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2 surgeries pending/urged to settle Georgia

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  • 2 surgeries pending/urged to settle Georgia

    I have been on W/C for almost 2 years and am being strongly urged to accept a settlement even though I have 2 surgeries pending. They will not do open medicals, I have tried. I am afraid what they are offering will not pay for the surgeries if there are complications. Also have been told that if I get hurt again in the same W/C injury before they settle that I will receive no settlement on anything. I have a torn miniscus in the same knee that a total knee replacement is schelduled for. If anyone can help I would greatly appreciate it. I have been told so many different things that I am about to throw in the towel.

  • #2
    Don't fight W/C claims like this alone. Get an attorney - after all, your employer and their insurance company certainly have them.

    You don't want to take a knife to a gun fight... get the attorney.
    Not everything that makes you mad, sad or uncomfortable is legally actionable.

    I am not now nor ever was an attorney.

    Any statements I make are based purely upon my personal experiences and research which may or may not be accurate in a court of law.

    Comment


    • #3
      Same advice. Get a mouthpiece. And yes, if you hurt the same knee again at work they have to cover it. That's a standard scare tactic.

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      • #4
        2 surgeries pending

        I hurt it again but not on the job. They fired me from my job and the doctor has not released me to find anything else. I was told that since I rehurt it in everyday life that it would not be covered.

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        • #5
          That isn't necessarily true.

          Get a lawyer. They are trying to scare you because you don't know the law. Believe it or not, lawyers are not necessarily honest people and don't have to counsel anyone NOT their client as to the behavior in their best interest.

          They will try to scare you to see if you will blink. Time to get your own hired gun.
          Not everything that makes you mad, sad or uncomfortable is legally actionable.

          I am not now nor ever was an attorney.

          Any statements I make are based purely upon my personal experiences and research which may or may not be accurate in a court of law.

          Comment


          • #6
            2 surgeries pending

            I liked the post about lawyers not necessarily being truthful. To tell you the truth I was worried that this might be a forum for lawyers. I have one and this stuff is what he is telling me. I know they get 25% plus expenses but since he is trying to get me to settle without my surgeries paid for his comes off the top before I pay for them. I am just disgusted with the whole process. My life is ruined. My job is gone and this jerk is sitting in his office telling me all these new laws every time I try to get a straight answer. I was hoping if someone knew if it was some kind of law to keep the medicals open if a patient wants them to. He is saying this company doesn't do that. That they want to settle now.

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            • #7
              Can you tell us what state you are in? Some states allow open medical on injuries. Some don't. Mine does not allow you to close out medical on uncontested injuries.

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              • #8
                2 surgeries pending

                I am from Ga. I just have lost alot of trust in this whole system. I think since the lawyer gets his cut before the medicals that he is just wanting to close, get his share and leave me hanging. I don't know if there is some kind of law that states that I can have open medicals. I have already had 2 surgeries on the knee and one on the ankle. Everything is held together with pins and screws. My ortho has said from the start that I woudl have to have knee replacement and now they are trying to tell me to wait, take the money and hope for the best. After the lawyers share and the surgeries (if there are no complications) I will end up with less than the lawyers share. When I mentioned that I wanted to go back to the ortho and set up the surgery is when he said if I told them I had rehurt the knee that I would lose all of my benefits and settlement. I hate to fire my lawyer and have to start all over but rigt now that seems like a better plan than what he is offering. Anybody got any ideas or website or something that I can go to to try and figure out some of these things. All help is appreciated.

                Comment


                • #9
                  You need a new lawyer and I rarely advocate that. No matter how you slice it, what this one is proposing is unethical. Whether WC will cover the subsequent injuries depends on whether it is because of the injury from work, (like your knee gave out) or some other cause (like a car accident). Generally, a torn meniscus does not require a TNR unless there were some major surgical complications. If it was due to degenerative conditions or an unrelated injury, WC isn't going to cover it.

                  If you don't want to settle it now, don't settle it. If you have two pending surgeries that are related and would otherwise be covered by WC, then settling is not in your best interest.

                  If you reinjured the knee in an unrelated way (such as a car accident) you do not lose anything with regard to your WC claim, though it may be more difficult to parse out what degree of disability resulted from the work injury and surgeries and what came about later. Future treatment would also most likely be denied as any future problems would be attributed to the most recent accident and not the work one.

                  Since it is never a good idea to take the advice of someone who is not an attorney in your state and hasn't reviewed any of the medicals, talk to another lawyer who handles such claims.
                  I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                  • #10
                    2 surgeries pending

                    Thank you so much for your imput. You have really given me some good advice. I had to go back to the ortho today and he said they are starting a new thing this year of taking out old metal before they do a knee replacement to cut down on anethesia time, so that is another surgery that is not added in to the costs. When I called the lawyer and told him, he was not pleased at all so maybe he is going to fire me. Does anyone know anything about a medicaid set aside. The long term disibility is wanting me to apply for SSD and I have been told that if I get accepted before I settle or have the surgeries SS will take the money. Any help would be so much appreciated.

                    Comment


                    • #11
                      You are actually talking about two very different things here. An SSDI off-set is completely separate from a Medicare set aside.

                      http://www.jjcelderlaw.com/SSDIOffsetMSABull.htm explain how SSDI off-sets work in as plain language as I've found. Whether you should apply or not is another matter and one you should talk over with your doctor. You can find more info on this here http://www.ssa.gov/disability/step4and5.htm

                      Medicare set asides are very complex and I won't bore you with the details, but essentially once your claim is settled, if your settlement meets certain parameters (hint most meet the parameters) there is a certain amount of the award that must be held in trust for future medical care related to the accident. Basically this protects Medicare's interests when you close out medicals.
                      I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                      Comment


                      • #12
                        2surgeries pending

                        Thanks. That website is very informative. It doesn't really say whether you have to be on disability already for this to apply to me. The company my long term disibility hired is working on it but I haven't heard anything from social security. I guess i am still pending. Would you know if you already have to be on it or is just the fact that they have applied for me going to be the same thing. I really don't want to get into any trouble with social security. I am hoping to get the surgeries as soon as possible and maybe I won't have to worry about it anyway. Thanks agin for your help.

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                        • #13
                          It applies as long as you would be receiving benefits are the same time. It does not affect your ability to apply for benefits, it only affects how they are paid out.

                          Why is LTD covering you at all if this is a WC injury? Why are you not receiving TTD?
                          I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                          Comment


                          • #14
                            2 surgeries pending

                            I don't know. What is TTD? My company fired me after my 3rd surgery and until then I didn't even know that I had the LTD, they didn't bother to tell me and since I had never had insurance with this company I had no idea what their benefits where. The insurance company is telling me that is why I had to apply for the SSDI because the LTD would stop after 2 years which is coming up. Please don't tell me I have been jerked around again by these guys. Was the dr. supposed to set that up or the insurance company? Or was I? Thanks so much for your help.

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                            • #15
                              TTD is total temporary disability and it is the pay you receive from the WC carrier while you are off work due to your injury and related medical treatment. This does not cease just because you are no longer working there just as the medical treatment continues.
                              I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

                              Comment

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