03-06-2014, 02:08 PM
Hello All:
I've been browsing these threads for awhile as I muddle through 2 California work injuries, one represented, the other not. While I have found alot of useful and intriguing information, I have been equally confused by much conflicting and contradictory advice. I would welcome any knowledgeable input. Here's my story:
The insurance company (IC) has accepted the doctor's QME report and my associated PD rating. Thus far, the IC has paid just shy of $10k for my medical treatment. My future medical could range anywhere from $500 per year to $300k+ if my condition deteriorates and I need surgery 10 years from now.
Not surprisingly, I received a settlement offer from the IC indicating that they would like to pay an additional sum of $$$ in order to buy out future medical. I currently have private insurance (PI) that covers 100%. My initial thought was NO WAY, even if you throw $100k at me now, I can't be on the hook for $500k somewhere down the road. But I realize that there is more to this and don't want to make a rash decision.
THE QUESTION: My PI has never had an issue with covering pre-existing medical problems. It's my understanding that the Affordable Care Act (ACA) has further locked PI companies into paying for pre-existing conditions. I'm in my 30's and nowhere near retirement age or qualifying for Medicare, so I don't think that a Medicare set-aside comes into play here. I will likely always have great PI through either my employer or my spouses employer. So, I am wondering if there is any measurable risk to having to pay for future medical by accepting a large settlement. Does this risk hinge on the ACA being repealed or changed? My gut feeling is that this is TOO risky, and I will likely need some future procedure that the IC should pay for. On the other hand, it sounds like once you reject a buy-out and opt for a STIPULATIONS only settlement, that the IC just starts denying treatment and making your life generally miserable, so you probably don't get the best treatment anyways. If this is to be expected, maybe I should just try to get a large settlement and cross my fingers that the ACA protects me by making PI pay?
Any thoughts on this?
I've been browsing these threads for awhile as I muddle through 2 California work injuries, one represented, the other not. While I have found alot of useful and intriguing information, I have been equally confused by much conflicting and contradictory advice. I would welcome any knowledgeable input. Here's my story:
The insurance company (IC) has accepted the doctor's QME report and my associated PD rating. Thus far, the IC has paid just shy of $10k for my medical treatment. My future medical could range anywhere from $500 per year to $300k+ if my condition deteriorates and I need surgery 10 years from now.
Not surprisingly, I received a settlement offer from the IC indicating that they would like to pay an additional sum of $$$ in order to buy out future medical. I currently have private insurance (PI) that covers 100%. My initial thought was NO WAY, even if you throw $100k at me now, I can't be on the hook for $500k somewhere down the road. But I realize that there is more to this and don't want to make a rash decision.
THE QUESTION: My PI has never had an issue with covering pre-existing medical problems. It's my understanding that the Affordable Care Act (ACA) has further locked PI companies into paying for pre-existing conditions. I'm in my 30's and nowhere near retirement age or qualifying for Medicare, so I don't think that a Medicare set-aside comes into play here. I will likely always have great PI through either my employer or my spouses employer. So, I am wondering if there is any measurable risk to having to pay for future medical by accepting a large settlement. Does this risk hinge on the ACA being repealed or changed? My gut feeling is that this is TOO risky, and I will likely need some future procedure that the IC should pay for. On the other hand, it sounds like once you reject a buy-out and opt for a STIPULATIONS only settlement, that the IC just starts denying treatment and making your life generally miserable, so you probably don't get the best treatment anyways. If this is to be expected, maybe I should just try to get a large settlement and cross my fingers that the ACA protects me by making PI pay?
Any thoughts on this?