My wife's knee was injured on the job 16 years ago to the point it required reconstruction and extensive therapy and injections over the years. Now the knee is worn and hurting so badly she needs a replacement. The insurance company (who just bought her case from the original company last year) is about to make an offer to settle her future medical (and tbh we are weary of having to get approvals every time she needs to see the dr). She is 46 and the future medical is good until she is 65. With rising healthcare costs and at least the looming knee replacement and its subsequent treatment, we believe anything below $500k Would be a bargain for the insurance company. is this realistic? If not what would be a more realistic amount to create a starting point to negotiate this?
Were you previously represented by a workmans compensation lawyer? If so, that lawyer should be willing to assist you in negotiating, or to at least evaluate this for you.
This does not make sense. If the case was already adjudicated, it should not be settled after you were awarded. This is a known insurance scam, where a new company buys up claims and then tries to get the individuals covered off of the roles. There are ways to do it "legally" but you should contact an attorney and if you do contact an attorney, ask them if they work for any of the companies involved. Also, your wife may qualify for disability, which would cover her treatments and is something to look into. You should consult an attorney. This is a common scheme where individuals like your wife are taken advantage of by unscrupulous insurance companies. No one can make you settle if you do not want to settle. Even your own attorney. Don't let anyone acting in self-interest bully you into an agreement that is not favorable to you.
If you have a lawyer assist your wife in her comp claim, contact them immediately to discuss.
Having stated this, I my opinion $500K is not realistic. I am licensed in Alabama and Tennessee, and the highest amount I have heard of a workers' comp insurance carrier paying solely to close meds was $100k.
Generally, I am opposed to my clients closing their right to future medical benefits, because there is no assurance that any personal health care insurance will cover any future treatment, but with changes brought to bear with the Affordable Healthcare Act, pre-existing conditions cannot be automatically excluded, meaning that many injured workers are tired of the hoops they consistently have to jump through just to receive the medical treatment they need, so they go ahead and settle their right to future medical treatment and get what they can. Again, this is not something to do rashly without speaking with an attorney.
Lastly, if your wife is on Medicare, then you have a different situation where Medicare Set Aside agreements with the Center for Medicare Services has to be factored in.
My best advice-Do NOT do anything without legal representation.
Years licensed, work experience, education
Peer endorsements, associations, awards
Publications, speaking engagements