What Is the Difference Between a C&R and Keeping Future Medical Open?
C&R vs. Stipulations – the practical difference
- C&R: greater control over future care, but you assume the financial risk that future treatment costs more than expected.
- Stipulations: approved future medical care generally remains the claims administrator’s responsibility, but treatment continues within the workers’ compensation system and its authorization rules.
- Findings & Award: if the parties do not settle, a workers’ compensation judge can decide disputed benefits and may award future medical care.
What Should Be Valued Before Closing Future Medical Care?
- Projected physician and specialist follow-up.
- Prescription medications and monitoring.
- Physical therapy, injections or interventional treatment.
- Potential surgeries and post-operative care.
- Durable medical equipment, prosthetics or orthotics.
- Mental-health treatment where part of the compensable claim.
- Diagnostic testing and complication management.
- The effect of medical inflation, access and geographic relocation on expected cost.
Why the Medical Record Matters Before a Buyout
Before evaluating a buyout, collect
- The latest permanent-and-stationary or maximum-medical-improvement report.
- Current medication list and refill history.
- Outstanding RFAs, UR decisions and IMR outcomes.
- Recent imaging and specialist recommendations.
- Any QME/AME discussion of future medical care.
- Expected durable medical equipment or prosthetic replacement needs.
How Can Medicare Affect a Workers’ Comp Medical Buyout?
CMS states that parties have responsibilities to consider Medicare’s interests when resolving workers’ compensation cases that include future medical expenses. CMS review of a proposed WCMSA is not required in every case, and its review criteria and procedures can change. Any Medicare-related settlement analysis should therefore use current CMS guidance and the facts of the individual claim.
When Might Keeping Future Medical Open Deserve Serious Consideration?
- The worker has an unstable condition or likely major future procedures.
- Future medication needs are expensive or difficult to estimate.
- There are prosthetic, durable-equipment or replacement-cycle concerns.
- The medical record is incomplete or physicians disagree about future care.
- The worker is Medicare-eligible or nearing eligibility and Medicare coordination requires careful planning.
- The settlement amount does not reasonably reflect the treatment risk being transferred to the worker.
Frequently asked questions
Do I have to accept a C&R?
No. DWC states that you are not required to accept the claims administrator’s offer. Settlement is negotiated, and any settlement must be reviewed by a workers’ compensation judge for adequacy.
Can I reopen medical treatment after a C&R?
A C&R generally closes the carrier’s responsibility for future medical care covered by the settlement. The actual agreement controls, which is why the document and included injury claims should be reviewed carefully before approval.
Is a WCMSA always required?
No. CMS does not state that every workers’ compensation settlement must be submitted for WCMSA review. Medicare’s interests must still be considered where applicable, and CMS publishes review criteria and current guidance for cases seeking CMS review.
Should I compare the lump sum only to my current medical bills?
No. A future-medical decision should consider expected long-term care, medications, equipment, procedures and uncertainty—not just bills already incurred.