurance to then cover it...is that what you are asking? I do not know the answer to this.

Before The Affordable Care Act my answer would be no, but now it is I do not know.

I do not recommend closing out the medical in your claim until you discuss this with an attorney, and he gives you an answer.

My next question is why you do not have any income? Since you have been off of work due to your injury, did you receive any type of work comp payments? Laws are state specific, and I am only familiar with California.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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