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Open Medical / eventual TKR repair
#1
1171, Thank you sooo much & bless you for helping so many people on this forum! The judge did bouce it & asked me how will I pay for knee replacement as they are not "lifetime" & no one can quarantee how long it will last. Mine is very successful ~ after 4 years, Dr says looks extremely well ~ I think would last til I am 65 & able to get Medicare. However judge explained that medicare will NOT cover as its a work related injury ( IC attorney told me it would!) ... especially since medicare $ getting tighter.
IC attorney argued as to whether I would even need it later on. Due to my age and family history I am sure I will live 30+ years to be in my late 80's.. 90's. Judge pretty much agreed I will need another one & said he could set a trial date for us. If I go that route, do I have to have an attorney? Can I see an IA (?) counselor without IC attorney present since I am pro per to have them answer my questions? And are MPNs usually state wide as I want to move 10 hours away? Thanks again!
 
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#2
sounds like you had a very decent judge who was looking out for your welfare.
I'm surprised the judge need not advise you to retain an atty.

no, an atty is not required.

yes, you can contact the Information & Assistance officer without the opposing atty present.
they should not be privy to your meetings or discussions about the upcoming hearing.

if the carrier has policies and accounts statewide then they usually have a large MPN to services them all or more then one smaller ones.

if you do decide to obtain legal representation start here and use the zipcode search:
caaa.org

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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#3
1171 ~ thank you again for you help! The IC attorney will call me next week after talking with "his client" with an offer. He did tell the IA officer that he could come up with another $15,000 (he was sure) but that would be $30,000 for C&R. Could sure use the $ as am living from (unemployment) check to check as many others in this economy are, but thinking it thru, would not cover another surgery down the road. Judge did say it was an easy case.. I was very lucky to get a judge that when he "bounced" it, explained why and cleared up the "misinformation" the IC attorney gave me regarding Medicare. Judge also reminded me that the attorney was representing the other side... ( I think in other words, don"t believe everything he says.. LOL)
 
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#4
using your medical settlement to pay bills could leave you high and dry when that knee gives you problems later.
you should look into buying some health insurance for the knee so when the time comes you are covered.

medicare requires you put medical settlement $$ in a trust account and use it before they will step in and cover a work injury.

more here:
https://www.cms.gov/WorkersCompAgencySer...taside.asp

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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#5
(11-03-2011, 12:24 AM)1171 Wrote: using your medical settlement to pay bills could leave you high and dry when that knee gives you problems later.
you should look into buying some health insurance for the knee so when the time comes you are covered.

medicare requires you put medical settlement $$ in a trust account and use it before they will step in and cover a work injury.

more here:
https://www.cms.gov/WorkersCompAgencySer...taside.asp

I have to say I agree with some of the advise 1171 gave on the other thread. An annuity is not a bad idea, and usually there are multiple options for payment,

Also, medicare would cover your later total knee IF the carrier gets a medicare set aside. You would be responsible for that money as part of the MSA.
 
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#6
Thanks... Now to get them to see it my way! Ha Ha Or would "Open Medical" be a better option? I am just afraid they will deny Dr. requests, take alot longer to get approval etc...
 
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#7
(11-04-2011, 04:42 PM)newknee Wrote: Thanks... Now to get them to see it my way! Ha Ha Or would "Open Medical" be a better option? I am just afraid they will deny Dr. requests, take alot longer to get approval etc...

if a lumpsum buyout (compromise & release) is unable to be negotiated then the default is periodic pd payments and open medical.
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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#8
newknee

I was injured 2005, bilateral knees, the lumbar spine was later added to the claim, and jus before I reached MMI on the knees and back I was injured by the wc doctor resulting in an ACDF of C5-6 earlier this year.

My first knee surgery was 2006, a failed surgery, I had a TKR of this knee in 2008. THe IME rating I recived on the TKR was 75%. The other knee (right)required surgery, meniscus & chrondyl repair and pilca sectioning in 2007, I will need a TRK of this knee in the future according to the surgeon.

I settled earlier this year and tried for open medical on the TKR, the insurance refused, did not matter was my attorney had to say. I receive social security disability so a medicare set-aside was requied with my settlement. The insurance company was able to fly under the radar and receive the approval of $4,600.00 on the TKR for life.

Part of the problem was the wc doctor saying the TKR would last me for life. I was 51 when I had the TKR surgery.

Good luck and I wish you the best!
 
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#9

hopefully Kansas Knees are much stronger then california ones.
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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#10
Well they may be stronger, one of the hospital nurses told me the surgeon likes to stuff the knee with wheaties while still in surgery.
 
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