Medical Buyout

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Latest post Wed, Apr 2 2008 3:54 PM by stevepsca. 2 replies.
  • Wed, Apr 2 2008 2:12 PM

    Medical Buyout

    I live in Ca and work for the county. I am planning on moving out of state in a few months. Retire from my job. I have 3 cases, 2 of them settled, one not. I was told the insurance prefers to settle everything including a buyout of lifetime medical for my lower back, Is this possible, any estimate on money? My new case will still cover my lower back, I plan to keep the future medical on that one.\Please advise
  • Wed, Apr 2 2008 3:31 PM In reply to

    re: Medical Buyout

    terms can be confusing especially words like "settle".
    I suspect you have finalized 2 claims with a stipulation and award and are planning on doing the same with the 3rd. You are inquiring about buying out the future medical of the prior stipulations.
    "Preference" really depends on the situation.
    If there is little or no medical activity and the PD has been paid out on the prior stipulated claims, there is little incentive for the carrier to buy them out -- especially if they also encompass back treatment for which they will continue to have a open medical award. They won't want to pay twice for the same benefit.
    Unless you're willing to C&R all the claims there's not likely to be any interest in the older ones.
    If you are represented, you should discuss it with your atty; treatment out-of-state under california UR and fee schedule could be problematic.

  • Wed, Apr 2 2008 3:54 PM In reply to

    Feedback [*=*] re: Medical Buyout

    While it is difficult to find doctors out of state to agree with the reporting requirements of calif WC, they are not subject to the Calif fee schedule...but that still doesn't make it any easier.

    The thing to keep in mind, as you say you are retireing soon... IF you are Medicare eligible within 30 months...through age, disability or application (for SSDI) you must take Medicare interests into consideration when there is any type of settlement to your claim. Particurlarly where you entitlement to future medical is affected.
    There are some new laws going into affect next year that makes this even more important.

    IF there is an issue to Medicare... you must submit a WCMSA to CMS/Medicare and they will tell you IF your need a setaside account and HOW MUCH will be required to satisfy CMS.

    As to your question on 'how much money?"

    There is no way to even guess to that.. one, you don't provided enough information... and two, more importantly... there is no way to tell what an IC will do when it comes to a SWAG..or "Scientific Wild Ass Guess"...(an accepted term at many WCAB offices these days)
    FM is always up in the air...and usually paid in "todays dollars'', and never enough to begin to cover any treatment you may require...
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