set-aside and WC

[genegene]

Thanks everyone. I didn't know who was in charge of doing everything. I understood the WC had hired a law firm to write everything up..Does anyone know if you do a set-aside does that negate WC leaving medicals open. Thats what I have ben told.
I was really being pushed for settlement before I had the back surgery and stuck to my guns. I was asked to cancel my application for SSDI and take the money, then was told I would have to pay for my last 2 surgeies out of the settlement. I did my own research and found I would have been almost 40,000 in the hole and that would be without any kind of complications. Needless to say I didn't make any friends with my decision to wait.
Timothy, when you say that my estate will get the remainder, if any, of the set-aside is that a rule that each state can interpret. I was told that it would go back to the government in the case of my death. Of course that is when they wanted me to drop the SSDI so that could be something that wasn't exactly on the up and up.
I really appreciate the imput everyone.

[kate]

On the CMS website (Medicare Set Aside website):

Death of a Claimant Prior to Exhaustion of the Medicare Set-Aside Money
(Ref: 4/21/03 Memo, Question 21)
Once the Regional Office (RO) and the contractor responsible for monitoring the claimant's case verify that all of the claimant's claims have been paid, then any amount left over in the claimant's WCMSA may be disbursed pursuant to State law. This may involve holding the WCMSA open for some period after the date of death, as providers, physicians, and other suppliers are permitted to submit their initial bill to Medicare for a period ranging from 15-27 months after the date of service.
Here's a link to the referenced memo. Question 21 addresses this issue. http://www.cms.hhs.gov/WorkersCompAgency...03Memo.pdf

[genegene]

Thanks Kate. This is a very informative web site. I wish I had known about it earlier. I have learned so much since I have been on here, a whole lot more than I could ever have found out on my own or through my attorney. Everyone on here has been so great about sharing their knowledge. It brings a little sanity in this insane world of workers comp.

[1171]

if you leave medical open there is no need for a set aside since you don't have the medical $$$.
no. unused setaside $$ does not go to the government. Medicare is federal and there is no state control of federal laws.

[Lilly]

This IS definitely a very imformative post chalk full of good questions and answers.
Thanks all!!
Lilly

[Timothy Belt]

The sad truth is that although there is a law there are no regulations on how the law should be administered. What we have is a series of memorandum issued by Social Security. According to the most recent memorandum that I am aware of, the money goes to your estate.

genegene Wrote:Thanks everyone. I didn't know who was in charge of doing everything. I understood the WC had hired a law firm to write everything up..Does anyone know if you do a set-aside does that negate WC leaving medicals open. Thats what I have ben told.
I was really being pushed for settlement before I had the back surgery and stuck to my guns. I was asked to cancel my application for SSDI and take the money, then was told I would have to pay for my last 2 surgeies out of the settlement. I did my own research and found I would have been almost 40,000 in the hole and that would be without any kind of complications. Needless to say I didn't make any friends with my decision to wait.
Timothy, when you say that my estate will get the remainder, if any, of the set-aside is that a rule that each state can interpret. I was told that it would go back to the government in the case of my death. Of course that is when they wanted me to drop the SSDI so that could be something that wasn't exactly on the up and up.
I really appreciate the imput everyone.

[jayne]

Timothy Belt Thank you for taking your time to answer us with heart and dignity....