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Body parts in MSA and settlement docs don't match
#31
Just thought of one other thing ..when you have a work injury and private insurance.

The Comp Carrier ( awarded medical care by the court ) is the primary provider for the work related injury or illness. 

The private health insurer is the secondary provider and maintains their right to subrogation.

I hear alot of "urban legend " regarding this issue,

I would love to learn more regrading this subject of C and R and legally shifting to private insurance.

I guess I am just stuck with Comp as a primary. But I can take the denials to a private insurer after the UR and IMR process has been completed.
 
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#32
(02-02-2018, 06:07 PM)Shadow Wrote: Just thought of one other thing ..when you have a work injury and private insurance.

The Comp Carrier ( awarded medical care by the court ) is the primary provider for the work related injury or illness. 

The private health insurer is the secondary provider and maintains their right to subrogation.

I hear alot of "urban legend " regarding this issue,

I would love to learn more regrading this subject of C and R and legally shifting to private insurance.

I guess I am just stuck with Comp as a primary. But I can take the denials to a private insurer after the UR and IMR process has been completed.

You can call The CA State Dept of Insurance and ask. An open work comp claim is different than a claim that has been closed via compromise and release. I have been told by several attorney 'subrogation in these cases are for open claims, not closed. I have called The CA Dept of Insurance about this over the years more than once and was told the same thing. I ask for a link today and was told there is not one as this falls under pre existing condition. I also asked previously same question for civil cases. They can subrogate for costs that occur before the civil case closes however after it closes the patient is free to use their private insurance.

I called CA Dept of Insurance today just because it had been a while and I wanted to make sure as laws change. Interesting the person previously worked as a claims adjuster for workers' compensation in CA. She said she has not seen one instance where an injured worker had issues using private insurance for their work related injuries after they compromised and released them. She stated if they did she was sure they would have contacted her or she would have heard about this issue. She stated Medicare on the other hand is a whole different issue. I agree.

The patients I have helped who are not in the workers compensation system and are injured and had civil cases have not had a problem with using their private insurance after their civil case closed. They did have to pay back monies paid by their private insurance for what they paid for their injury before the case was settled, but not after settlement.

Seeking Help, I mentioned your situation to her with your settlement issue as she was a former claims adjuster and she said she thought it was strange and stated her settlement documents matched with the MSA as far as body parts.

1171 the only links I found for this topic are on attorney web sites. I have never come across a California injured worker who posted they had issues with their private insurance after a C&R or had to use settlement monies before using private insurance after The Affordable Care Act was passed. I do remember before The Affordable Care Act there was some discussion. If you find out differently, let me know.
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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#33
I just called my AA 's office ( Firm ) ..the answer was you cannot C and R a claim , keep the money, and shift you workers comp injuries in to private insurance period. Depriving the private insurer of their right to possible third party recovery .

They said the same thing I have been saying read the policy provisions.

All heath insurance policies hav e exclusions for this very thing. Patient and providers are doing it left and right every day. Law Offices advise against it.

But the answer from my Attorneys office is no ! Period period period.

Denied and delayed care is different in workers comp and can be covered.

I say to anyone .. go for it !! Everyone is doing it anyway . I ain't doing it !
 
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#34
you would think there would be some court cases that would clarify.
there are millions of dollars paid out in settlements every every year for horrific accidents and injuries. its difficult to see how th patients are allowed to legally pocket the $$ and then obtain care thru their health plan.
i have a tendency distrust the pronouncements of those that have something to gain from an argument.
the comp attys invovled in C&R negotiations are not neutral bystanders; settlements are the bread and butter of their income stream--- both defense and applicant.
....but the regulators have have weighed in as well so the issue is still undetermined.
typically the legal language of both statutes and insurance contracts seem to contradict each other.
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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#35
(02-02-2018, 08:58 PM)1171 Wrote: you would think there would be some court cases that would clarify.
there are millions of dollars paid out in settlements every every year for horrific accidents and injuries. difficult to see how they are allowed to legally pocket the $$ and then obtain care thru their health plan.

The only thing I have seen with private insurance is they want money back for payments made leading up to settlement. Maybe these patients have just been lucky, I have no idea and do not see anything other than forum posts or attorney sites that say private insurance will cover it.

http://www.fieldslaw.com/workers-compens...nt-offers/

I have just assumed it was covered from the attorney's I spoke to, but sent you a pm with some conflicting info.

When I researched this in the past I did see questions about it but did not come across an actual patient who had an issue with using their private health insurance.

My personal thoughts on this is private insurance costs money and the patient is paying for it with their premiums, co-pays and deductibles. Even when someone's settles with a C&R in work comp or in many civil cases, they receive a lot less than what they lost with their loss of employment etc. It may seem like a windfall but spread over their lifetime it is usually much less than what they lost (in disabling injuries).

I agree with you about the attorney's. They have an agenda.

Well I am not sure on this then.
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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#36
I think people shifting in to private health care are ignoring the terms and condition of their policies . Or didn't read them to begin with. Possibly concealing that facts presented to provider. Maybe the provider knows and just looking the other way ?

My wife has purchased health insurance for the past three years under the ACA .. Workers comp is clearly excluded.

Once a person C and R's a claim. Pockets the money. They have no coverage period. Not legally anyway. The money they received was for the Workers Comp Medical. There is your medical coverage .. spend wisely Smile

Whenever I mention Workers Comp to a non MPN provider ..they get all weirded out .. it's funny .. I mean they asked my history . Comp freaks people out Lol !! It's miserable !

To those that are shifting your cost . You know if you are telling the truth or concealing facts to obtain coverage or following the rules of your Insurance providers.

I don't think its fair to us that keep our medical and do the right thing.. sorry !!

Good Luck !!
 
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#37
(02-02-2018, 09:30 PM)California_Help Wrote:
(02-02-2018, 08:58 PM)1171 Wrote: you would think there would be some court cases that would clarify.
there are millions of dollars  paid out in settlements every every year for horrific accidents and injuries. difficult to see how they are allowed to legally pocket the $$ and then obtain care thru their health plan.

The only thing I have seen with private insurance is they want money back for payments made leading up to settlement. Maybe these patients have just been lucky, I have no idea and do not see anything other than forum posts or attorney sites that say private insurance will cover it.

http://www.fieldslaw.com/workers-compens...nt-offers/

I have just assumed it was covered from the attorney's I spoke to, but sent you a pm with some conflicting info.

When I researched this in the past I did see questions about it but did not come across an actual patient who had an issue with using their private health insurance.

My personal thoughts on this is private insurance costs money and the patient is paying for it with their premiums, co-pays and deductibles. Even when someone's settles with a C&R in work comp or in many civil cases, they  receive a lot less than what they lost with their loss of employment etc. It may seem like a windfall but spread over their lifetime it is usually much less than what they lost (in disabling injuries).

I agree with you about the attorney's. They have an agenda.

Well I am not sure on this then.
 
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#38
They are contradicting themselves here :

Medical closed means that part of the money you receive in settlement is payment for potential future medical treatment. However, most people have their own private health insurance pay for treatment down the road when they have medical closed. The other consideration when deciding whether to leave medical open or closed is whether you are Medicare eligible or a Medicare recipient, because closing out medical can be trickier if you are receiving Medicare

Maybe it's different in Minnesota ? A smart injured worker would say great Mr Lawyer . Just back that up in writing .

Got my doubts. I have never seen a policy that says " we will pay your worker comp medical cost " Doubt I ever will Smile
 
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#39
This is recent case on if a MSA is required in civil cases. I thought this was interesting that they require it for work comp claims but not civil cases (for now).

https://www.francosignor.com/district-co...-settleme/


"This case originally settled in 2015, and just now in November 2017, the parties finally were able to resolve the settlement fully, and to ultimately determine an LMSA was not needed (an unfortunate waste of time, resources, and burden on our judicial system). This is clear evidence that the lack of clarity from CMS on LMSAs is causing settlement delays."
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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#40
(02-02-2018, 10:24 PM)California_Help Wrote: This is recent case on if a MSA is required  in civil cases. I thought this was interesting that they require it for work comp claims but not civil cases (for now).

https://www.francosignor.com/district-co...-settleme/


"This case originally settled in 2015, and just now in November 2017, the parties finally were able to resolve the settlement fully, and to ultimately determine an LMSA was not needed (an unfortunate waste of time, resources, and burden on our judicial system). This is clear evidence that the lack of clarity from CMS on LMSAs is causing settlement delays."


Workers Comp is a miserable mess . No one wants it . Civil is way different a person can actually receive a fair settlement and sometimes it includes enough to cover all future medical care.

I hate workers comp . Until someone can show a legal way to cost shift . Then I am stuck here regardless . I just chuckle when someone says that their private insurance will pick up a C and R'd claim Smile Cost shifting in the new scam out there . It'll come to an end soon enough .
 
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