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Future Treatment Needs in Missouri Work Comp

Future Treatment Needs

So, one of the aspects of any type of claim that we'll look at on behalf of our clients is going to be the need for medical treatment in the future. Typically, if you're injured, you get your medical treatment. We work you through that process to the point where you are at what's known as maximum medical improvement where the doctors don't think they can really do anything else for you to improve your condition.

Well, a lot of times when people are not represented, the insurance company just cuts it off at that. Well, there may be a position that needs to be addressed where you might not need or may not be entitled to treatment right now to make you better, but you may need treatment down the road that directly relates to your injury. That is often times something that the insurance company does not bring up, does not allow you to know whether that's a possibility for you.

Specific times where we see that a lot are with either hardware in place or like a prosthetic device. So, let's say you have a broken leg and you have to have a rod and screws put into your leg. Well, that wasn't there to begin with. Now it is. Those screws might back out. You may have a part break. You may develop an infection to it. There's all kinds of different things that can happen to that hardware that would may need, may lead to that needing to be taken out or adjusted or taken and put a different thing in. In those types of situations, if you don't have that addressed as part of either your settlement or a ward, that's on you as the injured worker as opposed to it being the responsibility of the employer insured, which it should be.

So, you've got to have an attorney on your side who understands the working of future medical and when it applies and when it does not. And oftentimes you may have to have that independent medical exam to where a doctor that your attorney chooses will address that specifically because there's have there has to be specific language that talks about it being a medical treatment that will be needed in the future to a reasonable degree of medical probability. In other words, it's going to be medically probable that I'm going to have to have x done at a later time.

Another example of those knee replacements or shoulder replacements. You don't need it right now. A lot of times the doctor doesn't want to do it yet because of your age or you maybe got a little bit of more weight than you need to and they want you to get that down. Well, if you don't address that in the settlement and later on down the road, you need it. Again, it's your burden not theirs.

You've got various different injuries are going to be more prone to have that need for medical down the road. Medication is one that's an example of a lot of times people are on ongoing medication that they're going to need forever because of these issues. Specific different ailments or injuries are going to result in specific types of medication that you can't just come off of. And so you have to be able to address that ongoing medication need otherwise, you know, again, you're not going to have that benefit and you're either going to have to just fit the bill yourself for that or have an insurance company that you have health insurance with take that over and a lot of times they may deny it because it's responsibility of another party.

It's a lot of times a life change. A really good example of this would be if you have a back or neck injury, something to deal with your spine and you have to have a surgery known as a fusion where they go in and fuse together to vertebrae in your spine. Anytime that you do that, you limit the motion at that level which puts more pressure on the level above and below it and the spine, which can develop what's called adjacent segment disease. So now I've fused a portion of my spine, doesn't move like it did. The spot above it and the spot below it have all this other pressure on it which can then result in treatment needs associated with that adjacent segment. You've got to address that as part of the settlement to make sure that that's being taken care of because it's going to take a while to happen and it's easily something that the insurance company is going to deny if you don't take it and make sure that it's spelled out.

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