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Thread: workers compensation ? help!

  1. #1
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    workers compensation ? help!

    Hi everyone

    I am looking for some help with workers comp. I am in a highly unusual position, whereby I am British and living in the UK, but covered by workers comp privately (long story). My income benefits are provided by a private insurance company at a rate that matches the rate paid in the state where my American employer is registered.

    I have only just been made aware that workers compensation can extend to equipment and adaptations et cetera. The insurance company have refused repeatedly to share with me the policy document for me to be able to understand what I'm entitled to, so I am kind of left in the dark guessing. I'm told I need medical proof that I need equipment like a wheelchair or an adapted vehicle. I don't know how I could get a doctor to write a letter like that. I cannot get a lawyer either in the UK or US because of the international dimension of the case.

    If you got workers comp, can you tell me what other equipment and adaptations you got and how you were able to get it?

    Sorry for the long message, and many thanks!

  2. #2
    Senior Member pfcs49's Avatar
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    I didn't get workers comp because I wasn't at work, but people who did say it's the best deal if injured.
    People with comp claims get things that medical insurance doesn't usually cover, like complete home renovations to implement accommodation, like elevators and ramps.
    In the states, or at least NJ, lawyers are compensated a percentage of the awards which are largely formulaic; workers comp has all kinds of funny calculus about what each loss is work as a percent of the value. I think your salary may be part of that calculus but am not clear.
    Workers comp does not compensate you like a malpractice or personal injury lawsuit does however, and in some ways your recovery for loss might be considered paltry.
    In NJ there are specialty attorneys that primarily handle comp suits, probably because it involves so much knowledge of WC.
    Last edited by pfcs49; 07-12-2017 at 06:31 PM.
    69yo male T12 complete since 1995
    NW NJ

  3. #3
    Workers' Comp is a state program (unless you were a federal employee) and varies from state to state. In many states, you get pushed pretty hard to settle with the WC insurer, and that settlement covers what will be covered (and not covered) in relationship to your injury. So it is impossible to give any advice without knowing what state the WC is under, and if you signed/agreed to a settlement. Most people find it critical to involve a WC lawyer in all of this, and that would likely need to be an attorney in the state in which your employer is registered.

    (KLD)

  4. #4
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    I have wc in Florida. I was paralyzed from the chest down 27 yrs ago. When it happened wc had a nurse figure out how much it would cost to take care of me the rest of my life. It was approved by a wc judge. Anything I need that is related to my injury is covered. I have 24 hr attendant care. I get a new van and wheelchair every 5 yrs. All medications are covered. If my Drs. say I need it I get it. It has been updated over the yrs. I went to mediation earlier this yr to possibly settle my case but the two sides couldn't agree on an amount. Honestly there is no way to know how much it will cost to take care of me. Atleast I know I'm covered for the rest of my life. Unfortunately I can't offer you any advice because your case is different than mine. Good luck!

  5. #5
    I don't no if this works for workers comp. But if you settle for a car accident....lets say.... then you get on medicare you have to pay back medicare out of your settlement for injury they pay for your injury before if any and in the future medical bills for that injury. Only one that gets rich there is the lawyers. Unless it has changed. So why settle you will lose it all. I know a lot of people who did this and didn't no and boy do they regret that very costly mistake.
    Art

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    Quote Originally Posted by Art454 View Post
    So why settle you will lose it all. I know a lot of people who did this and didn't no and boy do they regret that very costly mistake.
    I also have Medicare and Tricare. They cover anything not injury related. But as I said there is no way I would have settled my case. And believe me they really tried with what they thought was a lot of money. But what they offered wasn't even close to covering all my care.

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    Quote Originally Posted by HACKNSACK44 View Post
    I get a new van and wheelchair every 5 yrs. All medications are covered. If my Drs. say I need it I get it. It has been updated over the yrs. I went to mediation earlier this yr to possibly settle my case but the two sides couldn't agree on an amount. Honestly there is no way to know how much it will cost to take care of me. Atleast I know I'm covered for the rest of my life. Unfortunately I can't offer you any advice because your case is different than mine. Good luck!

    Thanks everyone.
    My employer was based in New York city. I'm already receiving an income based on the proportion of my earnings as you mention, pfcs49. Our national health service in the UK is free and also covers all my live-in care and prescriptions (thank God – things are so much better for us over here then you guys in the states). I would like to be able to get a decent power wheelchair and accessible vehicle. Like I say, impossible to get a lawyer because neither British nor American lawyers will represent me.

    Hacknsack44 you may be able to help me actually. Did you need a doctor to state that you needed a new van and wheelchair every five years? Does it mention a particular model, or value? I don't think my doctor is going to want to write a letter about mobility equipment to an insurance company – they tend not to want to put anything but medical diagnoses into writing. Which leaves me a bit stuck.

    Is there a comprehensive list of things that workers comp might cover in the way of equipment or is it a case of arguing for what you might need? Remember it's a private insurance company that covers me, not New York

  8. #8
    Workers comp in Arizona accident since 93 T-10 Para. I settle a long time ago for a lump sum from accident. Chose a lump sum instead of receiving monthly payments. In the settlement they agreed to cover all of my dme medical equipment, urological all stuff necessary for me to be in this wheelchair. With the exception they wont' do any home modifications or vehicle modifications. They will cover any thing that my Dr. writes a Rx for and I mean anything. I don't abuse the system so my case manager even calls me just to see if I need anything. With my lump sum settlement I purchased a an annuity. They pay me every month tax free for the rest of my life. I don't have to claim it as income pay no taxes at all. It's for life and does not pass on after my death.

  9. #9
    Quote Originally Posted by Art454 View Post
    I don't no if this works for workers comp. But if you settle for a car accident....lets say.... then you get on medicare you have to pay back medicare out of your settlement for injury they pay for your injury before if any and in the future medical bills for that injury. Only one that gets rich there is the lawyers. Unless it has changed. So why settle you will lose it all. I know a lot of people who did this and didn't no and boy do they regret that very costly mistake.
    If you have medicare for say a year and they are paying for your medical bills and then you get a settlement they would make you pay back a percentage of that years worth of bill and thats it and then you would just have your regular coverage from then on. I went through it not long ago but I had only had medicare for a month and they hadnt paid any bills so i didnt have give them anything.

  10. #10
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    What's an Rx, nmireles?
    My income benefits are till death as well. they did propose settling and an annuity, but the UK office were unable to do it, I think I would have preferred it.

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