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Settling a lifetime medical on a herniated disc claim - Printable Version

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Settling a lifetime medical on a herniated disc claim - Peanut - 06-11-2016

In 2012 I injured my back on the job. I have never lost time on the job. I muddle through work with the pain. I have been getting treatment on and off since the injury. Accupuncture, chiropractic , physical therapy and epidural injections. I ended up getting a couple of thousand dollars for the claim and then lifetime medical. I still get treatment on the injury but the delays in waiting for WC to approve anything is awful. I would actually prefer to just use my regular health insurance because since Obamacare, don't they have to accept pre existing conditions? 
If I did choose to settle the lifetime medical , how much do they normally settle out for ?

I also need to mention that I no longer work for that employer I had the injury with.


RE: Settling a lifetime medical on a herniated disc claim - 1171 - 06-11-2016

you should figure the present value of what is estimated they will pay on the balance of your claim.

it's a technical distinction. while your request for insurance cannot be denied because of a pre-existing condition, they don't have to provide care for the pre-existing condition if you have other coverage for it -- like workers comp, you'll have insurance for other conditions and they will cover care denied by workers comp.

P.S.your physician needs to obtain pre-authorization and/prospective review for care by using the appropriate Utilization Review process.
more here
http://www.dir.ca.gov/dwc/UtilizationReview/UR_FAQ_InjuredWorker.htm
if they delay a utilization review, you can take them to court for penalties:
"If your doctor has not been able to get a response from the claims administrator, you should file a declaration of readiness to proceed to expedited hearing. A claims administrator who fails to meet the appropriate deadline for a utilization review cannot object to the doctor providing the requested treatment."

you can also change doctors to any within the MPN.


RE: Settling a lifetime medical on a herniated disc claim - 1171 - 06-13-2016

you're welcome.
thankx for stopping by.