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workers comp lump sum settlement/ medicare set-aside account
07-29-2009, 12:21 PM
Post: #11
RE: workers comp lump sum settlement/ medicare set-aside account
Dutchy Hi and Welcome to the Forum!! Kate and MJC are giving You Great Info., I'm on SSDI and w/c, and in My State, (I'm not Sure if You Posted Yours) We have the Choice with a Lump Sum Settlement of the Ins. Co, continuing the Medical, or a Medicare Set-Aside. It's such a Difference on a Case by Case Basis, it would be Very Hard to give You the Best Way to go, but if You Trust Your Attorney follow Their Lead, if You Don;t Trust them, get a Second Opinion before You Sign Anything. You May have to Pay another Attorney for the Second Opinion, but it would be Well Worth it! I'm Totally Disabled from My injury, and only 47, so My Set-Aside or Future Medical Care is going to be Astronomical if I Settle, that's Why they are Fighting Me so Hard, and Buying Time, Hoping I get Frustrated and want to Settle for Less, that's about the only Reason I can Find for it any way! Best of Luck, You will get Great Info. Here!!Wink

Failed Back Surgery, Chronic Pain, Totally Disabled.

Knowledge is Power, Especially in the World of w/c. Learn as Much as You can about Your States w/c Laws, and don't Fight Battles alone, They Use Attorney's, and so Should You!!
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07-29-2009, 12:43 PM
Post: #12
RE: workers comp lump sum settlement/ medicare set-aside account
Dutchy Wrote:Thank you Jayne for the warm welcome. Can I assume that you are not on medicare therefore, you did not needa msa
I am on medicare...It took me awhile to accept that I was totally disabled so I didnt apply for SSDI till after I settled....

........I love cats, I just cant eat a whole one by myself......
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07-29-2009, 02:39 PM
Post: #13
RE: workers comp lump sum settlement/ medicare set-aside account
MJC Wrote:Welcome to the forum! It was explained to me that when you take a medical settlement it goes into a Medicare Set Aside account, like a trust. Someone pays your medical bills for you from your account. When the money is used up.....then Medicare will begin to pick up the expenses for your medical related to that injured part of your body, but not until all the money you settled for is used up. Hope this helps. I still have open medical because I can't see them putting a dollar amount on this injury and it is still on going as I am awaiting another back surgery approval and my injury was in 1999. Best of luck to you and hope we see more of you on here.

Cajun Hugssssssssssss,
MJC
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07-29-2009, 02:41 PM
Post: #14
RE: workers comp lump sum settlement/ medicare set-aside account
When you say medicare will pick up after all the settlement money is used up, do you mean the amount in the MSA acct or the total settlement amount. Thanks for your response, I appreciate any and all info. Love you ajun hugsssss lol
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07-29-2009, 02:47 PM
Post: #15
RE: workers comp lump sum settlement/ medicare set-aside account
Dutchy,
That means that when you use up the total amount of money that has been put into the medicare set aside (MSA) account for your medical settlement portion, then medicare will start paying the bills related to your injury. There are 2 parts to setteling your case. One is the indeminity portion which is your wages and the other is the medical portion of your settlement. They take the medicare set aside (MSA) only from the protion of your settlement that you are receiving for medical expenses. I hope this explains things to you better. If not, then ask away, if I can't answer it someone else can, I promise you. Take care!


Cajun Hugsssssssssss,
MJC

Lumbar Laminectomy L5 - S1, Lumbar Disectomy L 4 -5, Cervical Microdisectomy C-4 -5, Cervical Anterior Fusion C 4 -5, Cervical Anterior Fusion C 5 - 6, Lumbar Disectomy, Laminectomy and Foraminotmy L 3 - 4, Cryo Surgery Lumbar. --Ongoing Problems.. Permanently Totally Disabled.
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07-29-2009, 03:10 PM
Post: #16
RE: workers comp lump sum settlement/ medicare set-aside account
MJC Wrote:Dutchy,
That means that when you use up the total amount of money that has been put into the medicare set aside (MSA) account for your medical settlement portion, then medicare will start paying the bills related to your injury. There are 2 parts to setteling your case. One is the indeminity portion which is your wages and the other is the medical portion of your settlement. They take the medicare set aside (MSA) only from the protion of your settlement that you are receiving for medical expenses. I hope this explains things to you better. If not, then ask away, if I can't answer it someone else can, I promise you. Take care!


Cajun Hugsssssssssss,
MJC
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07-29-2009, 03:16 PM
Post: #17
RE: workers comp lump sum settlement/ medicare set-aside account
MJC Wrote:Dutchy,
That means that when you use up the total amount of money that has been put into the medicare set aside (MSA) account for your medical settlement portion, then medicare will start paying the bills related to your injury. There are 2 parts to setteling your case. One is the indeminity portion which is your wages and the other is the medical portion of your settlement. They take the medicare set aside (MSA) only from the protion of your settlement that you are receiving for medical expenses. I hope this explains things to you better. If not, then ask away, if I can't answer it someone else can, I promise you. Take care!


Cajun Hugsssssssssss,
MJC
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07-29-2009, 03:31 PM
Post: #18
RE: workers comp lump sum settlement/ medicare set-aside account
Thanks all, a lot to comprehend. I wasn't aware that this settlement consisted of 2 parts. Our attorney said that the MSA had to be a min of 10% of the total settlement. I believe MJC said a third party should handle MSA payments. Our attorney said we pick a bank, set us an account, and then just submit medical bills to the bank and they reinburse us. Is there a time limit on how long these funds are available? Is he simplifing this process of reimbursement? I really don't see using the aprox. $5K MSA as my husband has two knee replacements, having trouble with one and said he will never have another one. Our attorney told me that medicare could come back and request that the entire settlement be used for future medical bills, although he has never had it happen to him or heard of it. Apparently medicare usually looks at settlements of $250,000 and over for this purpose. Gosh this is so scary. Any thoughts?
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07-29-2009, 03:43 PM
Post: #19
RE: workers comp lump sum settlement/ medicare set-aside account
kate Wrote:MJC,
Yes, pretty much the jist of it, although in some cases, the injured worker can "self-administer" the funds instead of a third party. (Not recommended).

And even in your case where there may be future surgery necessary, you could settle with an MSA. They need to take into account any future needs, inflation, prescriptions, etc. In serious injuries, the IC usually has to get a "life care plan"

To submit a MSA for approval the submission should include:
1) A Cover Letter with the following information:

* Claimant’s Name
* Claimant's Date of Birth
* Claimant's Health Insurance Claim Number (HICN) or Social Security Number
* Claimant’s Address and Phone Number
* Claimant’s Counsel Information
* Entitlement Information
* Employer's Information
* WC Insurer
* State of Venue
* Attorney Representing Employer or WC Insurer
* Injury/Disease Date
* Type of Injury/Disease
* Total WC Settlement Amount
* Proposed Medicare Set-aside Amount

2) Evaluation of Life Expectancy
3) Claimant Release Form
4)  Life Care Plan (If the claimant’s injury/disease is extensive/serious)
5)  A copy of the proposed settlement agreement.
6) Current and Future Medical Treatment
7)  Patient Medical Recovery Prognosis
8) Total Settlement Amount.
9) Identify the total amount of the settlement that is designated for future medical benefits and how calculated
10) Medicare Set-aside Amount
11) Designate the administrator
12) Medicare Set-aside Arrangement Account
13) Fees

Does this help?
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07-29-2009, 04:25 PM
Post: #20
RE: workers comp lump sum settlement/ medicare set-aside account
CMS reviews settlements in the following situations:

* The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000; OR

* The claimant 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.


An individual has a "reasonable expectation" of Medicare enrollment if any of the following situations apply:

(a) The individual has applied for Social Security Disability Benefits;

(b) The individual has been denied Social Security Disability Benefits but anticipates appealing that decision;

© The individual is in the process of appealing and/or re-filing for Social Security Disability Benefits;

(d) The individual is 62 years and 6 months old (i.e., may be eligible for Medicare based upon his/her age within 30 months); or

(e) The individual has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD.

A WCMSA should be placed in an interest bearing account. WCMSAs should also be administered by a competent administrator (the representative payee, a professional administrator, etc.). When a claimant designates a representative payee, appointed guardian/conservator, or has otherwise been declared incompetent by a court; the settling parties must include that information in their Medicare set-aside arrangement proposal to CMS.

In addition, the claimant may self-administer his or her own WCMSA, if permitted under State law. Claimant should submit an annual self-attestation form when monies have been exhausted.
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