A reader asks:
I’m currently in the settlement process of my case. I have a T8 disc herniation and went to pt, then had an injection, then more pt since September. The Hartford is trying to settle, but I dont have much interest in the money, because it feels like the injection is wearing off. Instead of a cash settlement, is it possible to settle for open medical benefits for the injury. I’m worried that I will be getting many injections in the future as one wears off after the other and will be stuck with the bill, because I would have settled the case. My lawyer told me that this can’t be done, but I know a carpenter that settled for cash and open medical benefits about five years ago. Who is telling me the truth?
So the question is who’s telling the truth. In this case it’s probably both people.
It is incredibly rare for an insurance company to offer you a settlement and agree that if you ever need to see a doctor about the problem in the future, they will pay for it. Their motivation for settling is in part based off the fact that they get to close out your medical rights. Even by giving you money, they know what the total costs will be and can put your case to bed. If you’ve truly made a recovery it’s usually a win-win situation.
If you will likely need medical treatment, Federal laws require the insurance company to give you money to manage to pay for that care. This is called a Medicare set aside. Basically it’s money given to you that you have to use for medical treatment for the problem in the future. This amount is determined by companies that view your medical records and what anticipated medical treatment you will have. For example, if you have a rod put in to your leg because you broke it, chances are that it will need to be replaced some day.
If you want an assurance that if a problem ever does pop up that you can get it paid for, instead of settling, you take your case to trial. Assuming you win, you will keep your medical benefits related to the injury open for life. That means that if you hurt your back now and have problems with it in 20 years, if your future doctor relates those problems to your work injury then the work comp insurance company will have to pay for that medical treatment. I am a big proponent of every NFL player filing for work comp over concussions the day that they retire. That is one way to make sure you can get the care that you need without the NFL having to approve of it.
Even if you do go to trial, you will still get paid and it will likely be a similar amount of money as to what you could have settled for. The biggest difference is a trial offers no guarantees and the process takes longer. But if your health is the most important thing to you then you should go to trial or consider it if you had a serious injury.
I doubt the carpenter got a big fat settlement and the rights to see a doctor whenever he wants. I guess it’s possible, but not probable. I’ve never seen that happen in 17 years of being involved in cases.