Workers Compensation Lifetime Care Injuries

I’m Katelyn Holub, an attorney focusing on personal injury law in northwest Indiana.

Welcome to Personal Injury Primer, where we break down the law into simple terms, provide legal tips, and discuss personal injury law topics.

In Indiana, a catastrophically injured worker often will qualify for lifetime medical care.

What do I mean by catastrophically injured?

Take, for example, a worker who suffers an injury rendering them wholly or partially paralyzed. Such a worker often will qualify for paid medical care for life under the work injury laws in Indiana.

Such a catastrophically injured worker also will typically qualify for Medicare, or after a several-year waiting period will qualify for Medicare.

For a number of reasons, settlements of catastrophic work injury cases can be difficult.

Why? Because the attorney representing the injured worker must fashion a partial settlement that does not foreclose the catastrophically injured worker’s ability to get needed future medical care. At the same time, the attorney defending the claim will want to limit a payout on future medical care costs.

This typically leads to a stalemate.

What makes a settlement even more difficult is that Medicare will step in to make sure the burden of future medical care is not shifted to Medicare by the workers compensation insurance carrier as part of a settlement.

Medicare has great leverage to protect its interests. If the catastrophically injured worker were to run out of medical care money under a negotiated settlement with the workers compensation carrier, Medicare could penalize the insurance carrier and others involved in the settlement.

On the other hand, if a case is kept open and unresolved, both the catastrophically injured worker and the workers compensation carrier have ongoing risk, which is not good for either party.

A lack of proper medical care could lead to premature death. While a  family may be entitled to workers compensation death benefits under the Indiana Workers Compensation Act, this benefit rarely will compensate a family for the loss of a breadwinner.

On the other hand, if the catastrophically injured worker lives a normal life expectancy, the workers compensation insurance carrier may be required to spend millions of dollars to provide the required statutory medical care.

So the injured worker in need of ongoing care, and the insurance carrier paying out medical benefits, both have an incentive to arrive at a settlement under arrangements approved by Medicare.

The big question then becomes is there a middle ground where all parties can settle in a way that will garner Medicare approval?

Most of the time the answer is yes.

What does Medicare typically want to accomplish? It wants to see the workers compensation carrier fund the bulk of ongoing medical care, and make sure Medicare is only a last resort payor should settlement funds run out.

How can a settlement be accomplished in such cases? Typically it involves a structured settlement approved by Medicare, which we discussed in Podcast Episode 280.

I hope you found this information helpful. If you are a victim of someone’s carelessness, substandard medical care, product defect, work injury, or another personal injury, please call (219) 736-9700 with your questions. You can also learn more about us by visiting our website at DavidHolubLaw.com – while there, make sure you request a copy of our book “Fighting for Truth.”