Medical Set Aside & Settlement of Case

[randyfed123]

Hello everyone,

I really enjoy and respect everyone that helps each other on this board.

My question is how does medicare affect a settlement of a case. I have a friend who was out more than a year and qualified and recieved ssdi. once the settlement of the case arrived medicare stepped in ( since he qualified for medicare) and requested a higher payout. I was told that medicare requested the IC to pay out much more and not in a set aside account but in a check to him since he was not keeping the medical from workers comp.(he requested a C&R) Does this sound accurate? I do know that medicare has stepped in and wanted the Ic to pay more to IW since they dont want to be stuck paying on a injury that the IC is responsible for.

Thanks

[freebird]

(08-24-2011 04:36 AM)randyfed123 Wrote:  Hello everyone,

I really enjoy and respect everyone that helps each other on this board.

My question is how does medicare affect a settlement of a case. I have a friend who was out more than a year and qualified and recieved ssdi. once the settlement of the case arrived medicare stepped in ( since he qualified for medicare) and requested a higher payout. I was told that medicare requested the IC to pay out much more and not in a set aside account but in a check to him since he was not keeping the medical from workers comp.(he requested a C&R) Does this sound accurate? I do know that medicare has stepped in and wanted the Ic to pay more to IW since they dont want to be stuck paying on a injury that the IC is responsible for.

Thanks

When a MSA is sent to CMS for approval, CMS can change the amount. The MSA in the case above would be higher only. I do not think CMS would tell the IC to write a check to the IW that was not part of the MSA. Makes zero sense to me.

[jayne]

if he is on SSDI there is a medicare setaside(MSA)the settlement process then has to go thru medicare for the medical to be okayed the medical does not go to the person but is put into an account to be used for medical only before medicare will kick in....it can be a lenthly process that no one likes but is done to protect both the person and medicare....

[1171]

(08-24-2011 04:36 AM)randyfed123 Wrote:  Hello everyone,

I really enjoy and respect everyone that helps each other on this board.

My question is how does medicare affect a settlement of a case. I have a friend who was out more than a year and qualified and recieved ssdi. once the settlement of the case arrived medicare stepped in ( since he qualified for medicare) and requested a higher payout. I was told that medicare requested the IC to pay out much more and not in a set aside account but in a check to him since he was not keeping the medical from workers comp.(he requested a C&R) Does this sound accurate? I do know that medicare has stepped in and wanted the Ic to pay more to IW since they dont want to be stuck paying on a injury that the IC is responsible for.

Thanks

no it doesn't.
CMS is not licensed to act as an atty and represent the worker in settlement negotiations. they cannot negotiate a higher payout to worker. In many states it's up to the comp court to approve comp settlements and CMS has no jurisdiction to order comp benefits including settlements.
all they can do is refuse to approve the MSA.

[freebird]

(08-24-2011 03:15 PM)1171 Wrote:  

(08-24-2011 04:36 AM)randyfed123 Wrote:  Hello everyone,

I really enjoy and respect everyone that helps each other on this board.

My question is how does medicare affect a settlement of a case. I have a friend who was out more than a year and qualified and recieved ssdi. once the settlement of the case arrived medicare stepped in ( since he qualified for medicare) and requested a higher payout. I was told that medicare requested the IC to pay out much more and not in a set aside account but in a check to him since he was not keeping the medical from workers comp.(he requested a C&R) Does this sound accurate? I do know that medicare has stepped in and wanted the Ic to pay more to IW since they dont want to be stuck paying on a injury that the IC is responsible for.

Thanks

no it doesn't.
CMS is not licensed to act as an atty and represent the worker in settlement negotiations. they cannot negotiate a higher payout to worker. In many states it's up to the comp court to approve comp settlements and CMS has no jurisdiction to order comp benefits including settlements.
all they can do is refuse to approve the MSA.

When the MSA is sent to CMS for approval;
CMS can change the amount of the MSA if they feel it is inadequate or to much. Now the IC does not have to accept it BUT the IC either accepts the MSA proposed by CMS or leaves the IW with open medical.

I have a friend whose MSA was Increased approx. $75000 above the IC projection. The IC approved the change and his MSA went from $150k to $225k. CMS made the adjustment because the IC was caught low balling the IW over a internal bone stimulator

[LeglEgl]

randy - 1171 gave me this link awhile back, so you might want to take a look - it might help you out:

http://www.cms.gov/WorkersCompAgencyServ...wcmsas.asp