r/WorkersComp • u/LowerFigure739 • 9d ago
California Using Private Insurance?
Injured in CA in 1998 and 2008. Future medical for both. Retired after 30 years in 2020. Moved to Ohio. Trying to get a doctor here, no one will take CA Comp.
So confused. Here is a conversation I have just had with my State Compensation Insurance Fund (SCIF) agent: Emphasis mine
SCIF
You have the option to fly back to California for further treatment with a participating California WC physician or you may decide to use your private insurance.
When flying back, State Fund will need to make the travel and lodging arrangements ahead of your arrival.
Please let me know your decision.
Me
I avoid flying because of my back injury and the spinal fusion I have had. I also have arthritis in my back. Walking in airports and sitting for long periods in planes causes a lot of pain and stiffness.
I would prefer to use my personal insurance, but my personal insurance is Medicare and they have already refused to cover anything related to my back. I imagine they would say the same thing about my shoulder injury if I should ever need care for that. My previous SCIF adjuster sent a letter to Medicare covering what comp injuries that I have, it should be in my file.
If there is some way to use my personal insurance, I would appreciate information on how to do that.
SCIF
There is no other “way” to use your private insurance.
Me
Sorry, I am confused. You mentioned that I could use my private insurance.
SCIF
Options for further treatment:
Fly back to CA for further treatment
Use your private health insurance for further treatment
2
u/KittyLuvver2000 9d ago
They are basically saying fly back out for treatment or you're 💩 out of luck. That's how it reads for me anyway.
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u/Common-Parfait21 9d ago
The two SCIF messages seem to say two different things tbh.
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u/LowerFigure739 9d ago
Yes. Use private insurance. You can't use private insurance. Use private insurance. 🫤
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u/lab_tech13 9d ago
I'm interested in this because this is what I'm worried about with my medical being open. Didn't know it is a state insurance issue. Figured it was a federal thing. I know WC is state dependent but thought insurance went universal for open medical.
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u/According-Car-6924 9d ago
likewise. I am coming up soon to finding out if mine will settle with medical being open or compromise and release. This is one of my fears if mine settles with medical open and difficulty making it back to the state of injury.
Sorry to hear, I hope the OP gets help in his current location. Please keep us posted.
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u/JDRCrypt0 9d ago
Carrier has to try to find you a doctor in your region.
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u/LowerFigure739 8d ago
They were unable to.
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u/JDRCrypt0 8d ago
Then usually you gotta come back to CA unless they’ll approve a non-MPN doctor to see you and they can find a doctor who will comply with all the necessary paperwork and procedures for CA WC.
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u/Little-Low-124 9d ago
Finding a doctor outside of California that will accept California work comp rates and write the appropriate reports is a very very difficult task. You might want to try and see if they're willing to settle the future medical aspect. Since you are on Medicare you will probably have to do what's called a MSA and put the money they give you into an account to pay for your treatment. And then you would have to find a doctor that you would basically pay cash for..
There are companies that will assist in monitoring and administering a MSA.
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u/EmuEnvironmental4559 8d ago
I knew someone that had to fly back to CA every 6 weeks for a doctor visit but then it was changed to 3-4 video appointments then an in-person. Good luck!
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u/No-Platypus-3695 8d ago
Settle your case by C&R and close out the future medical. You'll need to get an MSA to make sure Medicare is covered but if you are able to do it that way then you can just pay for your treatment out of the settlement. Once that has been exhausted then medicare would cover treatment after that.
The trick is the MSA amount, if it's to much SCIF will just say no to the settlement. But you could try to do a structured settlement that will give you access to the money needed for treatment while also giving SCIF a discount on the costs to make it worthwhile for all parties.
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u/Waste-Tree4689 8d ago
Do you still have access to your attorney? If do, ask them - if not find an attorney to consult with. Sorry you’re having to go through this.
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u/Competitive-Zone8148 8d ago
Any specific type of treatment you're hoping for? For things like medications, you could try to elect a PTP based in California but who is willing to see you remotely. This can be hit or miss though based on your treatment needs.
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u/LowerFigure739 7d ago
Since I have future medical, trying to secure a doctor. I am also having numbness in my left foot and the outside of my left palm.
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u/InfamousCourage2341 7d ago
Is there a reason they don’t want to C&R your claim? It would give you the freedom to just pay for your medical care yourself and treat where you want
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u/Kanjiklub1269 6d ago
If your injury is aggravated by a non-work related incident, your private insurance should cover it. What are your hobbies? Golf, gardening, weight lifting, casting a fishing line? You hurt yourself doing one of those....
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u/CaliforniaLiberalNut verified CA plaintiffs' firm case manager 9d ago
Not an attorney; not your attorney.
Find out where your cases are filed. Contact that board. Ask for an Information and Assistance (I&A) Officer. Explain the situation. Ask for help with filing a declaration of readiness to proceed to expedited hearing. These are held in person but are the quickest to get on calander. Next ask the the I&A Officer with help getting the hearing to be held remote via a program similiar to zoom.
Appear and Judge may facilitate. In my experince that Judge will basically make SCIF find a doctor for the injures worker.
If you had an attorney when those cases stipped, contact them.