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attorney pushing to settle/threatened to dismiss me (CA)
#11
for california coverages: i wonder what theDepartment of Managed Health Care's position is on post comp settlement coverage?
https://www.dmhc.ca.gov/AbouttheDMHC.aspx#enforcement
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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#12
(08-02-2019, 02:17 PM)Shadow Wrote:
(08-02-2019, 11:37 AM)California_Help Wrote: Show me one post on the internet where an injured worker's attorney was not able to use their private insurance after a C&R and I will believe your attorney. So far I have not come across one injured worker who stated this.







ACA has a lot to do with it as it is against the law for private insurers to deny coverage on a pre-existing condition. With a closed work comp case you no longer have a work comp case. You have a pre-existing condition.(IMO)

These are attorney's responding on this link.

https://www.avvo.com/legal-answers/can-i...80275.html

You can do whatever you want and not use private insurance after closing your claim. That is up to you.

One lawyer says to withhold material facts ...Lol.

Pre existing injuries or illness that did not arise out of the course of employment are covered under the ACA.

Just make sure to call the private insurer and let the non mpn doctor know the exact circumstances .

The ACA remains silent on a private insurers right to reimbursement.

Contacting a new doctors office about a prior work comp claim that is closed can cause confusion with the doctors office, especially if they are not well versed on what a closed work comp case.

Private insurers have no right to reimbursement for a prior work related injury that is completely closed, from the injured worker. Private insurance is not Medicare.

I have provided links that back up my assertions about this topic Shadow on this string and others you have commented on. Can you provide one source of info that states you cannot use private insurance after closing a work comp case completely?
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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#13
https://www.workerscompensation.com/foru...532&page=4

Shadow do you remember I called your private insurance last year and was told they cover injuries on a closed work comp claim (not open medical)? Anyone can call and check. It takes 5 minutes and no need to go round and round on a forum.
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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#14
I have Medicare.

Wonder why the OP said he/she cannot get it covered through private insurance . I would be interested to hear why not ?

This law firm says no way : https://www.rolmlawyers.com/
 
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#15
I'm on SSDI.. have Medicare and Aetna... as long as my medical stays open, neither one will touch my comp injury. If I close out medical, that money has to be set aside and used for that injury... ONLY when that money is gone will my other 2 start paying....
Believe me... with the denials I have gotten from the Carrier, I asked the other 2 if they would cover it and nope...
 
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#16
(08-06-2019, 06:23 AM)tbear6410 Wrote: I'm on SSDI.. have Medicare and Aetna... as long as my medical stays open, neither one will touch my comp injury. If I close out medical, that money has to be set aside and used for that injury... ONLY when that money is gone will my other 2 start paying....
Believe me... with the denials I have gotten from the Carrier, I asked the other 2 if they would cover it and nope...

Same situation here I have Medicare and on my wife's Blue Cross plan. Workers comp is the primary for the industrial illness / injury.

I was told the exact same thing from both carriers . Actually Medicare keeps checking / updating my medical benefits ( online account ) to make sure the WC policy/ open medical is active .

The Blue Cross policy clearly excludes work related conditions and requires a notice if they are covering a third party claim within 60 days. So they can seek reimbursement if necessary.

I have 3 insurances , WC open med, Medicare, and Blue Cross and cannot get coverage .

God Bless America
 
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#17
You will have problems until you close your work comp claim.
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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#18
Exclusions

" Even if you do not claim those benefits "

Any conditions for which benefits are recovered or can be recovered either by adjudication, settlement or otherwise, under any workers’ compensation, employer’s liability law or occupational disease law, even if you do not claim those benefits.

See here : https://www.anthem.com/wps/portal/ca/foo...ations&
 
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#19
Medical is a benefit.
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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