While many claims settle with the payment of statutory benefits, there are other claims needing further consideration, for instance in those states where the medical portion of the claim cannot be closed. The adjuster then needs to evaluate possible future medical exposure, taking steps to conclude it when the disability claim is settled, even if it involves payment for estimated future medical expense.
In most states, if the medical portion of a claim is not settled, the employee has the right to unlimited future medical coverage. For example, if the employee has a disability rating to the lumbar spine, by leaving medical open, you may be paying chiropractor bills for the rest of the employee's life, or worse, for a surgery -- related or not to the workers comp claim.
Most plaintiff attorneys want to resolve the future medical, especially if they are entitled to a portion of the medical settlement in their fee.
A tactic commonly used by plaintiff attorneys is to overstate the value of future medical. Your medical director must review any estimate of future medicals over a predetermined limit set by your risk management department.
Often, it will be necessary for the medical director to consult with both the treating physician and IME doctor to determine what is necessary and what is not in the plaintiff attorney's future medical estimate.
Once the medical director establishes the need for future medical care, the adjuster and/or defense attorney holds fast to the amount, even if it means adjudicating that aspect of the claim with the Workers Compensation Board.