Please help soooo confused

[Gina]

I have been reading all that I can but there are some things I just don't understand. Here is a little background on my husband. He was injured on his job (Illinois) back in 2006. After months of therapy, shots & various medication he had Back surgery(L4&5) in January 2008. He was off of work for 4 1/2 months.
Our lawyer is telling us WC wants to settle and it's a fair settlement. My husband and I are 60 years old and he is thinking of retiring in the next year. There is also a chance he is going to apply for Social Security Disability in the next year.. This is something his VA Doctor wants him to do. So SSD would be for his veterans problems.
Is there something that has to be written in the settlement to make sure he is covered for future surgeries (if needed) for his L4 &5 problems. The lawyer is saying that one cannot keep medical open if there is a lump cash settlement.
We are so confused as one can tell from this post. I'm not even sure I'm asking the right questions. Can any please help and tell me if what the lawyer is saying is correct?
Thank you for any advice!

[jayne]

some states leave medical open some dont....at his age after 2 years if he is on medicare it will pick up....listen to your lawyer thats why you pay him....if it doesnt feel right pay to talk to another lawyer just to put your mind at ease...welcome to the greatest place in america to get the answers and love you need to walk the road of an injured worker

[Bad Boy Bad Boy]

Gina, you asked the right question.

In Illinois, it is not common that medical being open as we want. In Illinois mostly when settled medical is closed. If anyone gets Medical open in Illinois, you bet it will be years of on-going hearings and Appeals before that chance would take place. A good Attorney working in Illinois would advise your husband not to settle till after atleast 1 year from date of surgery. This allows time to heal, and if anything does go wrong, it might show up in that time frame.

[kate]

Please post your state or update your profile as WC laws are state specific.

Some Medicare Set-Aside info:

A Workers' Compensation Medicare Set-Aside Arrangement (WCMSA), allocates a portion of the WC settlement for future medical expenses. The amount of the set aside is determined on a case-by-case basis and is reviewed by the Center for Medicare and Medicaid Services (CMS), when appropriate. CMS determines an amount that they feel should cover future medical. Once the CMS determined set aside amount has been spent and accurately accounted for to CMS, Medicare will then pay for future Medicare covered expenses related to the WC injury.

A Medicare Set-Aside Arrangement is submitted to CMS for review in the following situations: The injured worker is currently a Medicare beneficiary and the total settlement amount is greater than $25,000 OR The injured worker has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.

[jayne]

first paragraph said it all Kate....

[RNvic]

Gina, as BB has said it is rare for medical set aside in IL. Usually in IL when settled medical is closed. Welcome to the forum as Jayne said of some of the best people you will meet. Come often, ask questions or just share.

Tinkerbell

[kate]

Sorry, missed your state in your post. I need to start reading slower.

[Gina]

Thank you everyone for the welcome and the
advice. I feel alot better now, knowing this lawyer
is steering us in the right direction.

Gina