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With each passing year it seems as if, despite the constraints of the California Workers’ Compensation system, we are able to settle many cases in the high six-figure, and at times, seven-figure range. This is in large part due to the nature of the injuries sustained by the injured worker (which are often considered catastrophic), but also to the necessity for a Medicare Set Aside.

A Medicare Set Aside (“MSA”), as used in the Workers’ Compensation system, is an allocation of a portion of a Workers’ Compensation settlement that is “set aside” to pay for future medical treatment related to the workplace injury or illness. These allocated monies must be spent before Medicare will pay for treatment related to the workplace injury or illness.

MSA’s are often required when a settlement exceeds a certain sum and, in addition, when an individual is either already entitled to Medicare, or has applied for Social Security Disability benefits, or is over a certain age.

Some companies offer evaluation services to recommend an appropriate MSA amount, and offer many benefits to the injured worker. At the (employer’s) insurance carriers’ expense, the evaluation provides a more realistic assessment of the total anticipated cost of an individual’s work-related medical expenses, projected over their “life expectancy”, or expected lifetime.

Additionally, in order for an (employer’s) insurance carrier to buy-out the injured worker’s future medical care portion of the Workers’ Compensation case, they must now pay no less, and usually significantly more than, the value of the projected MSA.

Because of the benefits offered to the injured worker, the (employer’s) insurance carrier would prefer to deal directly with the injured worker, paying them much less than full value to buy-out their “future medical”. Many times, the injured worker is very vulnerable; he or she may not be able to return to usual, customary duties due the severity of the injuries, may have run out of certain benefits, may have to care for family or loved ones, or any other stressors of daily life.

As a result, the injured worker is often anxious to settle and accept far less than full value for their cases. DON’T BE TAKEN ADVANTAGE OF! If you have serious or catastrophic injuries, speak to an attorney immediately. At Heiting & Irwin, we offer free consultations. You may call our office at (951) 682-6400.

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