Workers Compensation, do they frown on closing out the Medical Treatment for the workers to do themselves?

Asked over 1 year ago - Oxnard, CA

Do insurance companies settle the medical portion of a case and allow the worker to seek out treatment on their own? A higher than usual medical case value, would my insurance company consider allowing me and my wife to become the managers of my treatment? Closing the book on this chapter of my life might be empowering, do insurance companies close out the medical part of the claim or would they rather pay my bills (age 38 currently) for the next forty or fifty years?

Is there a "sweet spot" to settle my medical and treat myself with other methods? I can deal with either method but I want to say Good Bye to my insurance and closing out the medical would bring closure. Do insurance frown on C.R.?

Thank all kindly for answering in advance, your the best!

Attorney answers (5)

  1. George Ellis Corson IV

    Contributor Level 20

    1

    Best Answer
    chosen by asker

    Answered . The Insurance would love to close your case, but you are not going to get the full value of your perceived future medical needs. You can perhaps double the value of your claim by settling your FM. It might be slightly more or slightly less depending on your needs, but it won't be the full value. The WC carrier has about a half-dozen ways to control your medical costs, so it is perhaps worth a 60% discount to them to settle. I hope it works out for you.

    We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY... more
  2. Brett A. Borah

    Contributor Level 20

    1

    Lawyer agrees

    1

    Answered . What you are talking about is called a Compromise and Release, or C&R. The insurance does it all the time as they would love to close their books, know their exposure and be done with you. The value is more art than science but, as the astute Mr. Corson indicates, you won't get full value of what the lifetime medical will cost....you may die early, you may get better, you may have other insurance that will pay the bills, they may have ways to deny various treatments, etc.

  3. Nancy J Wallace

    Contributor Level 14

    1

    Lawyer agrees

    1

    Answered . I tell my Injured Workers this type of resolution is the same as a Divorce ... the insurer comes up with only the smalles amount possible to make you go away forever.

    My Learned Colleagues left out: MAKE YOURSELF REALLY EXPENSIVE TO KEEP!

    I mean get to as many treatments and get as many specialist consults and get as many braces and therapies and prescriptions (or, at least get them requested over and over) BEFORE YOU SUGGEST closing out future medical rights for cash.

    Ask for a Sleep Study because the injury symptoms wake you up all night. Ask for a Pain Management consult. Ask for a prescription for Elavil (anti-depressant) prescription because it doubles your pain tolerances and assists with regular sleep patterns.

    Instead of buying your own ibuprofen and pain patches, beg the treating doc to write prescriptions for these.

    You might have to change Treating PHysicians to a new doc within the Medical Provider Network who will write Requests For Authorization for ongoing treatment.

    When the Utilization Review physician writes 'non-certified' on each request, Appeal each Non-Certification over and over. (Don't get your panties in a big bunch when the denials come in the mail.)

    Maybe even write the Adjuster that if she doesn't approve treatments you'll be forced to get counsel for a hearing on penalties for unreasonable refusal to provide treatment timely.

    ALL THAT will make the adjuster really want to get rid of you!

    AFTER you've made certain the adjuster is getting lots of reports and requests for authorization and bills on her desk, ONLY THEN suggest surrendering all your future rights for New & Further Disability and Future Treatment for cash in a Compromise & Release Agreement.

    Happy Strategizing.

  4. Bonnie Jean Binder-Wilson

    Pro

    Contributor Level 5

    1

    Lawyer agrees

    Answered . Sometimes the best way to gain peace of mind is to settle with the insurance company. As the other responders mentioned you will not got over-the-counter prices in your settlement. But if there are sufficient funds available to close out the case you could then purchase your own insurance policy. There is a company that manages future medical care through a structured settlement. This company is able to reduce the over-the-counter prices to those of medicare, thus saving you considerable in future medical costs. There is also the question of whether or not you are on medicare. You may need to speak with an attorney.

  5. John M Connell

    Pro

    Contributor Level 19

    1

    Lawyer agrees

    1

    Answered . I cannot answer your question with regard to calif cases but If you are in a position of needing long term care and want to settle I strongly urge you to seek out an experienced workers compensation attorney. They can answer this question but also can make sure you are protected in any settlement. There sare issues involing medicare that need to be consideredin this type of settlement in most states that are important.

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