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What if

WramblerWWrambler Posts: 1,588
edited 06/11/2012 - 8:45 AM in Health Insurance Issues
Reading through the various postings on Spine-Health I have many times read the words that workmans comp has denied coverage due to "pre-existing conditions". I just read the words and went on about my business.

Suddenly I am struck with the thought that I am probably 1 accident away from having those same words written by me or about me on a medical chart!

Kind of gives me a case of the creeps. with an open medical management file that Human Resources here at work has never processed fully or even called me back about. I wonder exactly where I am standing?

I pay extra for short term disability, but since I have already had the accident and now have those dreadful "pre-existing conditions" Is that coverage worth a darn? Am I playing with fire every day I do work?

I don't really see an option.
Even with firm medical restrictions in place will the answer be the same if I get hurt? Am I wasting $30 a month on insurance that won't pay me when or if I need it?

Am I in danger of having my insurance fighting with workers comp and neither footing the bill? ARG.

I wish I had not thought of these questions, but sure would like an educated opinion...


  • Wrambler you need to read the policy. Most STD will have a waiting period for pre-existing conditions. Mine was 30 days. So if I started the policy today they would not pay if I go out within the next 30 days for anything that started before.

    My understanding of pre-existing for workmans's comp is that if you had injured say your knee before and now you claim you hurt it again at work they may disallow part of your claim because you were already injured in that body part.

    Here's my personal experience with my car accident. I had knee surgery 5 years ago for a fractured knee cap and torn miniscus. After the accident the knee was achy again. The orthopedist did xrays but didn't find anything operatble. I did some PT because there was some strain and stress there. WIthin a few weeks the auto insurance company disallowed treatment on my knee because of my pre-existing treatment.

    Check your policy. You are probably past any waiting period now. And relax about the pre-existing. If you aren't trying to hide anything you don't need to worry. And what's your alternative anyway?
  • SpineAZSpineAZ WiscPosts: 1,084
    STD and WC are very different.

    In addition, STD can be one of two options

    (1) a policy your employer offers, in which all eligible employees are covered, and you may pay part of the premim

    (2) A third party company that comes in and offers STD (such as Aflac, Colonial, and others). This is a private STD plan between you and the carrier. You can also take it with you when you leave.

    In either case get the STD policy and read the pre-ex section. One of the BIGGEST mistakes people make is canceling STD (or LTD) because "well I had back surgery so that's pre-ex, now I'll be denied". Then down the line they need a surgery for something totally unrelated or have a serious accident and now have no STD (or LTD) coverage. Don't assume any disability coverage is for the known, it's also largely for the unknown.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • You need to be clear about what area which insurance is involved with.

    WC pays for the treatment of work-related injuries. Since they're footing the bill, they seem to think they get to call the shots with regard to which medical treatments you have and/or don't have.

    STD is a completely different issue. Typically, they pay a percentage of your lost salary while you're out of work as a result of an illness/injury, but they have no direct involvement in your medical care. As long as you meet the waiting period established by the policy and/or your employer and your doctor continues to provide medical information showing you're unable to work, it doesn't matter what illness/injury causes you to be out of work.
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