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Workers comp
Anonymous3 views3 answers
I had an injury at work that resulted in a back injury. Some of back injury was pre-existing. Workers comp denied the claim. I hired an attorney. Insurer wants to settle for a dollar amount and not accept claim. My attorney recommends taking settlement and obtaining obamacare to pay for needed back surgery since obamacare excludes pre-existing conditions. Is this correct? I can have an injury. Need surgery. Then get obamacare and they will pay for surgery? Sounds a little far fetched. Just seeking other opinions if this is correct. Thanks.
I agree with Mr Bollinger however I have seen some problems come up with this type of case. If you end up with health insurance like Medicaid they might be able to come back and look at the settlement. If a majority of the settlement is for the cost of the surgery then they can argue that they should be able to get paid back. You need to discuss this further with your attorney and make sure that you understand all of the ramifications of entering into a settlement under these circumstances.
The ACA ("Obamacare") legislation prohibits insurance companies from denying care based on pre-existing conditions. The other exclusion that is pertinent to someone with a denied comp case is the "workers' compensation exclusion" written into health insurance policies. Those exclusions deny coverage when another insurance company, such as a workers' comp insurance carrier, is responsible for paying the bills. In a denied comp case, the workers' comp insurance carrier is not responsible for any bills. So, logically, if the health policy cannot deny coverage based on pre-existing conditions, and there is no other insurance company that is responsible for paying, then the health carrier is contractually obligated to pay.
Gilbert Earl FisherWorkers' Compensation LawyerFresno, CA ·
I agree with the responses posted. Currently, health insurance under the affordable care act should not exclude pre-existing conditions. It is yet to be seen, if insurance under that act will try to get reimbursement the way Medicare does now.
