[footballfan]

(07-24-2018, 07:48 AM)goingback Wrote: footballfan, As you probably know you are further along in the process than many. It takes many over two years to reach MMI in NYS WC (per NYS Medical Guidelines) http://www.wcb.ny.gov/content/main/hcpp/...tGuide.pdf , then could take years to be rated not to mention there are many that take years and years to settle.

SSDI is a federal program. WC is a state program. Two separate entities. The only thing in common with both is your injuries. They have different rating factors as you probably know speaking with your attorney. Your injuries "bolster" your claim .

All the best.

I'm in no rush to get rated to be honest. As long as the temporary payments keep coming. But at my last IME, the carrier requested permanency...but the IME wasn't prepared to give it yet. But he did write in his report that he would at the next one in 4-6 months. So it does look like my case is nearing an end. I'm no longer receiving PT and surgery is not an option. The only medical care that I get now is routine re-exams with my primary and appts with my pain management guy.

And I truly do understand the distinction between the two. I just can't figure out why. I do understand that they rate things differently...but in my mind, the SSDI ruling that I can't perform SGA equates to 100% LWEC in the WC world.

Unfortunately...that's in my mind. LOL.

Yeah...that talk with my attorney down the line will be quite the interesting conversation.

Maybe he could do one of those scenes on "Law and Order" where the attorney says something and then say "withdrawn." LOL

[redsoxfan]

My pain management doctor who oversees my multiple injuries has me at 85%. The comp board has me at 100% TTD because I just had a spinal cord stimulator implanted in March and I’m not at MMI yet. My case is pretty complicated because the carrier has appealed the courts decision that they are responsible for the SCS surgery and all medical bills associated with the surgery. The last IME I saw even stated that this surgery was necessary. So now I’m going through the appeals process which takes 6-8 months. My lawyer says if I accept the settlement offer the carrier will pay all those medical bills associated with the surgery. I’m not sure what I should do but I have an appointment with my lawyer this week. I’m worried if I take the settlement before I’m at MMI and something drastic happens to me in the next 6-8 months I have nothing to fall back on.

[1171]

Some things to think about:
check into your health insurance options; See what’s available and how much will it take to cover the premiums.
Sounds like it might be a high cost settlement. If so, Look into a structured settlement (carrier purchases an annuity that pays you but for IRS purposes it’s still comp $$ and immune to taxes).
Once your PD has been established and atty fee paid you may not have your attys undivided help in any future medical issues.

[footballfan]

(07-24-2018, 04:42 PM)redsoxfan Wrote: My pain management doctor who oversees my multiple injuries has me at 85%. The comp board has me at 100% TTD because I just had a spinal cord stimulator implanted in March and I’m not at MMI yet. My case is pretty complicated because the carrier has appealed the courts decision that they are responsible for the SCS surgery and all medical bills associated with the surgery. The last IME I saw even stated that this surgery was necessary. So now I’m going through the appeals process which takes 6-8 months. My lawyer says if I accept the settlement offer the carrier will pay all those medical bills associated with the surgery. I’m not sure what I should do but I have an appointment with my lawyer this week. I’m worried if I take the settlement before I’m at MMI and something drastic happens to me in the next 6-8 months I have nothing to fall back on.

I know 100% what I would do. But I'm not you and I don't know your whole situation. But I will give you some food-for-thought.

1) Your pain guy should have you at 100%, even temporarily, especially if the Board has you there. Small issue in the scheme of things.

2) If the IME stated that you needed the surgery and the judge already ruled in your favor...I can't imagine how that decision would ever get overturned by the appeals panel. Like we've already said here...SS and WC are two different animals. Overturns are common in SSDI. Not in NY WC. And the appeals panel will only overturn if the judge did something wrong in regards to WC law. They will not judge his opinion, just that he didn't violate any WC rules coming to that decision. And most of the NY judges are very good at what they do, which is why they don't get overturned often.

3) Unless I'm mistaken, even if the ruling was to be overturned...wouldn't you then be able to submit those bills to your regular insurance company for payment?

4) I guess the big question you have to ask yourself from a financial point of view is what do you think your % disability will be when you reach MMI? And if the carrier is willing to pay your medical bills in an agreement, then they should also have to be on the hook for future medical costs in regards to your injury. Unless they are trying to get you to give that up too.

5) You do indeed have a complicated case. And hopefully your attorney is acting in your best interests, not just for a expedited pay day. If you do decide to consider an offer after you speak with him...at the very least, you can ask him to try to negotiate your % higher than the 15%. And you really need to have a discussion about your future medical costs due to this injury. I believe it's possible that if you agree to no future medical...you may be on the hook for future bills out-of-pocket. Not sure about that...but something you should definitely investigate before signing on the dotted line.

6) Oh, and don't forget...it can take a very, very long time to reach MMI. And during that time you'll be collecting weekly checks the whole time and they will not count towards your final ruling.

[goingback]

redsoxfan, It's complicated. To add to what footballfan's comments you also have to think about the possibility of a MSA (Medicare Set Aside).
https://www.cms.gov/Medicare/Coordinatio...rview.html

It's rough going through all this while in pain and having to deal with the changes in life. This site helps to fill some of the pieces of the puzzle.

All the best.