Pegnim & Ivancich, LLP » Medical Care

The New Health Care Reform

caitlin — Mon, 17 May 2010 18:54:39 +0000

The Health Care Reform Legislation recently passed in Washington DC will significantly impact our clients. By October 1, 2010, Insurance Carriers will be required to offer insurance coverage for dependents up to age 26. So, your children will now be eligible to stay on your insurance until they are 26. No longer do your children need to stay in school to be covered. Coverage now is based upon solely on age. It is also important to note that marriage is not a factor that would exclude your children from your policy. As long as your child is under age 26, they can be covered on your health plan, whether they are married or not. The spouse of your child would not be eligible for coverage.

For our younger clients who do not have health insurance, it is important to discuss coverage options with your parents. Changes to the Workers’ Compensation Laws have made it difficult to get much needed medical care on a timely basis. Sometimes coverage through private health insurance is necessary to obtain treatment. The Health Care Reform Legislation may make a difference.

Lisa E. Ivancich

This is a Stick-Up! Your Money or your Future Medical?!

caitlin — Tue, 11 May 2010 14:58:09 +0000

Fist of all, if you’re at this point in your workers’ compensation claim where you have to answer this question, congratulations! You have most likely already had your deposition taken and have been to multiple medical evaluations. You are now at the settlement stage. However, there are 2 types of settlement: Stipulations with a Request for Award (Stips) and Compromise and Release (C&R).

Stipulations (a fancy word for “agreements”) with a Request for Award is a settlement that allows for the future medical care associated with your work injuries to remain open. In other words, the workers’ compensation insurance carrier still has to pay for your medical after you sign the settlement. In fact, they will be on the hook for it as long as you need it (it’s lifetime medical, but only on the work injury). However, they can still send treatment requests from your doctor through Utilization Review (UR), which is where they determine to reject or deny a particular treatment based on their determination of the treatment’s “medical necessity.” In other words, even though the medical care is left open, they can still review it and deny it if they don’t think it’s necessary. Also, with a Stip settlement you can re-open your case within 5 years from the date of injury if you feel that your work injury has gotten worse and has resulted in new and further disability since the settlement.

The Compromise and Release (C&R) is where the insurance company issues you a tax free lump sum check in exchange for being relieved of liability (taken off the hook) for future medical care associated with the work injury. In other words, the benefit to you is that you receive all of the settlement money at once, while the benefit to the insurance company is that they no longer have to worry about paying your doctors. The lump sum check often takes into account the benefits associated with your permanent disability, the estimated cost of your future medical care, and the value of giving up the right to reopen your case. Lastly, if you are still working at the job you got injured at, the employer most likely will not be agreeable to settling by way of C&R. The reason is because of you settle by C&R and go to work the next and injure the same body part, they are on the hook again for medical treatment of that body part. It defeats the purpose of them agreeing to enter into that type of settlement; not having to be liable for the medical care in the future.

Which one you choose is of course ultimately your decision to make. If you know that you are going to require a lot of medical treatment because of the injury and do not have any other type of insurance, you will probably lean toward leaving the future medical open. If you do not get a lot of treatment or are getting by without it and don’t anticipate it being a problem in the future, you might want to settle with a C&R.

By RODMAN J MARTIN, esq

More Paper for Medicare

caitlin — Tue, 02 Feb 2010 01:40:00 +0000

As your workers’ comp claim comes to a close (it does actually happen), you may be asked to provide information to the insurance carrier regarding Medicare information. This will most likely be the case if you have a lot of life experience (are older). If you’re young the only time it would typically be requested is if you are suffering from kidney failure.

The bottom line is you will have yet one more form to fill before you can put your claim to bed. This is because the federal government wants to know how much money has been allocated for the future medical care of your work injury. They do not want to pay for something that is considered in the settlement of your workers’ comp claim: the cost associated with your future medical care.

This is all to “coordinate benefits” between Medicare and the workers’ comp insurance carrier. Remember, in workers’ comp you are receiving benefits associated with your injury, not damages like in a personal injury lawsuit.

If you are presented with a “Medicare questionnaire form” don’t panic. Simply read the instructions and fill it out. You only need to provide your social security number if the Medicare claim number is unavailable. You will be required to sign the form before you send it in.

To summarize, if you are less than 65 and have been receiving Social Security Disability for 2 or more years, or if you are 65 or older, or if you are suffering from kidney failure, Medicare is going to want to know about your workers’ compensation claim.

Rodman Martin, Esq