SETTLEMENTS WITH MEDICARE SET ASIDES: ARE THEY THE WAY TO GO? (PART 1)

This can be a very complex issue, so we will just touch on the basics in this blog.

If you are already a Medicare beneficiary or are likely to become one within the next thirty (30) months, it is worthwhile to look into a lump sum settlement whereby you accept a greater sum of money to close your future medical care available to you through the Workers’ Compensation System.  In that way, you don’t have to deal with the frustration of trying to obtain authorization for timely medical care and treatment through your Worker’s Compensation matter. Instead, you can have Medicare take care of your future medical care related to your work injuries and be done with the Workers’ Compensation carrier, self-insured administrator or other entity responsible for administering your future medical under this system.

In very basis terms, here is how it works.  If it is agreed upon between the parties that a certain case fits the appropriate criteria, the defendant carrier or administrator pays an independent company, typically called an MSA vendor, to review your medical records and evaluate, on a Medicare cost basis, how much your injury-related medical care will cost over a certain life expectancy.  This usually costs the defendant in the rate of $3,000 to $4,000.  Once that figure is obtained, assuming there is otherwise adequate medical evidence (i.e. reporting) to substantiate a demand for settlement – negotiations begin.

The real beauty of a settlement with a Medicare Set Aside (MSA) is two-fold.  First, as stated above, you can obtain a lump sum settlement closing your future medical care available through your W/C case, but still have future medical provided by your MSA and Medicare.  Secondly, a good MSA settlement would not only pay you the assigned MSA allocation figure and the value of your permanent impairment, but would also pay you a decent sum over and above these figures, such that you would be in an even better position financially than you would be with a typical Worker’s Compensation case and you would still have open medical care – just not through the Worker’s Compensation system.

In the next blog, I will give you at least one example as to how this works to hopefully give you a greater sense of how this could/would benefit you.