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Settlement offer need advice
#1
I am new to all of this but here's my question and need help. I was electrocuted back in 2007 and ended up with CRPS as result. Was type A person and kept working through treatment and two spinal cord stimulators. I was awarded Lifetime Medical and reject offers to settle repeated. I finally allowed WC to put offer on the table because I'm sick of the system. My question is will the ACA require my PI insurance to cover my maintenance to the SCS's in the future. I've contacted them and went as far as given the procedure billing numbers and was told they would "consider for coverage'. I'm not trying to double dip I just want back control of my own health. At the beginning of the call I explained that a settlement was offered and asked if there was a way I could add a rider to the policy at additional cost that would ensure coverage. The response was it wasn't needed and I would be covered. I want to believe this but also don't want to take the settlement and regret it in a few years. Any help would be appreciated.
 
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#2
Are you on Medicare, or is this a private insurance?

There has been much debate on this and my response is I do not know. I have read articles on this subject and no one seems to know at this time. It may have to be litigated in the courts before we know.

I would request a complete copy of your private insurance policy, and see if it covers it. That is my nest answer if it is private insurance. If it is Medicare, then you would need a MSA.

Are you from California?

I do not recommend closing out your ml with RSD, unless you know 100% it is covered by the private insurance carrier.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#3
(08-22-2014, 07:17 PM)California_Help Wrote: Are you on Medicare, or is this a private insurance?

There has been much debate on this and my response is I do not know. I have read articles on this subject and no one seems to know at this time. It may have to be litigated in the courts before we know.

I would request a complete copy of your private insurance policy, and see if it covers it. That is my nest answer if it is private insurance. If it is Medicare, then you would need a MSA.

Are you from California?

I do not recommend closing out your ml with RSD, unless you know 100% it is covered by the private insurance carrier.

 
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#4
It's private insurance (blue cross/blues shield through state of Va). I'm 43 so awhile before I hit Medicare.
I live in NC but work in VA if that helps.

I too have read differing opinions, views etc on whether PI must cover settled claims now that ACA is law.

I'm not looking for a windfall just want to control my own care. My company has changed WC carriers now so I don't have the leverage (I was an officer of company at one time) that once had.
Thanks
 
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#5
Don't worry about double dipping, the ins. comp. rip us off everyday.

I too have rsd, have had 5 spinal cord surgeries, and they want me to sale my
FM also. they did a MSA it came back over $800.000 They changed their minds.

In California, the injured worker is only transferring responsibility to state instead of ins. comp.

Why would I let them off the hook?

They haven't paid me a penny, in 8 years.

After 2 years of td, they cut you off, and make the state pay, via ssi disability.

Why are they allowed to do that? I never worked for the state.

Ins comp. with their lobbyist, that's how.

Seems like the company I worked for, should be responsible for their injured workers.

Still trying to figure out if I get o-stupid care, will that satisfy medical set aside.
 
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#6
(08-22-2014, 09:27 PM)dolphins Wrote: Don't worry about double dipping, the ins. comp. rip us off everyday.

I too have rsd, have had 5 spinal cord surgeries, and they want me to sale my
FM also. they did a MSA it came back over $800.000 They changed their minds.

In California, the injured worker is only transferring responsibility to state instead of ins. comp.

Why would I let them off the hook?

They haven't paid me a penny, in 8 years.

After 2 years of td, they cut you off, and make the state pay, via ssi disability.

Why are they allowed to do that? I never worked for the state.

Ins comp. with their lobbyist, that's how.

Seems like the company I worked for, should be responsible for their injured workers.

Still trying to figure out if I get o-stupid care, will that satisfy medical set aside.

 
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#7
Are you saying that if I go on Social Security/Medicare that my insurance company for my workers comp will be off the hook to pay me. I haven't seen a penny yet from them. I am on state disability at this time, but worried about money when my state disability runs out. Northern California.
 
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#8
052614, No that is not correct, your work comp carrier will not be off the hook if you apply for SSDI.

If you have not been receiving payments from work comp, your injury is denied and I recommend hiring a work comp attorney ASAP.

You should also apply for SSDI if your injury will cause you to not be able to work for a 12 month period, which it appears it has.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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