I have a few questions that hopefully someone on here might be able to offer some help with.
First off, if there is a lawsuit involved, the law requires the comp bill be paid back. There are some options on how to deal with this, so I've been told. One could be that I simply pay back what I owe them up to this point, and any future treatment would not need to be paid back.
Another possibility would be for comp to offer me a settlement to close my case. This would have to be quite a sum of money, and I'm not sure I'd consider it because I would lose any future benefits related to my injuries.
Now onto my pain mgmt question... I have had a history of back and neck pain which I need to be treated for in addition to my comp injuries. Since PM treatment is all done by one doc, and meds are only coming from one source, would my insurance cover it or will I run into problems if they see one of the pain problems is work related?
I would rather go through my insurance for my PM treatment, for obvious reasons. I don't like trying to deal with comp, and seeing as a PM doc should be taking all my pain issues into consideration, I couldn't see how they could split up the costs between insurance and comp.
I'm just concerned with the PM doc visits, and not any surgeries or other types of treatment.
I think keeping the comp , as opposed to taking a lump sum settlement, may be beneficial considering there may be a chance that I am no longer able to work someday.
Sorry for all the questions, but any advice is greatly appreciated.
Hey Thomason, Each state has a limit of liability, Some states will only cover 2/3 of lost wages for up tp five years and some will cover 10, If you don't settle you will likely be eligable for life long medical beni's which will far outway 2/3 of the remaining years left of their liability.
Just as an example, The last year I had prescription benis, My private insurance picked up 23 K in prescription costs, Spread that over a lifetime and you can see why they would want to settle.
Once you settle and your beni's expire your healthcare insurance will start covering costs of your inury, If your present doc is not part of your private HMO you have to either change docs or get prior auth to go outside of network. There are many things to consider.
If you made 100K a year and fell from a building at work , and were a quad, their liability as far as lost pay is the exact same as if you picked up smething and caused a disc injury that prevented your work. The only time a comp settlement turns into big money is when there is neglegence on the employers fault and they could have prevented the problem or new of the existing danger and did not protect you. Regular comp settlements aren't cash bonaza's, But the lifetime medical is so uncertain and could include additional surgeries, thousands a month in scripts and PT and on and on, that's why they want you to settle.
It just depends on how tough the game gets. It's not uncommon to cut you off and make you ask for a hearing and if your unable to stay afloat during the proceeding months, you could loose everything in hopes of a better settlement which may or may not occur.
If they go by the IME from a comp doc, then a comp offer would be 2/3 of 50% of your previous salary for the remaining years you are covered. Most have lmits but fed and state programs are better. In my state there are 5 different comp catagories you could fall under, were you a state or fed empl? Did you work as a long shoreman or in the ship trade, Did you work on ships that would fall under the Jones act.
You need a lawyer at the point of negotiating a settlement, He/she will be able to tell you what the max benefit for replacing the ramainder of lost wages and what they predict your future medical needs are. Look at the cost of your present meds spread over a lifetime to get an idea of how much a script benefit could be worth, However if comp docs aren't going to precribe you are pretty screwed.
Comp is not the giant money maker that these investigative reports show. The only way they are money makers is if your collecting comp and still working off the books somewhere, then the comp is just a way to colect Xtra money and likely the case false which could have Fraud implications.
You really need a lawyer , Good luck , Dave.
Don't be surprised by a rediculously low first offfer.
I don't understand the comp part,you say the law wants you to pay comp. back,then you say comp owes you a settlement? I know in n.y.s there is a certain amount by law comp has to pay yuoi,for example,$20,000 is the most,and $500 is the least[something like that]
And,i've become pretty good at the comp thing,since i've had hearings and all.I just got offered a deal,becuaes the comp. doc . didn't show up to my hearing for the 2cd time.BE CAREFUL,a friend of mine was going through all this,her lawyer called her and said they made a offer,she was worried about losing her benifits,the lawyer said,no,don't worry,thats not part of the deal,well when she signed off on the paper work,she didn't read the fine print,she got a good chunk of money,be she didn't realize she signed off on here medical! The lawyer mislead her.Here is some advise i would like to share with you.If you don't already have a lawyer,when you go to get one,ask how many,or what is the percentage of comp. cases he or she handles.You want a lawyer that if not all,at least 80 percent of the cases he or she takes on are comp. cases.
Sorry to keep posting,but i wish i wuold of came here and asked when i was first on comp! Have you been ordered by comp. to have an i.m.e done? I'm telling you,bring a tape recorder! You don't have to hide it.No matter how bad you are,the comp. doc. is going to say otherwise,thats his job.Has a nurse from your comp. carrier been calling you? No matter how nice he or she seems,they are not on your side! Just to give you an idea,my first i.m.e i went to,he said i was addicted to my pain meds! But the idiot didn't realize i started pain management the very same day i had my i.m.e! So he was saying i became addicted to my meds. in one day! My pain doc laughed when he got the report. And make sure you bring at least one person with you when you go. Sorry for hogging up all the posts here,its just that i would hate for you to do what i did,i had trust in my insurance company,and the doc. I thought doc. had to take an oath. You could walk in your i.m.e with your backbone hanging out,and the comp. doc. would say,"you'll be fine to go back to work,just put some ducktape around that bone,you'll be fine[ha]
Thanks for the advice. Here the max. weekly benefit for comp is $644/wk when you are off work. Doesn't matter if your a professional football player and get hurt at "work" .
I haven't met with the attorney at my law firm that strictly handles comp to discuss options yet. I've only talked with my attorney, and he gave me a couple possible scenarios.
The law requires you to pay comp back 65% of what your total comp has cost... including the weekly pay, medical exp, etc, etc. My bill is close to 100k, so I might need to pay back 65k. This is required when you win a lawsuit that finds another company responsible for the accident.
My company is self-insured, so they basically own the comp company. I am back to work full-time, but my pain is so severe I don't know how many years I might have left. I'm 30 yrs old. They said its possible that comp would be willing to make a settlement which would wipe away that 65k I owe (which would come off the top of my lawsuit) plus pay me an additional amount (lawyer thinks the max immaginable would be 100k). So this is something I have to think about because I don't know my future, but I do know what a pain comp is to deal with. They are difficult, but since my company is self-insured and DID get two citations when the accident occured it makes them look pretty bad. The state says you can't sue your own employer for anything except workers comp, and they have been giving me that.
So I'm just looking for ideas. I just want to make a good decision. The money might make it tempting, but I have to remember that I may need care down the road or may be unable to work. If I was unable to work, then I would want to be sure I would have some type of income coming in.
Hey Thomas, The only way i could imagine you walking away with 100K is if there was neglegence involved, they new there was a problem and didn't fix it, etc.
Paying back your insurance carrier sounds like a comp injury where you are a minor and using military medical beni's and Champus will be paid back. When all is said and done, Unless your a fed or state or longshorman if you walk away with more than 20 K it's would be a large settlement in my state. Through a couple years medical in but a couple years isn't enough time to learn if a surgery has failed or was succesful. If you losta limb yo might make a little more but there is no such thing as pain and suffering in comp law, Once you retain an atorney in my state, the comp carrier can't even talk to you, everything goes through the lawyer. In my state the lawyer is limited to what he can charge, 20% up to a max of 4K.
It's very different from state to state.
Good luck, Dave.
Re: dealing with workers comp *update, please help*
Its been awhile since I've posted, and its good to see all the help still being offered here.
I am in a difficult situation now, as my pain is becoming so bad that I am barely able to walk. For the last 7 months or so I've been on OxyContin 20mg TID.
I was increased to 40mg BID, and once my body became tolerant to that I requested that it be increased again. The doc said that it was not a good idea, and that was "too much pain meds". He said the next step was the duragesic patch. While reading on here I noticed that most people get 48 to 72 hrs out of one before they change to a new one. While talking to my PM doc, I asked him how long they last and he said on some people as long as 5 days. That seemed quite different than what I've been reading on here, so I decided against trying them because it didn't sound like he was going to prescribe them properly. At that point, I decided to go back to the OxyC 20mg TID because I can spread them out through the day and I actually got more relief with the more frequent doses.
After several months of being on the 20mg, and not getting as much relief as I needed, I found myself taking an extra one every so often and as a result , running out by the end of the month. I recently became irritated from being so dependant on the meds that I figured maybe I could take myself completely off of them. I asked the PM doc to wean me off , so he wrote me 10mg OxyC TID. Its been 2 weeks since that appointment and I am in extreme pain. I called about a week ago to get back in to see him because I just can't handle this. I have an appt this Friday and I am going in to see what needs to be done. My ability to work is almost completely gone, and with the pain I'm in , I can't see working. Its a struggle to say the least, and even if I were to go back to the 20mg TID dose, I know I will still have extreme pain.
This leads me to a couple questions that I've been constantly dwelling on. If I go back in and get back on the 20mg TID, I may have some of the ability to walk returned and I may be able to funtion a little better, but thats not what I really wanted. I am really frustrated with the medication, and I know the issue is because my body has become tolerant to the low 20mg dose and with my doctor not willing to increase it, I feel I'm trapped. I have thought I should just try out the duragesic patch, even if he gives me a low dose , just to see if I get relief. I just don't want to be struggling with a med that is supposed to last 48 to 72 hrs, and him expecting me to make it last 4-5 days. I'll be right back in that situation of running out early if I start to self medicate as needed. I just wish I could find something that gives me some relief , and I'm not kept and such a low dose its not enough to help with the pain. I feel like I wanted to just rid myself of the meds because of the dependance issue, but at the same time, I can't deal with the pain without them. Does anyone think I should try the duragesic patch, and if so , what would be a comparible dose to the 20mg OxyC TID that barely relieves the pain? I know everyone is different, but I do have a tolerance and I have a vacation coming up that I'll be in Europe in two weeks and I don't want to be miserable. At this point, it can't be much worse as I can barely walk through the house.
The second issue is work. I am expected to do alot of walking at work, and since this drop to the 10mg, I can't even do it. I spoke to my lawyer and they say that before I can go back to receiving any workers compensation, a doctor has to decide that I'm unable to do my job. I am scheduled to see my PM doc in two days and the surgeon next Tuesday. I don't expect them to see any visual problems on x-rays or anything , and I don't know what they are going to say about my pain other than they don't know why I'm having it. The surgeon thought that by removing my hardware in my leg/ankle that the pain would somewhat be relieved. Its been one year and the pain has become worse. I'm also not sure that working while on these meds is OK. I have just been trying to manage , go to work, pay my bills , etc. But now I feel something needs to change. My PM doc says that I shouldn't be working on these meds, so I can't see how he would not stand up for me about it. The surgeon on the other hand is the typical surgeon.....once they have done their job and the bone appears healed, then you should be fine. I can only imagine what the surgeon is going to say when he finds out about the OxyC. I really don't care if he gives me his "lecture" on pain meds, because I have been through plenty of it and know what I'm into. The fact is, I can function when I have sufficient pain meds, and I'm borderline running to the ER when I go without.
Does anyone else go to work on these meds? Is there a limit to what you are allowed to do by law while on these meds?
I am prepared to stop working, or if they want to give me a desk job , then I will consider it. I just don't know if being on these meds will be a negative thing as far as my future at my employer. If my employer knows about these meds, then it would always be in the back of my mind that they are treating me in a different way because they know I am on narcotic pain meds.
Any advice would be extremely helpful, as the stress is really tearing me up. I hope someone can help me with some ideas, because I feel like I'm in a really tough spot.
I wasn't around when you last were posting. I just wanted to say that I too work on Oxycontin and take 10mg 2x day (which is way too little). Read my posts and you'll see a few weeks ago I was complaining about inadequate pain relief (also back issues) at 20 mg/ 10mg/20mg but than my brilliant dr decided I should go the "less is more" route and so now take 10 mg twice a day (after a week of nothing, so i'm grateful, really I am, for what I do have). I also take up to 4 vicodins as needed per day - and I need them... Then I crawl home and go to sleep.
I do work a desk job, but with lots of running around, and though technically its only 4 hrs a day (temporary PT, was FT but had a fusion in December that i'm not healing well from), i'm being "stuck" there closer to 6 most days.
My boss probably assumes on on "something" but doesn't need to know what.
I just didn't want you to think you were alone. I personally need to keep working for now, partially for the money, and partially for myself-- I think the moment I quit, will be the minute I accept that all the nasty things I assume others (my mom, my husband, my evil doctor, etc...) think about me is true (being a lazy hypochondriac drug addiact quitter who wants to sit on the couch watching soap operas all day).
Good luck with your appt, we'll be anxious to hear how it goes,
StMishl Failed Bk Fusion, facet joint/hip issues & RA -Wish I could Jump like him!
I whent thru the NYS w/c system and had a lawsuit, the way it works and it's nuts as far as im concerened is the longer your on w/c the less they want back. For example my w/c bill was 275,000.00 of that they only wanted 60,000.00 back if i was on it longer it would have been less even my att for my lawsuit thought it was nuts. But keep in mind for you to settle your lawsuit w/c has to give the ok otherwise its a no go on settling. As far as my medical goes since i had no other insurance it is covered by medicare.
Appointment went ok, back to 20mg TID. I don't know how long I can get by on this dose. I do have more relief, but I would be better off increasing to the 40mg or switching to another med. I am also getting dehydration with the meds, and its really getting annoying. There are lots of negative side effects to taking these meds, which leads me to want to change my work situation.
I told the PM doc about my appt with the surgeon next week, and how I can't see being able to work. He told me to have the surgeon write him a letter. When I go to the surgeon I am going to tell him that my life is unbearable and that it can't continue this way. I don't care if I will bring in less income, my ability to have pain under control is worth more to me than money. I will ask if I can work less hours and be given a desk job. If not, then I want to be taken off work due to permanent disability. I just can't work anymore and I am done torturing myself. I hope that the docs back me up, because without them there isn't much to stand on. I know they are probably going to say that your bones look healed and we don't know why you would be in pain. This is going to really anger me because I literally can barely walk without excruciating pain in my ankle and foot. I don't know what other tests can be done besides x-rays , or if a bone scan , cat scan or MRI would help show anything wrong.
well, gotta run to work. Today is my last day of work before I see the surgeon, I'd like to think its going to be my last day of doing physical labor as well.