08-12-2016, 08:49 PM
State of California. 48 years old.
My attorney met with the IC attorney for a status hearing on Aug.2 and he told me that things were moving along really well and the session was productive. He said the IC attorney is willing to do a C and R and things could be finalized if all goes well by end of December.
(I am not sure what my PD rating is as the Rater was not in attendace on Aug 2nd at the courthouse – but my WPI rating before any prior injuries were factored in was 45%)
Factored into the AME Drs final assessment for future medical care is that I may need Lumbar surgery. He did not specify which kind. I understand that there is a scale that is used to equate the surgery to a cash price that is below what one might find outside of the work comp world.
I have cervical and thoracic issues as well but the bulk of the future medical seems to be dedicated to my lumbar issues which are: 2 mm disc bulge at L4-L5, 5 mm disc bulge at L5-S1. Moderate to severe foraminal encroachment on the left L5 nerve root, small annular fissue at L4-L5 and small annular fissure at L2-L2.
I understand that by signing the C and R, it could potentially be very damaging to me if I end up needing lumbar surgery down the road and I have not set aside that lump sum settlement for it.
If I take the C a nd R and I have private insurance, and somehow God forbid down the road, I re-injure the low back, either in a car accident, or something that causes the disc to come out more, do private insurances consider that a new incident, therefore not a pre=existing condition?
Right now I am getting chiropractic care, pain meds, etc for my low back, all covered through my private insurance. So I am curious if the need ever arose in 3 years or so for me to have lumbar back surgery, if they would put up a stink. I understand every insurance company is different but I am just trying to get a lay of the land.
The Utilization Review process and request for treatment are so incredibly tedious and unproductive, that to settle my case leaving the Future medical Open, is not something I want to do. The bureaucracy involved in getting anything approve d is just too much to handle. Because nothing gets approved.
My attorney is very much wanting and pushing for the C and R and also doesn’t’ really get too involved in the “what if” questions. So I am hoping someone out there may have some experience or know someone who settled for C and R, and ended up needing surgery and having it covered by their private insurance.
Thanks!
My attorney met with the IC attorney for a status hearing on Aug.2 and he told me that things were moving along really well and the session was productive. He said the IC attorney is willing to do a C and R and things could be finalized if all goes well by end of December.
(I am not sure what my PD rating is as the Rater was not in attendace on Aug 2nd at the courthouse – but my WPI rating before any prior injuries were factored in was 45%)
Factored into the AME Drs final assessment for future medical care is that I may need Lumbar surgery. He did not specify which kind. I understand that there is a scale that is used to equate the surgery to a cash price that is below what one might find outside of the work comp world.
I have cervical and thoracic issues as well but the bulk of the future medical seems to be dedicated to my lumbar issues which are: 2 mm disc bulge at L4-L5, 5 mm disc bulge at L5-S1. Moderate to severe foraminal encroachment on the left L5 nerve root, small annular fissue at L4-L5 and small annular fissure at L2-L2.
I understand that by signing the C and R, it could potentially be very damaging to me if I end up needing lumbar surgery down the road and I have not set aside that lump sum settlement for it.
If I take the C a nd R and I have private insurance, and somehow God forbid down the road, I re-injure the low back, either in a car accident, or something that causes the disc to come out more, do private insurances consider that a new incident, therefore not a pre=existing condition?
Right now I am getting chiropractic care, pain meds, etc for my low back, all covered through my private insurance. So I am curious if the need ever arose in 3 years or so for me to have lumbar back surgery, if they would put up a stink. I understand every insurance company is different but I am just trying to get a lay of the land.
The Utilization Review process and request for treatment are so incredibly tedious and unproductive, that to settle my case leaving the Future medical Open, is not something I want to do. The bureaucracy involved in getting anything approve d is just too much to handle. Because nothing gets approved.
My attorney is very much wanting and pushing for the C and R and also doesn’t’ really get too involved in the “what if” questions. So I am hoping someone out there may have some experience or know someone who settled for C and R, and ended up needing surgery and having it covered by their private insurance.
Thanks!