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FUTURE MEDICAL TREATMENT

Defined by 8 CCR §9785, "Future medical treatment” is treatment which is anticipated at some time in the future and is reasonably required to cure or relieve the employee from the effects of the injury.

SB 863 has restricted Agreed and Qualified Medical Evaluators' opinions on treatment to future medical care, rather than continuing medical care (see revised Labor Code §4061)

Award of future medical treatment: Future medical treatment is generally awarded in cases where there is a medical opinion that it may be needed. Board Rule §10606. (Physicians' Reports as Evidence) requires a report to "include where applicable" various items: "(j) treatment indicated."

An award of future medical treatment, or an award terminating medical treatment, must be supported by substantial evidence.

"Open medical" is often referred to, erroneously, as "lifetime medical." In fact, the benefit is limited and, as the law changes, becomes more so. Recent reforms have limited choice of treating physician (see Medical Provider Network), types of treatments (see Medical Treatment), objections to utilization review (see Independent Medical Review), etc. Any treatment must be necessary to cure or relieve from the effects of the industrial injury or its compensable consequences.

The defendant can petition to terminate the medical award under Labor Code §4607, but risks having to pay the injured worker's attorney's fees if the petition is unsuccessful. Given the potential cost of medical-legal evaluations and attorney fees for the defense and potentially for the applicant, the process is little used. The petition is not required if only one type of treatment is terminated rather than all treatment.

Buying out future medical treatment: While workers often wish to have a lump sum to spend as they like, and want to settle by way of Compromise and Release, there are inherent risks. See the Websites and Magazine Articles below.  

See, too, Medical Research

Label Item Links Comments
Labor Code See above  
Regulations/Rules Future medical treatment defined 8 CCR §9785  
Cases  
Forms      
Websites

HealthPartners Cost of care

CMS/Medicare Fee Schedules

Vimo hospital & procedure costs

Costhelper

Comparative cost of medications by drug & condition

Medical treatment utilization schedule (MTUS)

Cost of care

CMS fee schedules

vimo

Costhelper

goodrx

MTUS

 
Practice Tips  If settling future medical treatment, always get a signed Informed Consent along these lines : "I acknowledge that I have closed out my rights to any further benefits, including compensation and medical treatment (including surgery) and, upon approval of this settlement, my case shall be closed in its entirety for all purposes. My case will be closed even if the doctors have indicated a probability of my need for further medical treatment or surgery. My attorney has advised me that she cannot estimate the actual cost of future medical treatment and that she cannot warrant coverage under any medical plan. She is therefore not recommending that I close out future medical treatment. I have elected to do this anyway after full consideration of this issue, with knowledge of the impossibility of accurately predicting future medical costs, because I desire to control my own medical treatment."    
Articles
     
Magazine Articles Calculating the Cost of Future Medical Treatment by Marjory Harris, Esq.

The C&R Dilemma – The Future Medical Buy-Out
by Michael McDonald, Esq.

How Your Structured Settlement Broker Can Help Determine the Value of Future Medical Costs by Steven F. Chapman and Gregg Chapman, Esq.
Calculating FMT


Buyout dilemma


How broker can help
 
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