Yes, my case is still open, but only for a couple more days or so. I either have to settle, or it will go before a judge on the 9th, which is Wed. My attorney advised me that if it goes before a judge that I will get even less than what the insurance company is offering me, so I don't want that to happen.
I did see a QME, and the percentage of my permanent disability is based upon his report, minus what they percentaged out for my prior neck and shoulder surgeries. It's hard to battle when I saw 2 different neurosurgeons and they said that I needed neck surgery, that the one they did wasn't successful vs seeing their orthopedic surgeon for 15-20 minutes who took X-Rays and said that I don't need it.
As far as my neck injury, it was being handled by the secondary workers comp case as an accumulative injury, as well as my shoulders.
So, my dilema is, keeping future medical and basically getting no money except, maybe a couple of thousand after attorney's fee's and paying back the advanced monthly payments. Or taking the compromise and settlement and closing out the case, with no future, I have to take care of my own medical, and I have to pay the first $60,000 before medicare will pay if it has to do with the workers comp injuries to my neck, shoulders or lower back.
That's why I've been asking for suggestions and opinions. I'm at a roadblock here. I'm a single mom, even though my kids are grown, one of my daughters lives with me as well as her 3 little ones, ages 8, 2, and 4months. She works and helps me, and takes care of the house.
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Originally Posted by Dubious
Is your case still open, have you had panel QME (Qualified Medical Examination) from the state before you were represented?
It is a very bad omen when you are complaining about multiple regions of pain initially after the accident but your doc apparently only diagnoses and treats a lower back injury. If your neck or other regions were injured in the fall but not reported by the initial medical physician and then you push to add them later, the ins. carrier will very likely view that as embellishment or fraudulent. If your neck was not ACCEPTED by the ins. carrier, it seems that you should be able to see a doctor independant of your WC claim.
It starts to get complicated on who should pay. And treatment is regionally specific (the area of your body that was hurt) to the ACCEPTED diagnosis. If your case is "open" then you are at the mercy of the ins. co. doc or you are treating on a "green lein" thru a WC attorney. If your case is closed with no future medical, then any other insurance you have is a potential reimburser. If your case is closed WITH future medical, then you are back to bowing to the mercy of the ins. co. doc for the ACCEPTED diagnosis.
Ongoing care while your case is open is subject to ins. review (and ACOEM) but if your case is closed, further care is specifically addressed by the physician who authored your "permanent and stationary" report, the QME report (if done) or some variation thereof thru "compromise and release" or stipulation and award." All of the medical treatment however is subject to scrutiny by the good book from the American College of Occupational and Enviornmental Medicine (ACOEM). Really sucks!
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