Workers' Compensation Settlement

Why Choose a Workers’ Compensation Settlement?

Settlement allows you to secure the treatment you want when you want it without potential denials or other barriers.

Less Restrictive Treatment Options

Settling can mean less restrictive treatment, the freedom to see any doctor, provider, or specialist, and use any pharmacy. If you have been having treatments denied through Utilization Review, settlement represents the opportunity to seek the treatment you would like outside of state treatment guidelines.

Treat with the Healthcare Provider You Want

In some workers’ compensation systems you can be required to see healthcare providers that you did not choose or that are not located close to your home. For someone with a significant injury, traveling to and from medical appointments can not only be a challenge, but also exhausting and frustrating.

Settling allows you to see and treat with the healthcare providers of your choice.

A New Perspective

Settlement can represent a fresh start. You leave the workers’ compensation system, begin to put your injury behind you, and move on with your life. You no longer have to attend independent medical examinations or court dates and can concentrate on getting your life back on track.

A Shift in Responsibility

Settling a workers’ compensation claim ultimately represents a major life event. It is a life changing process that will have numerous impacts on the way you live.

Potential Challenges After a Workers’ Compensation Settlement

With settlement comes a new set of challenges. The increased freedom often means increased responsibilities, and decreased support and resources.

Support After A Workers’ Compensation Settlement

One of the largest challenges you could face after settling your workers’ compensation case is a lack of professional support. Once a case is settled your adjuster, attorney, support from the regulatory system, and any nurse case manager steps away. This may leave you without the resources you once relied on to help coordinate your care or answer questions in an increasingly complicated healthcare system. A Professional Administrator can help answer your questions and provide you with support once you settle.

Keeping Network Discounts on Treatment

While in the workers’ compensation system, you are able to treat through the carrier/employer, and therefore get access to their volume discount networks for pharmacy, provider, and other medical treatments. Through the workers’ compensation system and vendors that are utilized, carriers/employers pay less than full price for the treatments and prescriptions – these discounts lead to dramatic savings that accrue to the benefit of the carrier/employer and the workers’ compensation system.

Once you settle your case, you must utilize your settlement funds to continue treatment, but you will not have access to the same medical discount networks you had while in the workers’ compensation system. Many injured workers who have settled their cases end up vastly overpaying for their treatments because they are charged full retail price. You could find that you are spending through your settlement funds at a much quicker pace than expected. For example, Celecoxib, an anti-inflammatory, might cost the insurance carrier around $3.82 per pill. Once you settle, you will be paying retail, around $7.58 for the exact same medication. One way to save treatment funds is by using a Professional Administrator who has access to network discounts.

Medicare Set Aside Reporting Requirements

Once you choose to settle, you are responsible for managing your own medical care, coordinating treatments, and, if you have a Medicare Set Aside (MSA), complying with the guidelines put forth by the Centers for Medicare and Medicaid Services (CMS). Keep in mind that if you fail to comply with CMS’ guidelines, you risk having your future Medicare benefits denied.