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  • Question on Insurance Continuity - Workers Comp. and/or Medical

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    Old 08-02-2006, 06:40 PM   #1
    bgsha
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    Question on Insurance Continuity - Workers Comp. and/or Medical

    I have two questions and would appreciate feedback:

    I had injury while at work and was put on workers comp. I am being treated by Doctors from the medical network of workers comp. insurance and/or my employer

    1) Does workers comp. insurance continue if the job is changed? If I move from one state to another state with different company, will the workers comp. insurance continue in another state (and now a different company). Thus can I continue to obtain treatment from Doctors of the workers comp insurance in another state and with a different company?
    2) How about the Medical PPO plan? Will the new medical PPO of another company offer me treatment for the injury or consider it as pre-existing condition? I am currently with BCBS PPO and other company may have a different PPO plan.

     
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    Old 08-03-2006, 07:07 PM   #2
    Green Frog
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    Re: Question on Insurance Continuity - Workers Comp. and/or Medical

    The worker's compensation claim should remain active regardless of whether or not you leave to go to another company in terms of treating the medical condition. Your benefits such as being paid wages for any time lost would not continue, however, if you quit. The work comp insurance will continue to pay the medical claims as long as it continues to be a legitimate claim. As far as the new medical insurance at a new company covering a pre-existing condition, it depends a lot on the insurance company's contract with that employer. Some contracts do not have any stipulations for pre-existing conditions as long as you haven't had a lapse in insurance coverage for a period of greater than 60 days. Other insurance plans do have stipulations against pre-existing conditions. The best thing would be to call the HR dept. of your new company and ask about pre-existing conditions and if their medical plan will cover them or not.

     
    Old 09-25-2006, 01:21 PM   #3
    xinerevelle
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    Re: Question on Insurance Continuity - Workers Comp. and/or Medical

    Regardless of whether there is a pre-existing conditions clause the personal or new group insurance plan probably won't cover ANYTHING that was related to a work comp case prior. There is always a question on the intake form that says "was this a work-related injury" (there's also usually a "was this an auto-accident injury" question). When you sign the form it usually states that you are acknowledging that the things on the form are true. When the insurance company sees that this was a work comp injury, they are going to refuse payment and send you back to the work comp folks for treatment and payment. (Same situation if you are in an auto accident and try to claim it on your regular insurance instead of under your personal injury protection (PIP) on your auto insurance.)

    This is why when you settle your work comp case some amount is set aside for your future medical care. In the meantime, you should continue to get treatment from the WC insurance provider, regardless of where in the country you live. These companies have large networks and I'm sure have partnerships with different networks that are outside of their primary area (similar to how the different BC/BS state plans work). Just because you've been injured on the job doesn't mean that you have to limit your life to staying at the same job and staying the same job.

    Additionally, if you quit your current job (where you were injured) and start working at another job, and your doctor puts you on a "do not work status" you can still collect temporary total disability. This happened to me... I had back surgery a year after my injury. I was working for a different company at the time and got my checks for the 4 weeks I was out.

    And if you don't have a lawyer, get one. Surely, the work comp folks have lawyers on their side... protect yourself. Your lawyer will be able to answer these kinds of questions for you and is familiar with the intracies of the myriad of complex laws regarding WC.

    Good luck!

     
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