Having a strong support system is invaluable to help us survive and thrive. It helps attain higher levels of well-being, better coping skills, and live a longer, healthier life. Research shows it has been proven to reduce depression and anxiety, as well as reducing stress. Nowhere is the need for an active social support network more imperative than for injured individuals and those helping them. Knowing one can rely on others to help them through tough times contributes to positive emotional and physical health and helps maintain and foster the continuation of any physical and mental health gains already made. In this article, we’ll take you through some key considerations to keep in mind when approaching settlements and how to better manage your funds.
The Challenge of Change
A significant change in a person’s life is one of the most stressful times for any of us – even if it is perceived as a positive change. Leaving the workers’ compensation system to take charge of one’s own care is a prime example of such a change. A solid, consistent, dependable team of supportive people is instrumental in helping these individuals and their caretakers succeed and flourish.
While experiencing and trying to recover from an injury is itself a potential nightmare, the decision to settle an injury claim creates its own set of extreme difficulties. There are concerns, questions, and confusion. In addition to significant changes and decisions that must be made are the seemingly minute, day-to-day struggles injured individuals face. Those helping with their care face their own challenges and may not know where to turn. Fortunately, professional administrators excel at helping injured individuals and the professionals who work with them address these difficulties head-on.
Post-Settlement Needs
Problem: Navigating Independence
Injured individuals trying to settle their claims have many concerns – some of which they may not even realize until after their claim has closed. Once the claim is settled, the injured person is on his own to locate providers, pay out-of-pocket for medical services, and address any government requirements. Typical questions include:
- Will there be enough money?
- Who will I call for advice since my claims adjuster and attorney will no longer be part of my team?
- How will I protect my medical funds?
- How will I know if I am paying the right amounts – for physicians, medications, and medical treatments?
- How will I address the complicated Medicare system (for those who are or will soon be eligible for Medicare) or other government benefits?
- How will I find the best providers?
- What if I need ongoing support, such as durable medical equipment, prosthetics or home health?
Solution: Using A Professional Administration
Professional administrators work on behalf of the injured worker. Period. They and their partners are experts in all the various issues that arise post-settlement.
Money Management
Problem: Financial Security
A primary reason injured individuals are hesitant to close their claims is fears about running out of money. While there may be a substantial amount of money included in the settlement, it is a finite amount with no guarantee that it will last the person’s entire lifetime. An injured person with physical limitations who cannot return to full-time employment faces the fear that their money may run out. This fear can be debilitating.
Solution: Relying on Financial Expertise
Professional administrators collaborate with experts to address financial issues. Their responsibilities include ensuring the money needed for medical needs is protected and used wisely. They offer:
- Network discounts. Professional administrators contract with many physicians and pharmacies to ensure the injured individual pays rates below what the actual retail price would be. This greatly helps stretch the dollars earmarked for medical services and treatments.
- Fee schedules. The prices for various medical treatments are typically based on fee schedules, which vary widely among jurisdictions. The unknowing injured person may have no idea what he should be paying. Professional administrators are adept at knowing the appropriate costs among different states.
- Medicare issues. Injured persons affected by Medicare must ensure they pay for treatment for their specific injury out of their settlement funds and not bill Medicare. Failing to do so risks losing Medicare benefits for their injury. It means they must pay for any treatments for their injury that Medicare would otherwise cover. They must also comply with the various regulations involved.
Professional administrators and their teams of experts handle the Medicare challenges. If the settlement money for treatment is depleted, professional administrators have the knowledge and tools to demonstrate that the proper steps were followed, ensuring Medicare will pay.
Having the support of a professional administrator means the injured worker can have peace of mind, knowing that his money is being spent wisely and will last forever. It also gives the injured person’s former attorney peace of mind knowing that these needs are being addressed – meaning he can focus on active cases.
Advice and Guidance
Problem: Lack of Support
One of the most frightening issues post-settlement is going it alone. With claims adjusters, nurse case managers, and attorneys out of the picture, navigating the healthcare system alone can leave the injured feeling desperate for advice.
There is also the issue of how and when providers should be paid and ensuring the amounts are correct and in compliance with Medicare, if applicable. There may be questions about what forms a physician must complete and what information from the injured person is required.
Solution: Accessible Expertise
Professional administrators provide expert advice to their members on all things medical. They typically have dozens of experts available via email, phone, or through online chats. From finding providers to questions about suggested treatments and the best medications for their condition, professional administrators can answer their questions easily and within a reasonable amount of time.
In addition to helping the injured person find the best and most appropriate providers, the professional administrator will send a ‘welcome’ letter. This outlines how and where bills should be sent and how and when the provider will be paid. It also includes information required for authorization. Professional administrators can also speak directly to providers with any questions.
Knowing the professional administrator is the injured person’s point of contact post-settlement provides great peace of mind to insurance professionals such as attorneys, as they can focus on their existing business rather than having to address their former clients’ concerns.
Customized Needs
Problem: Unique Care Requirements
No two injured workers are alike. Each has different care needs – there is no one-size-fits-all solution. Some injured persons need a wheelchair, a ramp at home, or home health care. They also need help maintaining and replacing certain items. The upkeep of certain devices is completely unknown to most, except experts.
They may have government benefits they need to protect, such as Medicaid. These may require a special needs trust.
Injured workers are likely unaware of where and how to get the best solutions to their unique issues and equipment.
Solution: Customized Support
Among the dozens of experts involved with professional administrators are those who excel in customized support. One may have specific insight into the best prosthetic for a specific condition. Additionally, this expert will know where and how to find a replacement that might be necessary. A wheelchair that is perfect for an injured worker who is 35 years old might not be appropriate for that person 20 years hence. An injured person who gains or loses a substantial amount of weight may need a different device.
Durable medical equipment won’t necessarily last forever. Professional administrators who specialize are aware of when to start looking for replacement equipment ahead of time, so the injured person has it when needed.
Conclusion
Closing a workers’ comp claim often means losing a dedicated support team, except for family and friends. This loss can create a void that negatively impacts mental, emotional, and physical health. A strong expert support team can make a tremendous difference, leading to optimal outcomes for injured individuals and the professionals who have supported them.
