Wednesday, October 03, 2007

Medical Care in Workers Comp and Social Security

Unless you qualify for medicare or medicaid or other state assistance a claimant seeking Social Security disability gets no medical care except any he can obtain on his own. Often in my town an impoverished person can try for Peak Vista which is a community facility manned by hard working dedicated people. Once you obtain SSDI (the typical Social Security disability) then medicare is possible (it kicks in after you've received 2 years of benefits but this could be soon if you were entitled to back amounts). What I do mean to point out is that you have no right to medicare until it kicks in but sometimes the agency will send you for an examination on your case. It is not treatment. In workers comp the process is different. Even in a contested case you may be able to obtain medical care though it is not always extensive until the claim is admitted or ordered to be covered. My problem is that in workers comp even in an admitted case there can be controversy over the extent of care. Insurers love to question causality by suggesting maybe the problem is not work related. Insurers love to second guess even the dedicated doctors by saying the surgery or expensive treatment requested may not be reasonable or necessary. I recall one time where my spouse using her health coverage had a knee operation many months before my workers comp client had his knee surgery. Delays seem to cause more expense and even medical complications. Of course in workers comp a covered treatment is paid 100% but nothing by the claimant. Also in workers comp long term care can be covered for life at zero expense to the claimant if it is appropriate. But for me I keep thinking that we should all have a national health plan and then all we would quibble about in workers comp is the extent of disability not wait while we dispute the treatment. Some physicians have a website calling for this at :

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