Settlement offer

[Bad Boy Bad Boy]

Gatekeeper, we all want it over with. So you know your not alone on that issue. I've been in the soup now since 2001 or so. Still working on settlement since 2004....

[Gatekeeper]

Bad Boy Bad Boy Wrote:Gatekeeper, we all want it over with. So you know your not alone on that issue. I've been in the soup now since 2001 or so. Still working on settlement since 2004....

that does not sound encouraging BBBB, I hope this is over for you soon also. I dont believe more surgery will benefit me so the most worry I have is meds and my doctor will work with me on that issue. If they open me up again it will just createmore problems. thanks again

[Gatekeeper]

endofmyrope Wrote:Hello fellow Michigander. I recently settled my case after it was disputed in August of 2008. The wording in my paperwork spread the settlement amount out over my remaining life expectancy and was divided by that number of months to come up with a monthly amount. This amount coordinates with SSDI payments for your lifetime. I do not believe that a settlement could be worded to avoid the offset to SSDI. Even though I received a settlement, known as a compromise and release of my claim, the WC carrier never did accept responsibility for the injury.
Medicare's interest should be taken into account if you will be eligible for it in a short time. I believe it is 24 months after initial SSDI approval. The way I understand things in MI it is rare for future medical to be included in a settlement unless there is a catastrophic injury. It is possible that your current insurance could refuse to pay for care once you settle your case. I would not take anyone's word for continued coverage unless it was in writing from the company insuring you. If the Aetna coverage replaced the BCBS they may place a lien on any settlement amount also.
On one hand if you settle you are out from under WC's thumb, a BIG relief!!. On the other, what do you gain if you lose insurance coverage for your injury and have to repay much of the settlement to SSDI and BCBS?
My attorney has an excellent reputation, is known as a "Super Lawyer" and did not bring up some of the above issues unless specifically asked. I second that beware from BBBB. 1171 and BBBB are right on the money with their comments. Your attorney should be informing you of all the ramifications. Best of luck to you.

Hi, thanks for the input on the settlement. The way I see it if I keep fighting the system will get more than I stand to get. If i get out now and take some money with me I can start fresh where the weather is warm and put all the IMEs and W/C people behind me and in 1 0r 2 years the state will cover my surgery thanks to Obama! I am a libretarian but I have been screwed for 2 years now and I am sick of it! Did they put a MSA for you cuz I read that if your settlement is under $250k they don't. I have been collecting SSDI for 2 months and I won't agree to another surgery also my remaining bulging disc is not from my injury it happened after my fusion surgery. Don't know how thats gonna play out but we will see.
thanks for the advise.

[Bad Boy Bad Boy]

Gatekeeper Wrote:

endofmyrope Wrote:Hello fellow Michigander. I recently settled my case after it was disputed in August of 2008. The wording in my paperwork spread the settlement amount out over my remaining life expectancy and was divided by that number of months to come up with a monthly amount. This amount coordinates with SSDI payments for your lifetime. I do not believe that a settlement could be worded to avoid the offset to SSDI. Even though I received a settlement, known as a compromise and release of my claim, the WC carrier never did accept responsibility for the injury.
Medicare's interest should be taken into account if you will be eligible for it in a short time. I believe it is 24 months after initial SSDI approval. The way I understand things in MI it is rare for future medical to be included in a settlement unless there is a catastrophic injury. It is possible that your current insurance could refuse to pay for care once you settle your case. I would not take anyone's word for continued coverage unless it was in writing from the company insuring you. If the Aetna coverage replaced the BCBS they may place a lien on any settlement amount also.
On one hand if you settle you are out from under WC's thumb, a BIG relief!!. On the other, what do you gain if you lose insurance coverage for your injury and have to repay much of the settlement to SSDI and BCBS?
My attorney has an excellent reputation, is known as a "Super Lawyer" and did not bring up some of the above issues unless specifically asked. I second that beware from BBBB. 1171 and BBBB are right on the money with their comments. Your attorney should be informing you of all the ramifications. Best of luck to you.

Hi, thanks for the input on the settlement. The way I see it if I keep fighting the system will get more than I stand to get. If i get out now and take some money with me I can start fresh where the weather is warm and put all the IMEs and W/C people behind me and in 1 0r 2 years the state will cover my surgery thanks to Obama! I am a libretarian but I have been screwed for 2 years now and I am sick of it! Did they put a MSA for you cuz I read that if your settlement is under $250k they don't. I have been collecting SSDI for 2 months and I won't agree to another surgery also my remaining bulging disc is not from my injury it happened after my fusion surgery. Don't know how thats gonna play out but we will see.
thanks for the advise.

I think that is under $25,000 for the MSA you read... But, MSA's must be in the best interest at all times, no mater the settlement amount.

I would (beware) what your calling Obmama care. As your forgetting something. Pre-Exisiting medical is different from a Pre-Exisiting work injury. Meaning that it isn't the same thing as you may think...

The new Bulging Disc after a fusion may have been caused by the Dommino effect, which then could be related to the work injury. This is a common thing that does happen sometimes. Where the remain Disc take up the Pressure and weight from the ones no longer in use anymore.

[Gatekeeper]

Good point and I just read the pre existing thing, but I can sit in the W/C pit and never get approved for another surgery. Screwed if I do and Screwed if I don't!! An injured individual who is not yet a Medicare beneficiary should only consider Medicare's interests when the injured individual has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement date, and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.

A memorandum was issued on May 23, 2003, from the Department of Health and Human Services in an attempt to clarify the review threshold for claimants who are not yet Medicare beneficiaries. The memorandum from Thomas L. Grissom, Director, Center for Medicare Management, states in pertinent part:

[T]o the extent a WC settlement meets both of the criteria (i.e., the settlement is greater than $250,000 AND the claimant is reasonably expected to become a Medicare beneficiary within 30 months of the settlement date), then CMS-approved Medicare set-aside arrangement is appropriate. However, if a WC settlement is $250,000 or less OR where the claimant of that settlement is not reasonably expected to become a Medicare beneficiary within 30 months of the settlement date, then a CMS-approved Medicare set-aside arrangement is unnecessary. ...[W]hen an individual's settlement does not meet both thresholds Medicare will make payment for WC related services that are otherwise reimbursable under Medicare once the individual enrolls in Medicare.


I found this on line:

[Regrets]

Q. Are there any special considerations when settling my claim if I am on Medicare, or expect to be on Medicare in the near future?

A. Absolutely. If you are currently on Medicare and your case settles for more than $25,000, then you must obtain approval from the Centers for Medicare and Medicaid Services (CMS). If you have a reasonable expectation to be on Medicare within the next 30 months, and the value of your settlement is over $250,000, you must obtain CMS approval as well. The law requires that workers' compensation settlements take Medicare's potential interests into account. This is done through the creation of a Medicare Set-Aside (MSA) which is money set aside for future work-related medical treatment. There are complex rules concerning when a MSA is necessary, and how the MSA can be spent. However, if it is done properly, Medicare will pay for work-related medical expenses once the MSA is properly depleted.

[Gatekeeper]

Regrets Wrote:Q. Are there any special considerations when settling my claim if I am on Medicare, or expect to be on Medicare in the near future?

A. Absolutely. If you are currently on Medicare and your case settles for more than $25,000, then you must obtain approval from the Centers for Medicare and Medicaid Services (CMS). If you have a reasonable expectation to be on Medicare within the next 30 months, and the value of your settlement is over $250,000, you must obtain CMS approval as well. The law requires that workers' compensation settlements take Medicare's potential interests into account. This is done through the creation of a Medicare Set-Aside (MSA) which is money set aside for future work-related medical treatment. There are complex rules concerning when a MSA is necessary, and how the MSA can be spent. However, if it is done properly, Medicare will pay for work-related medical expenses once the MSA is properly depleted.

Hey Regrets thanks for the post, yes I am within the 30 months but I also have group health care coverage. My settlement is less than $250k with no future surgeries do you think they will ask for a MSA?

[Regrets]

From what I Read Probably not, but Please Check with Your Attorney before Making any Major Decision on the Writing of Your Settlement. Also Double Check, now don't Quote Me on this but I Think there May be a Typo on the $250,000.00 amount on the Answer I Provided, but I May be Wrong. I'm on Medicare, so I Fall into the Category of Either Needing One, or Letting w/c Keep My Medical Open, but if I had My Way, I would want the Set-Aside and w/c Out of My Life!! I'm almost 6 Years in, and that's 5 Years, 364 Days, and 23 Hours too Long for Me!! Best of Luck, and Please just Double Check before You Commit to Anything.