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Glossary Check: Conn. Workers’ Compensation Medicare Set-Aside Arrangement

23 May, 2023 Frank Ferreri

connecticut 43752 640
                               

Hartford, CT (WorkersCompensation.com) -- Those who have spent some time in the workers' compensation industry have likely encountered Medicare set-asides.

Because of the significance of MSAs in its state workers' compensation schemes, Connecticut has spelled out definitions and rules in a memo update, as the following chart details.

TopicsNeed-to-Know Info
Definition of "Workers' Compensation Set-Aside Arrangement"A financial agreement that allocates a portion of a workers' compensation settlement to pay for future medical services related to the workers' compensation injury, illness, or disease
When Medicare will payWCMSA funds must be depleted before Medicare will pay for treatment related to the workers' compensation injury, illness, or disease
How much is the WCMSA?The amount of a WCMSA is determined on a case-by-case basis
When to submit for Centers for Medicare & Medicaid Services reviewWhile there are no statutory or regulatory requirements provisions requiring that a WCMSA proposal be submitted to CMS for review, submission of a WCMSA proposal is a recommended process
Criteria for CMS reviewCMS will on review new WCMSA proposals if:
--> The claimant is 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

Workers' Comp 101: If a WCMSA is part of a settlement agreement, it behooves the parties to follow state procedural requirements. In Snyder v. Gladeview Health Care Center, 90 A.3d 278 (Conn. App. Ct. 2014), as part of an anticipated final settlement of the case, the U.S. Department of Health and Human Services approved a proposed Medicare set-aside trust, which was to have paid the claimant $2,512 annually. In addition to this Medicare set-aside account, the defendant agreed to make a single final payment to the claimant in the amount of $75,000. The agreement ended up falling apart in court because it never properly made its way to a commissioner for approval.

If you want more state-focused materials, you want Simply Research

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    About The Author

    • Frank Ferreri

      Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law.

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