Settlement Decision

[huntfun]

We are trying to make a decision concerning settlement offer. My husband was injured in April (torn cartilage in knee). Had arthroscope surgery in June-rehab for 3 mos. Back to work in September with continued pain. Had cortizone shot in October-almost all pain gone now(only occasional). Released by DR in November with no restrictions. Received 10% PPI to the lower extremity with offer of $10K which is 1.25 times the rating and open medical for life.
Is this a good offer? How do you decide? If we decline, what happens then? Can we get an offer with closed medical? We have been told that in that case we would still have 1 year of medical. If we go that route, and he develops trouble with knee after 1 year, will our personal insurance cover it, how does this work, how would ins. co. know the difference or would they care? Please help with info. We are in TN.

[Bad Boy Bad Boy]

Sounds like the normal settlement, plus add on the open medical.

[lfoster21]

I have always been told not to accept closed medical because you just never know if you are going to be re-injured. Now if the injury was one that you think is completly heeled and is very unlikly to need further treatment...then I guess it might be ok. But I know one surgery for me is 80,000.00 and my reg. insurance would not touch it.

I do't know how they do it, but I know your reg. insurance can find out if your claim is W/C, because I have been turned down by my ins. (I did not mention it to them, but they figured it out.)

Good luck.

[mistreated]

All Hospital, WC, and Surgeries are accounted for by your SS# and there is a clearinghosue of such that Ins./WC/Physicians can check and see what your status is or what has been done to you. It is one of the checks Life Ins companies do when they are screening you.

[AQA]

Is that info being recorder elsewhere???

[Pooh]

AQA

I have no idea, the only time my health insurance has ever questioned any treatment on my shoulders is when WC first denied the claim and they were faxed the letter that they were denying any further treatment for the shoulder. Since then the only other thing I have had to fill out was why I needed an MRI of the shoulder - standard for our health insurance actually.

My understanding from my health insurance is that it's recorded according to code number that they bill under. So if you have a lumbar sprain it's code is one thing and that is what it is coded, where has a shoulder strain is something else. At least that is how my health insurance looks at the billing and does the auditing. I am not sure if there is a code for work related injuries or not.

[huntfun]

Thanks to everyone that replied. This has been one of the more challenging situations to deal with for us. Sorry to seem so uninformed. It sounds like the best thing for us to do is make sure we have open medical. I was hoping that maybe after a period of time, our ins would cover it in the future, but I guess that's not the way it works. So now the only concern is: are we being offered a decent deal? We have no idea what is considered good or bad.

[ksgirl]

Have you checked your state website to see if you can find out how they figure settlements? The Kansas website shows you how to figure what the settlement would be.

Call your insurance company to see if they will cover w/c injuries after settlement. Most don't, but you never know. I wish you the best of luck!

[AQA]

I think that is great advise KS. I have seen the question regarding open medical quite a few times over the years. I never really paid it much attention because I knew my medical ( for the injury ) would be for life.

I do recall reading reading several insurance policies at work, they all had one thing in common. The insurance would not cover any pre-existing condition that had been treated until one year had passed.

[capricorn]

Although, AQA that clause can be waived, it does pertain to most personal health insurance plans. If you switch froma BC to another BC it is waived and most if there is not a lapse in converage for more than either 30-60 days they'll waive it. As far as a WC injury goes my understanding is that no insurance will pay for any treatment once it has been accepted and paid on by the WC IC. I have investigated this all I can so if anyone has ever found a clause or exception to personal insurance paying on a WC injury AFTER it has been accepted and paid on by the IC please pass it on. I understand that most insurance will pay for WC injuries IF the claim is denied, been there for over a year and hubby was for 4 years BUT once the WC IC picked up the case our personal insurance is out of the picture for any WC injuries.

God bless all,

CAP