Will my health insurance cover treatment for chronic back pain following a settlement?
A few years ago, I sustained a back injury from a fall at a business due to a hidden hazard. The settlement I received was modest, covering only about 25% of my costs and allowing me to pay off some debts.
Initially, my back improved over time, but lately, the pain has intensified significantly—far worse than it ever was before. I now have to brace myself against something solid to avoid severe pain when I cough.
One thing my lawyer didn’t clarify was how my health insurance would interact with my settlement. Sadly, he passed away shortly after the settlement, and I haven’t had a new contact at the firm.
If I decide to see a doctor now, how will my insurance respond? I’m uncertain if the pain is connected to my previous injury. Could they deny coverage? Would they seek reimbursement from my settlement? Would I be responsible for the entire settlement amount, or just the portion I received?
I do have some savings set aside that are separate from the settlement money, but that settlement is long gone.
I’m not a legal or insurance expert, but I can offer some general guidance on your situation.
Health Insurance Coverage: Your health insurance should generally cover treatment for chronic back pain regardless of your past injury settlement, as long as the treatment is considered medically necessary. The specifics can depend on your policy, so it’s best to check directly with your insurance provider.
Causality of Pain: If the current pain is not related to the prior injury that led to the settlement, it should not affect your ability to access treatment through your health insurance. However, if they determine that the pain is related to the previous injury, they may ask for documentation of the settlement.
Reimbursement: Many states have laws requiring health insurance to be reimbursed for costs incurred in treating a condition for which you have received a settlement. This usually involves the health insurer claiming a portion of the damages you received if the treatment is related to that injury. The amount they can claim may depend on the specifics of your settlement and state law.
Consulting a New Lawyer: Given the complexity of your situation, especially since your previous lawyer has passed away, it may be worth consulting with a new attorney who specializes in personal injury or health insurance law. They can provide advice tailored to your circumstances and help clarify your rights and obligations regarding your settlement and insurance coverage.
Keeping Records: When you see your doctor, make sure to keep a thorough record of your visits and treatments, especially if they start to suggest that your current issues are related to your earlier injury. This documentation can be helpful in case there are any disputes with your insurance.
Financial Planning: Since you’ve mentioned that your settlement money is already spent, preparing for any potential financial responsibility arising from the insurer’s claims is a smart move. Having your savings set aside can give you some peace of mind in case unexpected costs arise.
Overall, it’s important to communicate openly with your health insurance provider and seek competent legal counsel to navigate these issues effectively. Good luck, and take care of your health!