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open medical pros and cons
#11
Timothy Belt, Can you explain the IF's that if the medical is say bought out to close things up, what and how does this effect the reasoning then behind the need when a MSA is required, yet they took the open medical option, would this not have some bad ending results then if the medical was said to be bought out?
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#12
If I am understanding you correctly, and I may not be, the need for a Medicare set-aside arises from a federal statute called The Secondary Payer Act. This law requires that in any settlement of future medical, Medicare's potential interest must be taken into account. This is true whether or not the individual is Medicare eligible. If the individual is Medicare eligible, the memorandum's (not the statute) indicates that approval of a set-aside amount should be obtained from Social Security, and if the approved set-aside amount is funded and used only for the payment of medical bills related to the work injury which would otherwise be payable by Medicare, Medicare's interest is protected.

Therefore, if the medical benefits are left open, Medicare has no potential interest to protect and the Set-Aside issue never arises.
 
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#13
Timothy Belt, okay, and lets say the Medical portion is left opened, or better said Open Medical and case settled. How would selling out the medical then be a benefit? Could, or wouldn't that selling off the medical create a problem because they are on SSDI/SSI, with Medicare?

Because medical was left opened, and there was no need for a MSA in the case then...
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#14
I'm actually leaving the office right now to go to a mediation on this exact fact pattern. In this situation, the only real benefit is that the money to pay the bills will be coming from the set-aside and not the IC. When you have an active IC that is constantly disputing bills, this can be a huge plus.
 
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#15
Timothy Belt Wrote:I'm actually leaving the office right now to go to a mediation on this exact fact pattern. In this situation, the only real benefit is that the money to pay the bills will be coming from the set-aside and not the IC. When you have an active IC that is constantly disputing bills, this can be a huge plus.

A huge plus for who? If the active IC is constantly disputing bills or medical procedures in a settled open medical case, I feel the IW could be at a major disadvantage.

I can see some advantages to having open medical but the huge disadvantage seems to be the IC is still "hanging around" and in control. This stinks the more I think on it but I am trying to be logical and reasonable in my thinking.

Thanks a million for your input.
 
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#16
I had workers comp case settled in oct 2006 with open medical I want to close the open medical part of the settlement, how do i go about doing that.mitchell g
 
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#17
you should start your own tread rather then create a zombie from 2010:
http://www.workerscompensation.com/forum....php?fid=4

each state had different laws; some do not allow settlement of medical.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#18
What a old thread by Freebird....... I love that song and nice car for Aviator.
 
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#19
(12-10-2012, 07:38 PM)lucky Wrote: What a old thread by Freebird....... I love that song and nice car for Aviator.

Freebird is so lucky that if lucky would have been here in 2010 freebird wouldnt be so lucky.....lol..
 
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#20
(04-22-2010, 04:55 PM)Bummer Knees Wrote: I have always been under the impression that if receiving SSD or SSI an injured worker must settle with a set-aside, open medical is not a choice.

Am I wrong?

If medical is settled you need a set-aside, but you can settle with open medical in which case Medicare does not have an interest in the settlement, and a set-aside is not needed.
Timothy D. Belt
DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The answer given is based only on the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.
 
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