Ending process

[karenrae]

Hello everyone. < Wisconsin State of Injury> i was wondering what happens now that papers have been signed? Does the WC Judge need to approve the settlement and if he doesnt what happens then? I would also like some opinions on why this is being done. The WC Ins is covering all past medical bills < except the lower back surgery> my attorney said it was because it I have seen so many Doctors when I moved back to Michigan. I for one figured that if ALL referrals were made from my primary care physician then it should not matter. Perhaps once again I was wrong in assuming things. i tried explaining to my attorney that it was very difficult to find a Doctor to even work with me with my WC case being from another state. So since the Ins is refusing to pay for the lower back surgery and medicare has already paid for it, is that part done and settled or will I need to reimburse Medicare? Thank you for you help.

[Bad Boy Bad Boy]

Well, as told to you before in another thread, about you saying your attorney will add your back injury in at a later date. We showed concern for you. I too thought your attorney was sounding fishy on that, and not trying to get it added in before you tried to settle. Now, your being left out in the cold by your attorney on the lower back issue. Now, how will medicare or any insurance handle this, is going to be up in the air, as it all matters to what is stated in your medical records that they will get. If a insurance or medicare thinks it is work related, I'm sure they will let you know about it, and they will let you know what their going to do.

[1171]

whether you will have to reimburse medicare or not should be contained in the terms of the settlement. if it's not included and there is no lien it's not likely.
the comp judge is required to approve settlements to make sure the payment is reasonable given the facts and the issues involved. I also believe the court has to approve the atty fee to make sure it's also fair.

[fireball]

JUST FYI (for the seniors who help all to keep in their files) and others to help answer her question. I recieved a letter from medicare last week stating they were alerted that i had another insurance co. who might be responsible for some of my medical payments that they already paid for. Medicare has paid all my bills for the last year and 1/2. first i was curious as to how they got the information etc so instead of filling out the form I called in. this is what I was told. by law anytime someone is on workcomp and that insurance co. is aware you are on medicare they "must" inform medicare--she stated they are well aware of the procedure. Medicare sends you out a form for you and your attorney to sign which states you cannot sign and have the settlement go through without it stating the amount that workcomp must repay medicare. This she says also helps protect us in the long run as once a judge sees that medicare is involved they will also want to see a medicare set a side fund for future medical expenses related to the injury. Medicare tracks your expenses by the diagnosis code of all the injuries related to your w/comp injury. even if workcomp has escaped the law by not providing medicare with the information required by law medicare does all the work to go after them to get their payment for treatments they have paid for you. although it is sometimes hard to get(it took me a year) medicare will pay your bills and go after workcomp now and in the future if you have a writen statement from workcomp stating they will no longer pay for future/present treatments. ie w/comp refused to pay for any of mine over a year ago although they still pay for all meds. in order for my pm to preform the surgery for the scs he had to have this writen letter in order for medicare to approve it.--as directly related to her question regarding repayment of the back injury--if the diagnosis code for the injury to the back is related to any paper work with it being related to your injury than medicare will go after workcomp to get repaid. they will not come after you as long as they know who the responsible party is. knowing what i know now if I were you I would stay with the law--contact medicare and let them know the name of your workcomp carrier and have all the diagnosis codes of your work related injuries on hand to give them. I know all this could cause a delay in getting your settlement and gosh knows we all cannot wait for that but in the end like she said you are protecting yourself as your attorney already should of had a medicare set a side fund set up before he even gave you the settlement and once seeing the medicare involved the judge will want to see one. You will get your relief knowing anything in the future related to these codes will automatically be paid. As tempting as it is stall the settlement contract until you have all the information on it that should be included--dont let your attorney say their working on it etc--first of all it is the law and not abiding by it could cost you big bucks in the end. hope this helps and by all means I am not a know it all its just after 15 years I have been through everything imaginable from workcomp--investigators-doctors-treatments-social security and medicare.
p.s. regarding how they found out she couldnt see right away but once im assigned a case manager i should know for sure. My attorney is hoping they are starting the process of the medical set aside fund as I won my case in dec. they said they wanted to appeal but have not done so yet (they have offered settlements in the past but way to low for me to take)im keeping my fingers crossed my attorneys guess it right!!!!

[karenrae]

FireBall, BBBB, 1171, thanks for the information. Medicare was made aware of the Ins Company when i filed for SSDI and they know it is a WC injury. What gets me is the Ins only refused to pay for the back surgery that i had in 06. They are paying for everything else meds, physical therapy back to the injury date which was in 05.. My settlement amount after Attorney fee's is roughly 29,000 with open medical for life which is fine with me so there will be no MSA. My main concern was with the Ins refusing to pay for the lower back surgery in 06 how would "that" affect the settlement. I was able to contact my attorney yesterday and find out what was going to happen regarding that issue. He made things vey clear to me and I was happy with what information he provided. He also indicated that he should be getting the Papers back from the Judge this week. It always seems like the last mile is the hardest to get threw..

[fireball]

Karenrae, I have not seen all your last post and just because an attorney makes you happy with what information he tells you does not mean it is correct and it could only be because he wants this case closed. From what responses I have seen from others regarding your issues is that they have been concerned about your attorney from the get go. As long as you know for sure that the back surgery from 06 is not related to the injury obtained in 05 you are in good hands.(however, ;you still do not know why they have not paid for it-if it is work related why is your attorney letting it go) however, if anything in your medical file relates that surgery to your injury in 05 it needs to be included. You may be happy with open medical yes workcomp will pay for any future problems you have that are all related to the injury besides the back injury. Where you could get into trouble is if your medical records show the back injury was related to the injury. you settle--your attorney gets his money--and years later when your medical records show the back injury was related to an injury in 05 you might be reliable for expenses out of pocket. Just out of curiosity why did workcomp deny your back surgery as it sounds like you thought it was part of your workcomp? and what did your attorney actually say "regarding that issue" that convinced you that it should not be a part of your workcomp issue as you believed originally was. please do not forget that although your settlement can say "open medical" it must also state each and every injury and diagnosis that has come about from your injury. If you are so convinced that the back injury was related to 05 injury than why are you so anxious to sign off for an amount that would not even come close to what a back surgery would be if needed in the future. Like I said it is so hard in the end you want to settle and you want to do it quick. all im saying is look at the past records from your back surgery see if any of them make a reference to your injury of 05 and if they do do not sign until the issue of the back injury is totaly settled with nothing relating it to the injury of 05. Like you say the last mile is the hardest to get threw--but the most important to make sure you are covered for anything related to your injury even if it takes longer to finish this mile than you want to!

[karenrae]

Hi FireBall. sorry for the late response. yes the lower back surgery is part of the claim and have Doctor statements stating it is/was work related. At this point and time i'm just happy it is over with. Yes i know i am one of many who they wore down and i have finally given up. But as stated in the agreement is that they will cover medically everything to do with the back. I personally feel that if this had continued any longer that my depression, stress, anxiety would have gotten the better of me and put me in a mind set that is even more less healthy then where i am now. So now it is just s sit and wait game.