I have an option to re-open a claim on my employers self insurance(like WC) but I am a little hesitant for this reason. My spinal specialist(not a surgeon) has told me that if I want to have an ADR, that my chances would be much better through my health insurance than WC because WC always lags behind on new procedures. Does anyone have any opinion on this topic?

I had my ADR in January 11,2005 with Workmans Comp. Yes I had to jump through hoops for the WC people. Like, they didn't want to do it because the Prodisc at three levels is not approved by the FDA except for the Clinical Trials going on.
Luckily for me the doctor I had to see for my WC people was a collegue of my surgeon. And I was approved by the FDA for the three level Prodisc.
I'm back at work at modified duty.

Re open that claim. You don't know how fortunate you are to have care thru WC~ it's so often denied.
WC has authorized ADR surgery for me twice tho I've not yet had it. I was denied by the Utilization Review Board that the auths go thru but the WC insurance carrier themselves have overridden this and approved the surgery.
I would reopen your claim and keep your WC insurance going. If you should get denied by WC to have this surgery you can still try to get your Private carrier to approve if you carry this policy also.

Actually if you open the worker's comp claim on your back, the private carriers generally no longer will cover the surgery if w/c denies. And w/c in your state I believe does not cover fusion which makes ADR a harder sell.

I would talk to a w/c lawyer before making a decision as w/c decisions are more final, determining care for your back for your life. You lose on surgery in a w/c case it can be very hard to get coverage any other way.

I lost on my surgery (not ADR another kind) and it was bascially on a technically (The insurance lawyer got medical reports from a nationally known surgeon excluded from evidence.)

W/c is designed to limit liability for serious work injuries, like major back injuries, and generally provides less coverage for major medical problems than other insurance. (80% of w/c medical costs is in the 10% most injuried cases so that's where cost containment is focused)

I was able to use both WC and my group insurance from work for my injured low back for the last 20 years.
However usually if the private carrier knows you have WC, they will want to submit the bill to WC. I did have quite a bit that I was afforded to have done under my group policy that WC wasn't covering~ never had a problem with it...

Lisa,

You make the very points I am concerned about. I have been treating my back with medical insurance for the last 4 years.

Previously though, I have had more than 1 WC claim filed for similar injuries and was actually awarded a monetary settlement at one time. On a separate WC claim that closed in 2000, I still have an option to re-open it until 2007, which is what I am debating.

I am just very concerned how the medical insurance is going to react when they find out that the last 4 years has actually been a work related injury. On top of that, my doctor knows WA State process as well as anyone and she says I will have a much better chance of getting an ADR sooner than later with regular medical insurance. I may also talk to a couple local surgeons here to see what they have to say about it.

That's atypical in my experience. Most people I know with w/c aren't getting any coverage under private insurance for injury that w/c is supposed to cover even if w/c is covering almost nothing or nothing (and with the new law in my state denials are about 90% so w/c not covering anything is the typical case).

My private insurance would not cover even though w/c would not authorize any treatment at all.

I am glad to hear you are getting such good coverage.

Lisa,

So are you saying that because I have had past related injuries through w/c, that if I tried to get a major surgery done through my medical insurance that there would be a good chance I would get denied?

Boy, I hope not. Wouldn't the medical insurance have to prove that my present condition is caused from the past w/c injury? When my latest flair up started (3 years ago) I went to my doctor and said that it was not a work related injury because there was no one particular incident at my job that set it off.

Also, if my medical insurance was in denial and thought that it was a w/c injury, wouldn't they have denied payments on all my medical claims over the last 3 years. So far, they have paid in full everything Dr. visits, Epidurals, neurotomy, prescriptions, MRI's, discogram, and CT scan.

It sounds like you are okay in the current scenerio.

Mostly I was just encouraging you to be clear on the w/c law with a lawyer if you reopen the w/c case. Reopening the case may turn out to be the best thing for you. I am just cautious because I know too many people in the never never land where neither insurance pays. But for other people on the boards it has worked out fine.

Ending up in this never never land seems from the cases I've seen to be some complex interaction of the w/c laws in your state, how your w/c settlement is written , your group or individual policy (or medicare if you end up disabled), the policies of your w/c carrier and to some extent what adjuster/defense lawyer/judge you get assigned. Hence my suggestion to see a lawyer before you decide.

If they do decide your back is work related if you reopen the case, I think your present private insurance will then try to collect for the treatment they gave you from w/c.

Sorry if I was overly alarmist.

My Doctor told me the only 2 "Approved" Surgeries he has performed where both W/C cases...

I dont know if that helps your decision, but he said from talking with his collegues in NC, W/C cases seem the easiest to get paid.....