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Workers Comp, BC/BS and Medicare
#21
(03-07-2018, 10:51 PM)California_Help Wrote:
(03-07-2018, 03:57 PM)Shadow Wrote:
(03-07-2018, 12:53 PM)California_Help Wrote:
(03-07-2018, 05:47 AM)Shadow Wrote: https://www.dolmanlaw.com/risks-associat...-injuries/

You do understand in that link they are talking about OPEN work comp claims, not closed.

Yes and they are in Florida.

I just made an appointment with my attorney to discuss selling my medical , picking up a private insurer , having the recommended work related surgery ( joint replacements) and then possibly dumping that insurer. Or maybe keeping them I dunno? Could always put it on another carrier at a later date if needed I guess .

Let you know what he says. Appointment next week Thursday. My Lawyer was admitted to the bar in 1978 and Board Certified in Workers Comp

I want money !! and I want a private insurer to pick up my medicals since I closed my claim .He gets 15 % of the sold medical . I have had alot of surgery. A C and R ,should fetch at least 50 grand ..they offered 57 some years ago. I turned it down ..boy was I stupid. He and I both can now jump on the gravy train.

Everyone else is doing this ..why cant I ?Take a few of these messages with me to show him this can be done. Explain that the ACA pre existing condition clause is the supreme law of the land. Once the claim is closed ,medical is sold off, private insurers must provide health care for the work injuries period !

Actually I am a bit upset because when I had a offer for a C and R ( about 3 years ago) . My lawyer told me that I could not use private insurance after taking a C and R. That's not right! I need that money !

This is cool. I was so exited with this I couldn't sleep a wink last night.

California Help ..do you any advice . Any other citations ? I could be over looking something. Want to be fully prepared for my legal consultation.

What do I do if my lawyer ( once again ) says I cannot use private insurance post C and R for work injuries?

Thanks

Shadow

I follow the advice from my attorney(s).

That's good .

I spoke with my lawyer today and asked about this whole ACA requires insurers to pay for closed work comp claims,where the claimant pocketed the money. He laughed and said this argument holds no weight whatsoever .It comes up from time to time at the WCAB and in his office.

So the answer is complicated as most attorney answers are .. you must account for " all that money first " and you would need to show they are not treating a work injury and the burden is on YOU ! Making false material misrepresentations is flat out fraud. Insurers workers comp exclusions are in full force regardless of the ACA. The ACA has nothing to do with work comp exclusions.

So based on sound legal advice ..I authorized my board certified workers comp attorney admitted to the BAR in 1975 to arrange a Medicare Set Aside with a structured settlement due to the IMR denials. I am very happy with my AA ' s honesty and integrity today. He can get me out of the work comp arena, release the carrier, make a few bucks for himself. I can keep my doctor. Medicare becomes primary after each years settlement payment depletes for that year.

Might be a win win situation here. Never heard of a structured MSA. Lawyer said it can several months to complete this process. I asked for a professional administrator for the funds . Money does me no good actually with my injuries. Need health care more.

I was a bit bummed out . I wanted to sell my medical today and stick it to the private insurers. Buy that new truck .So for now I just keep driving my old Chevy.

There is you answer CA Help. Yea yea i know my lawyer is wrong.
 
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#22
(03-16-2018, 12:25 AM)Shadow Wrote:
(03-07-2018, 10:51 PM)California_Help Wrote:
(03-07-2018, 03:57 PM)Shadow Wrote:
(03-07-2018, 12:53 PM)California_Help Wrote:
(03-07-2018, 05:47 AM)Shadow Wrote: https://www.dolmanlaw.com/risks-associat...-injuries/

You do understand in that link they are talking about OPEN work comp claims, not closed.

Yes and they are in Florida.

I just made an appointment with my attorney to discuss selling my medical , picking up a private insurer , having the recommended work related surgery ( joint replacements) and then possibly dumping that insurer. Or maybe keeping them I dunno? Could always put it on another carrier at a later date if needed I guess .

Let you know what he says. Appointment next week Thursday. My Lawyer was admitted to the bar in 1978 and Board Certified in Workers Comp

I want money !! and I want a private insurer to pick up my medicals since I closed my claim .He gets 15 % of the sold medical . I have had alot of surgery. A C and R ,should fetch at least 50 grand ..they offered 57 some years ago. I turned it down ..boy was I stupid. He and I both can now jump on the gravy train.

Everyone else is doing this ..why cant I ?Take a few of these messages with me to show him this can be done. Explain that the ACA pre existing condition clause is the supreme law of the land. Once the claim is closed ,medical is sold off, private insurers must provide health care for the work injuries period !

Actually I am a bit upset because when I had a offer for a C and R ( about 3 years ago) . My lawyer told me that I could not use private insurance after taking a C and R. That's not right! I need that money !

This is cool. I was so exited with this I couldn't sleep a wink last night.

California Help ..do you any advice . Any other citations ? I could be over looking something. Want to be fully prepared for my legal consultation.

What do I do if my lawyer ( once again ) says I cannot use private insurance post C and R for work injuries?

Thanks

Shadow

I follow the advice from my attorney(s).

That's good .

I spoke with my lawyer today and asked about this whole ACA requires insurers to pay for closed work comp claims,where the claimant pocketed the money. He laughed and said this argument holds no weight whatsoever .It comes up from time to time at the WCAB and in his office.

So the answer is complicated as most attorney answers are .. you must account for " all that money first " and you would need to show they are not treating a work injury and the burden is on YOU ! Making false material misrepresentations is flat out fraud. Insurers workers comp exclusions are in full force regardless of the ACA. The ACA has nothing to do with work comp exclusions.

So based on sound legal advice ..I authorized my board certified workers comp attorney admitted to the BAR in 1975 to arrange a Medicare Set Aside with a structured settlement due to the IMR denials. I am very happy with my AA ' s honesty and integrity today. He can get me out of the work comp arena, release the carrier, make a few bucks for himself. I can keep my doctor. Medicare becomes primary after each years settlement payment depletes for that year.

Might be a win win situation here. Never heard of a structured MSA. Lawyer said it can several months to complete this process. I asked for a professional administrator for the funds . Money does me no good actually with my injuries. Need health care more.

I was a bit bummed out . I wanted to sell my medical today and stick it to the private insurers. Buy that new truck .So for now I just keep driving my old Chevy.

There is you answer CA Help. Yea yea i know my lawyer is wrong.

I listen to my own attorney(s) advice too. Good luck to you.
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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#23
I could be totally wrong about this, I am not a lawyer, but I think that if you are injured on the job by someone who does not work for the same company---a contractor or private citizen---then, in addition to your workman's comp claim, you can also have a personal injury claim against the person or company that caused the accident. You can have both and get paid by both.

I was told this by a law firm in Seattle: https://www.injurytriallawyer.com/practice_areas/

I agree with Shadow. Now matter what you should talk to an attorney to find out your legal rights. But I think you have to distinguish between a workman's comp attorney and an injury lawyer----because their jobs are totally different and the kind of help they can give you is totally different too.

Either way, good luck with it.
 
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#24
No you can’t have both. Workers compensation is entitled to re imbursement from your third party recovery.
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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#25
Dear wguage52,
(I'm replying to the original post, a lot has been addressed here) If she left medical open with her WC case, and her treating physician believes that this is a natural progression from her injury then yes it is my understanding that workman's comp is responsible for treatment. That's why I'm leaving mine open. As far as medicare is concerned I have no idea BUT I have medical and they'll cover most medications related to my injury (because it's easier than the request/review/interrupt med repeat you get from WC). So who knows, but I would hope medicare could help her with this.
"Spread love everywhere you go." - Mother Teresa​
I am not a professional and I live in California. I've been in the system 93 months and counting so I've been around the block a couple of times.
 
Reply
#26
You know that post is over 2 yrs old and poster has not returned in over a year...
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.
 
Reply
#27
LOL >.< I'm super new. I didn't notice. It was just at the top of the injured worker forum for me. I guess there is a continuing conversation I didn't read...
"Spread love everywhere you go." - Mother Teresa​
I am not a professional and I live in California. I've been in the system 93 months and counting so I've been around the block a couple of times.
 
Reply
#28
Didn’t want you to expect a response anytime soon.....?
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.
 
Reply
  


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