[QUOTE]Originally posted by Mariaa:
My WC claim was in 1982. I was awarded what was called "Lifetime" Future Medical Benefits but I've been told several times from Claims Adjustors it is just Future Medical.
Anyway, until recent CA.reform with WC, these benefits served me quite well. Pretty much what was ordered was authorized. Now it's nothing like that. Everything goes through Utilization Review (like an HMO).
After all these years with Future Medical I'm pretty much being advised that a beneficial idea to me would be to settle my claim.
I know that the insurance company of course has a vested interest in this happening...
What I wanted to get to bring this back to is that in 2003 when I became eligible for Medicare benefits, I had to sign a waiver or release form stating the injury to my low back was being covered by WC and Medicare wouldn't cover this part of my spine.
So this much I'm aware of... right now the Claims Adjustor is talking about the option of settling the claim and Medicare set aside benefits. From what I can decipher, the amount I'm going to be offered isn't enough to last my entire lifetime with the current pain situation I have, but would probably cover a future surgery ?? but I have to have a plan from a surgeon (have had 3 surgeons propose surgery but none written the right way for whatever is going on in WC's mind..) of what is proposed and Pain Management care afterward...
Really given the fact the surgery could be a success, partial success orpartial or complete failure means there's much room for variation there..of course not to WC. Often one spine surgery begets another ...While I can't see having to fight for every epidural I need to have 3x/year (that is a conservative amount), I have to wonder if this settling out is the way to go or not... I imagine lowball figure is what would fly with a WC settlement~
When one settles out Future Medical, I think it would be advisable to retain an attorney but the Claims Adjustor said that I will get the same amount one way or another, and that hiring the attorney will cut off around 15% of the award... still seems worth it if it's going to make sure everything is done correctly and to best benefit me...
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