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IC refuses to fund MSA
#1
1 year after mediation, the IC has decided not to approve my MSA Proposal.The IC hired the company that projected my MSA Cost.. ..

The insurance company would rather pay the claim out over time than fund an MSA of that size. This ties up my Idemnity because it is contingent on the MSA being approved by ALL parties before CMS looks at the proposed MSA.

I do not know where we go from here. I will talk to my Attorney soon. . One year ago I would have 100% believed I would be settled but...
The IC IME declared me PTD in March 2009.
 
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#2
will you please refresh my memory on your injuries and was there a reason?
........I love cats, I just cant eat a whole one by myself......







 
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#3
jayne Wrote:will you please refresh my memory on your injuries and was there a reason?

A failed midback fusion (T12 corpectomy with a titanium cage, bolts screws etc.) I have severe facet nerve pain, back pain, and scar tissue pain. My injury was in late 2002.

The Reason is the IC states the Medicare Setaside is to expensive. They seemingly would rather "gamble" and payout medical over time.

I just wonder where this leaves my Idemnity portion we agreed upon when the MSA was approved by CMS.

Heck,The IC will not allow it to proceed to CMS because it is "a substantial" amount. I mean really, That amount is out of my control. It is based on my past 2 years of medical and prescription drug needs.

Maybe 1 hour sleep last night. I am a fighter but right now, I am knocked down but not knocked out.
 
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#4
so will they maybe settle with open medical? many do.....rest your mind a bit you are at a point where there is nothing you can do but wait...do you trust your lawyer? give it to him and God and wait it out.....be praying for you
........I love cats, I just cant eat a whole one by myself......







 
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#5
Freebird I also have a problem with settlement & the MSA.

The insurance company wants to limit the MSA to $10,000.00.

The insurance company wanted me to sign a document which reads the knee replacement and other injuries are not a result of the work injury, and in return they and will seek reimbursement from the state fund for medical bills (knee replacement) they have paid and agree to a settlement amout, (low dollar)

I told my attorney if I signed this document I would be lying. My attorney then told me, "Then you may never settle"
 
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#6
FreeBird, I have heard of this many times before. The IC will keep the Medical Open, and settle the case.
For (1) it thens leaves you with and Attorney that then has been paid.
For(2) You have open medical, and many times need approvals each time, sometimes leading back to hearings, and you then may have to pay an attorney if you need one.
For(3) They try to have your medication set to certain limits and changes. Or just not pay for them, when they feel it is not a needed medication-leading you back to a hearing once again.

Surly you read some of these stories here in the past.

Too me, my opinion, is Open Medical is another form of wearing a person down. Reasons I think why then many wish to try and get their medical bought out.

The Gamble is, The IC keeps their money where they want it, not where you want it; They spend as only need be; Their incharge still of you, and your medical; This allows them to spend as an on need basis only; They keep their Interest money not you; They have Attorneys on Retainer, your's will be paid once settled leaving you with no Attorney; If you then need an attorney you will then have to pay one to fight for your needs. This is one reason I haven't even tried to fight the MSA issue, either they pay it, or pay what CMS thinks is best, will suit me just fine. I want the IC out from under me and my needs.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#7
Okay BBBB, I see what you are saying but at what point does a Attorney get paid? In other words, they have not "yet" offered to settle with open medical and pay the Idemnity portion of the settlement.

What happens if they continue to pay me weekly and not actually settle? I would think they would offer my Idemnity with open medical but this has not happened.
I continue to draw a weekly WC check as I type.

My Attorney basically said there will be no settlement with the MSA not being approved. This is email talk from a few days ago; I am waiting on his call.
 
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#8
yup. there are a couple bills introduced into congress to try and put some order into this system. As CMS has inserted itself more aggressively into each states settlement process complaints have been growing. One area with obvious need is an appeal process.
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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#9
FreeBird, that is correct, they will simply keep sending you checks, and pay medical as times keeps ticking away. Your attorney will not get paid, as settlement isn't on the table anymore now. So, the IC sits back, and just keeps doing what they been doing.

It now all depends on how many Chess pieces are left on the playing board, and who has control of the Chess game. Who's in Check, who isn't, who will bring on CheckMate though?
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#10
Bad Boy Bad Boy Wrote:FreeBird, that is correct, they will simply keep sending you checks, and pay medical as times keeps ticking away. Your attorney will not get paid, as settlement isn't on the table anymore now. So, the IC sits back, and just keeps doing what they been doing.

It now all depends on how many Chess pieces are left on the playing board, and who has control of the Chess game. Who's in Check, who isn't, who will bring on CheckMate though?

Well, Currently I feel I am in "check" because they will not be able to financially starve me out. Wink I have waited almost 7 years; I am in it for the long haul if needed. My medical needs are being met....

Who will get the Checkmate? Hell if I know but I will fight for what is reasonable. Thats all I ask is for the IC to be reasonable with a proper MSA. I do think the use of AWP pricing effective June 1, 2009 by CMS is extremely inflated but honestly thats out of my control.

I would love to get the IC out of my life though.
 
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