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Work comp and MMI

CapsdadCapsdad Posts: 92
edited 09/22/2013 - 3:03 AM in Health Insurance Issues
Has anyone been in a work comp situation and hit maximum medical improvement? What happens with a settlement and what does that mean for the rest of your life? All these unanswered questions have me so worried I'm getting anxiety and beating myself up. I'm so scared of the unknown future.
Left side MicroD l5-s1 2/7/13. Re herniated immediately
Revision bilateral MicroD and posterior lumbar decompression 9/9/13. Failed. L5-S1 fusion on 3/6/14.


  • I am moving this to the insurance forum for you, since the people who post there might have more answers for you. I wish that I knew more about the WC system than I do but it is my understanding that once you have reached MMI, they try wto settle your case . If I am correct, once you settle, once you do settle, then they no longer will pay for your medical /prescriptions, etc and whatever monetary settlement you get/negotiate should include whatever treatment/medications/visits you think you may need. If I were you, I would consult with a WC attorney in your area. Almost all attorneys offer a hour or half hour consultation for free and it might help you to get some of your questions answered.
  • The best answer about this could possibly come from your states Dept. of Labor. Each state is a little different. In a nut shell, usually a year after surgery, your doctor will have an assessment done on you called a Functional Capacity Exam (FCE). this is a long physical test that will be done t see what you are capable of doing and not doing. The surgeon will take that along with consulting a textbook that informs doctors how much each body system is worth in percentages as it relates to the whole body. For example, in 2007 each level of a lumbar spinal fusion was worth 10% rating of the whole body. In my case, I had a two level fusion that equaled 20% and then I got another 5% because my back surgery caused me to have erectile dysfunction. So, all in all I have a 25% partial permanent disability rating. Your settlement is typically based on this number plus certain multipliers can be factored in such as age, education level and possible job retraining. Your best bet is to call your WC Adjuster and ask how they are going to process your settlement. They may offer you two amounts. One will be with continuing medical coverage and another will be without continuing coverage. Again, it depends on which state you are in as to what all actually happens.

    If you need more info, feel free to PM me.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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