WC settling me out/decision time?

[Maria]

edited as necessary

[KL Aguilar]

Maria, you may remember me. We met at a Huntington Beach dog park in January of 2003 I think. Mark invited a bunch of us.

I have a wonderful WC attorney. Please PM me and I'll share.

[dshobbies]

Maria,

Your fear and hesitation in going forth for another back surgery is more than understandable for those of us who have walked in those shoes. I chose to live a life of pain, actually no life, rather than have another surgery until I discovered the ADR world. You still have some mobility and don't want to chance it. At the same time you don't want to become a Humpty Dumpty. So what to do? WC is pushing for a solution, their solution to which you should have primary input. If they're not listening to you and it sounds like they're not, take KL's advise and get yourself a good attorney.

No one or entity should push you into something you're not ready for or limit your options. One lawyers opinion may not be the only legal opinion out there. Consult with another. At this point it seems you have nothing to lose.

As long as you're mentally capable, you and only you should have all the decision making power about your body. Good luck,

Dale

[Maria]

The letter states: We are in the process of obtaining authority to settle your claim by way of Compromise and Release. Attached you will find a Consent for Release of Information form and Social Security release requiring your signature. These forms will be used to determine whether you are currently or soon will become entitled to any Medicare or SSDI benefits. This is a necessary step in the process to determine if a Medicare Set-Aside Allocation will be needed in your case. Once received, we will submit the signed release to First Health.

I have been receiving SSDI since 2000 and have Medicare part A and B. I have been recommended by at least 3 reputable surgeons to have fusion at L5S1 and ADR at L4. I do not think this makes me MMI but rather that would be determined after surgery.

I called Frank Hakim's office ans~left the most coherent message possible

[Maria]

I had placed a call to the Risk Manager as I didn't want to sign anything w/o knowing what I was signing.

First question was do I want to do a compromise and release? I said I didn't know what that is and she stated it's where I get to manage my own health care dollars. I then asked if that meant lump sum settlement. She hemmed and hawwed a bit and replied to the effect in a round about way it is.

I then asked about the medicare set aside fund and she said it's $ goes into a medicare account if I'm eligible so I would have to sign the paperwork so she could start the process to find out if I'm eligible for this and how much I could get.

Before this I had stated that I still wanted surgery and she had asked when so I didn't want to make it sound too far into the future so I said 2 months and some other things that she was typing into a report.

Back to Medicare Set aside fund I told her I had looked at a website for a company that does this and they have detailed the steps needed to take but it was mentioned that the person should be MMI and then I said that I didn't think it could be determined that I was MMI if I hadn't had surgery yet that was recommended and authorized by the surgeron and WCAB of CA had approved this. I said that I thought MMI would be determined after surgery and probably that then is when it would determined if I were to do a medicare set aside fund ... (I had replied I have had SSDI and Medicare since year 2000 and not worked since then and she sounded taken aback like I'm the world's biggest slacker)...

She sighed and agreed. Then I asked what happens if I don't sign this paper and had stated I wanted to keep my benefits structured the way they are now..

She replied that I just need to write on the paper that I don't want to do either of these options at this time and send the form back so I then asked again if things would remain the way they are and she said yes.

I'd like to speak to a WC attorney before I return anything because I just to be sure what I'm doing.

But see how WC works? They send a form and if one doesn't ask questions and just returns the form ~ they gotcha!

Knowing the insurance carrier I'm sure there is another card up their sleeve like sending me to a QME or just trying to cut me off with nada..

I will try cold calls to some attorneys to see what information I can glean and I hope that someone will actually talk to me even if I have to pay a blob of $ for 10 minutes..

[mmglobal]

Wow Maria... I wish I had something to offer here, but this is part of the process I've not seen yet. Get some expert and uninterested opinions. I look forward to hearing some good results,

Mark

[Maria]

Allan gave me a referral and this really pleasant/nice attorney returned the call and referred me to someone so hopefully I'll be able to reach this attorney soon.

My thanks to ans for always coming thru on links,referrals, connections, and so forth~

Mark, WC is something that you've had a bit of experience w/just with myself and some other clients I imagine and it's an evolving learning experience for the person utlizing this system unless well versed in WC law. So learn as I go.. and pass it on as best I can in the hopes whatever happens to me will be of some assistance to someone else somehow~ and you were greatly helpful to me accompanying me to that decision making 2nd surgical opinion in La Jolla!