When you suffer a work-related injury, you may require ongoing medical care that will continue to be necessary even after you’ve settled your workers’ compensation claim. In some cases, this need for ongoing treatment may even last for the rest of your life.
Workers’ compensation insurance is supposed to provide you with payment of medical bills, but when the bills are going to continue on an indefinite basis, it becomes very complicated to make sure that you do not get hit with huge and unexpected costs after your settlement is finalized.
Talk With Our Workers’ Compensation Lawyers Today
Our South Carolina workers’ compensation lawyers at Joye Law Firm represent clients throughout South Carolina who have suffered work injuries and who will need ongoing medical care. Since 1968, we have helped clients who have experienced work injuries. To learn how we can help you, contact one of our South Carolina workers’ compensation lawyers today.
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Our firm assists clients in negotiating settlements for future medical care. We deal with Medicare set-aside arrangements and assist clients in requesting hearings in front of the South Carolina Workers’ Compensation Commission in order to be awarded ongoing medical coverage.
Understanding Medicare Set-Asides and Workers’ Compensation Benefits
Traditionally, when a workers’ compensation insurance company settled a claim with an injured worker who was disabled, they would often pay a small amount for future medical expenses with the expectation that future treatment would be covered by Medicare. Medicare is a federal insurance system that provides coverage for both senior citizens and disabled Americans.
Unfortunately, assuming that Medicare is going to cover future treatment can be a big risk. First and foremost, the future of the Medicare program is uncertain. Medicare is experiencing serious financial uncertainty, and the problems with the system are likely to grow worse as baby boomers age and retire.
The bottom line is that Medicare may not be around in 10 years or 20 years, at least not in the form that it is now. Even if it does continue to exist, there are no guarantees that it will cover future treatments you need for your work-related injury. Further, with a looming financial crisis, Medicare is pushing back against being forced to assume responsibility for paying for injured workers’ treatment costs and is instead aiming to put some of this responsibility back onto workers’ compensation insurers.
Due to the complications and risks involved in making assumptions about Medicare, workers’ compensation insurers have now begun the practice of setting up Medicare Set-Aside Accounts in larger workers’ compensation settlements. Essentially, to set up these accounts, the insurance company asks a life-care planner to estimate what types of Medicare-covered treatments an injured worker will need over the course of his or her lifetime, and then seeks to have this projection approved by the Centers for Medicare and Medicaid Services (CMS). The insurance company will then pay the amount of money approved by CMS. However, the injured worker will be required to put this money into a special Medicare Set-Aside Account. The account is an interest-bearing account that can be used only to pay for treatment expenses incurred due to the work injury. The expenses must be paid at the same rate as Medicare would pay. Only after the money in the set-aside account has been properly spent will Medicare kick in to cover treatment for work injuries.
Everything about these set-aside accounts is very complicated. Determining future covered costs under Medicare is not an exact science. Also, there are often future treatment costs which would not be covered by Medicare, frequently referred to as non-covered costs. In many cases, an injured worker can receive more money to settle their future medical coverage rights if an experienced disability attorney is consulted to help. Your attorney may advise working with an independent medical examiner or life care planner to provide a different — and more accurate — estimate of what the covered costs will be so a larger settlement can be obtained. Also, your attorney may advise you against settling your future medical coverage rights as it may be in your best interest to keep your workers’ compensation coverage intact. Every situation is different.
Once the Medicare Set-Aside Account has been set up, it can also be complicated to manage the account and to prove to Medicare that it has been properly exhausted. Your workers’ compensation lawyer can advise you on this process as well.
What You Need to Know About Ongoing Medical Coverage
While you may want to settle your case completely and receive a lump-sum payment for your future medical coverage, you are not required to do so in order to receive a scheduled member or general disability award. In fact, there is no requirement mandating that you accept a lump-sum payment for future medical costs. Likewise, there is nothing which requires the workers’ compensation insurance carrier to pay a lump sum to settle this aspect of a case.
In many cases, a South Carolina workers’ compensation lawyer at Joye Law Firm may advise you to instead request a hearing before the South Carolina Workers’ Compensation Commission. The commission can decide your claim for disability benefits and may protect your right to ongoing payment of medical bills. This can be beneficial because Medicare may not fully cover certain types of ongoing treatment costs, such as prescription expenses.
In order for the commission to award you ongoing medical coverage, you will need to have your physician prepare a summary report or complete a Form 14B using very specific language. Your doctor must specify that your future medical treatment needs are expressed in the form or in the summary “to a reasonable degree of medical certainty.”
While doctors may overlook this question or fail to use proper language, failure to fill out the form completely or failure to use the correct language may hinder your claim and prevent you from being awarded ongoing or future medical coverage. This is why it is so important to have a South Carolina workers’ compensation attorney if your injury will require ongoing treatment. Your lawyer can work to ensure your doctor has completed all forms correctly and can otherwise take action to protect your rights and make sure that all future medical costs are covered.
Medical Coverage Questions Demand a SC Workers’ Comp Lawyer
Because workers’ compensation settlements are complex, you should have a workers’ compensation attorney guiding you through the process and around the pitfalls. Your employer’s insurance carrier will certainly have lawyers looking out for the insurance company’s interests. You should have a workers’ compensation attorney working to protect your medical rights and interests, too.
If you’ve been injured in a South Carolina workplace accident, you can trust the attorneys at Joye Law Firm to work to get you the money and medical coverage benefits you are entitled to receive. Since 1968, we have helped injured workers like you obtain the money and medical coverage that you are entitled to so you can regain control of your life.