Has any one settled with open medical and not been able to get treatment?

[Confusedd]

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I am in the settlement process, I have been told by several persons inlcuding my attorney that even if i settle this with open medical it is amost impossible to get treatment.

They make all of this very confusing for most of us.

I am just wondering if any one has settle with OPEN medical and been able to get the treatment they needed.

Or, is it true even if you settle with Open medical it is still almost impossible to get the treatment you need.

Thanks
Confusedd

[frustratediw]

The problem that we are faced with is that the IC still controls the treatment. Their pattern of delay delay deny does not end just because there is a settlement. So yes in many cases it does become, if not almost possible, very difficult.

So far in my own experience I have been getting treatment after settling. Of course I also began filing numerous audit complaints against the IC for their delays. They have so far been found guilty of at least one of them. A costly situation that seems to have gotten their attention, at least for now. As time goes on I expect that things will become more difficult again. Fortunately I have some very good doctors who have and continue to fight for me.

[ksgirl]

I think I am getting close to settlement time and I am worried about the exact same thing. My dr put me at MMI then I went back to work. When he put me at MMI, I didn't think my back was fixed right, but after working it's even worse than it was. Now I am having a terrible time getting wc to let me go back to the dr. If it's this bad now, how hard will it be to get treatment after settlement? I am going to try to remember to ask my attorney some of these questions. I'm almost thinking I would be better off to close medical and pray!

[Bummer Knees]

My sister has the same wc attorney as I do. She has had several wc claims and settled with medical left open. Each time she needs treatment it is back to court for approval.
She did have a cortisone shot recently that was approved without going to court.

My attorney tells this is the norm for Kansas.

[Confusedd]

Bummer Knees Wrote:My sister has the same wc attorney as I do. She has had several wc claims and settled with medical left open. Each time she needs treatment it is back to court for approval.
She did have a cortisone shot recently that was approved without going to court.

My attorney tells this is the norm for Kansas.

Bummer Knees,

Are you saying even after settling with open medical you sister has to go to court for treatment?

Wow, that seems so crazy, even if you settle with open medical, they still try to control the rest of your life?

Pretty scarry.

[lfoster21]

I don't know if this is the same thing, but when I 1st got my lawyer and she filed the paperwork to notify the state that I had a w/c case, there was a hearing. I was just expecting the courts to acknowledge receipt of the paper work...but rather there was actually a hearing & both sides had to submit all the Dr. reports that they had. Then the Judge made a determination that the I/C had to pay my medical for life (which, in VA, is defined as 10 years, not my actual life). So that was determined by the courts at the beginning of this whole ordeal and not at MMI. The 1st 2 1/2 years they accetpted everything with 2 procedures where we had to take them to court. However, since last April, they fight everything. I am now waiting for multiple court dates, to have 3 different procedures done. (I have no idea what will happen when I do get to MMI...I don't know how much worse it can get.) I have heard from 2 friends who have already settled and they both said no matter what, do not get rid of the medical. Even though I might have to wait or have to go to court, I think about what would happen if I need another surgery and my mdeical was closed...Even if I had reg. insurance that would cover it, how much of an 80,000 surgery would be my share...I don't think I ever have that kind of money.

I wish you the best.
Good luck and keep us updated.

[Confusedd]

lfoster21 Wrote:I don't know if this is the same thing, but when I 1st got my lawyer and she filed the paperwork to notify the state that I had a w/c case, there was a hearing. I was just expecting the courts to acknowledge receipt of the paper work...but rather there was actually a hearing & both sides had to submit all the Dr. reports that they had. Then the Judge made a determination that the I/C had to pay my medical for life (which, in VA, is defined as 10 years, not my actual life). So that was determined by the courts at the beginning of this whole ordeal and not at MMI. The 1st 2 1/2 years they accetpted everything with 2 procedures where we had to take them to court. However, since last April, they fight everything. I am now waiting for multiple court dates, to have 3 different procedures done. (I have no idea what will happen when I do get to MMI...I don't know how much worse it can get.) I have heard from 2 friends who have already settled and they both said no matter what, do not get rid of the medical. Even though I might have to wait or have to go to court, I think about what would happen if I need another surgery and my mdeical was closed...Even if I had reg. insurance that would cover it, how much of an 80,000 surgery would be my share...I don't think I ever have that kind of money.

I wish you the best.
Good luck and keep us updated.

Thanks for all the input, I sounds like it is going to be a hard decision either way.

I heard that even if we do settle with future medical the insuranc company makes it almost impossible, just like everything else.

Confusedd

[1171]

Under california work comp laws all medical treatment has to meet utilization review criteria, even where it's part of an open medical award.
Treatment is also thru the carrier/employers Medical provider network.