Post Lump Sum Claims for Medical Benefits

Massachusetts Workers’ Compensation Law Firm

The Massachusetts workers’ compensation lawyers at Kantrovitz & Associates have over 20 years of experience representing injured workers before the Massachusetts Department of Industrial Accidents and Review Board. We are dedicated to asserting your right to receive medical care after a lump-sum settlement. Based in Boston, we represent workers seeking additional injury-related treatment in Massachusetts, Rhode Island, and New Hampshire.

Lump-Sum Settlements

Insurers prefer to settle workers’ compensation claims when payment of a lump-sum amount is less than the full value of an injury claim. Rather than continuing cash payments and exposure to liability, insurers may offer what looks like a great deal of money now rather than doling out benefits over time. However, settling for a fixed lump sum may not necessarily be a good idea if the worker:

• Requires future invasive care such as surgery
• Has a disputed injury
• Questions ailing health
• Lacks legal representation
• Seeks alternative treatment
• Is eligible for future increased weekly benefits
• Shows worsening symptoms
• May have permanent disability
• Does not understand a condition
• Requires chemotherapy treatment
• Has greater “extended” claim value

Once employees agree to a lump-sum settlement, they give up certain rights, including the right to receive weekly compensation checks. They also give up the future right to challenge the same injury or illness settled by the award. Workers must appear before an administrative law judge to defend medical expenses incurred, or to obtain ongoing care, after the settlement as “reasonable, necessary and causally related” to the industrial injury.

Insurance Misconceptions

Workers often believe that once insurers settle a claim “with liability,” they will continue to pay for future medical care because they have admitted “fault.” This is not true. Insurers have the right to deny medical treatment that they believe to be “unnecessary, unrelated or unreasonable”. Services that seem vital to recovery may be considered superfluous by insurance companies seeking to cut costs. These may involve:

• Medical devices
• Use of painkillers
• Itemized treatment
• Radiology treatment
• Occupational therapy
• “Preventive” medicine
• Multiple hospital visits
• Future surgical operations
• Chiropractor, acupuncture
• Adjusted cost for payments
• Independent medical opinions
• Further lab tests and diagnoses
• Disfavored providers, networks

Insurers employ experienced claims adjusters and attorneys to avoid “high cost” claims. They use complex formulas to save money, “contain costs,” and minimize losses through indemnity. Injured workers will never know why “liable” insurers have discontinued their medical care, but can seek to protect their right to further treatment in a hearing before a judge.

Legal Representation

Insurers are always represented by counsel at workers’ compensation hearings. Injured workers seeking continued medical care should do everything they can to build a strong case. Large corporations assembling personal data, including patient demographics, specific treatments, and medical provider characteristics do not necessarily have workers’ interests in mind when calculating the lowest cost required for care. Employees who are actually suffering deserve experienced advocates who understand that they are not just statistics, but human beings entitled to medical care that is critical to their health.

Seeking Post Lump-Sum Medical Expenses

If you were offered a lump-sum settlement, but believe you have an injury requiring further invasive medical care, call the Massachusetts workers’ compensation attorneys at Kantrovitz & Associates today. For over 20 years, we have helped injured employees seek necessary treatment after a lump-sum settlement with insurers. At Kantrovitz & Associates, we understand that appearing before a judge to seek vital benefits is scary. That is why we are dedicated to protecting your right to medical costs for a job-related injury. We serve disabled workers in Boston, Essex, Plymouth, Middlesex, Suffolk, Norfolk, and Merrimack counties, among others. Call 800-367-0871 for a free consultation or contact us online.