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CandR w/open medical
#1
IW in California

I talked to my attorney and he told me that he is submitting a request for a CandR with open medical.

I have been denied SS disability 3 times and decided not to go for a fourth (at the request of my attorney) so we can settle my case. We received a Medicare set aside quote that was added to the permanent disability and lifetime pension amounts. The insurance company wants to ‘review’ the amount for Medicare so in the future, when/if I need to apply for SS disability, the amount SS comes up with is equivalent to what the quote is.

My attorney seems to think next week the insurance company will grant the CandR and pay it out once approved by the judge (roughly 6-8 weeks for the payout), keep the medical open and once the Medicare set aside is to their liking, will then close that (several months from now).

I trust my attorney and share his optimism. How often has this been successful with anyone here in the forum? Are my hopes too high that this is going to get done? This just seems like a unique way of settling this and cannot find anything in the forum of anyone who has done it this way (unless I am looking in the wrong areas of the forum).

Thanks for any input!
 
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#2
(03-02-2012, 03:38 PM)Collins Wrote: IW in California

I talked to my attorney and he told me that he is submitting a request for a CandR with open medical.

I have been denied SS disability 3 times and decided not to go for a fourth (at the request of my attorney) so we can settle my case. We received a Medicare set aside quote that was added to the permanent disability and lifetime pension amounts. The insurance company wants to ‘review’ the amount for Medicare so in the future, when/if I need to apply for SS disability, the amount SS comes up with is equivalent to what the quote is.

My attorney seems to think next week the insurance company will grant the CandR and pay it out once approved by the judge (roughly 6-8 weeks for the payout), keep the medical open and once the Medicare set aside is to their liking, will then close that (several months from now).

I trust my attorney and share his optimism. How often has this been successful with anyone here in the forum? Are my hopes too high that this is going to get done? This just seems like a unique way of settling this and cannot find anything in the forum of anyone who has done it this way (unless I am looking in the wrong areas of the forum).

Thanks for any input!

Okay, A Medicare set aside has absolutely nothing to do with the amount your SS disability pay. If you are trying again for Social security Disability continue on because your WC settlement has NOTHING to do with your SS check. Now your Indemnity portion of your C&R can effect your SSDI pay if the proper spread language is not used for a Indemnity lump sum bu=y

I just settled out after 9 years. I fail to see a MSA approval if you settle with open medical. Personally, I did not want open medical because the IC is still in your life. I went with a MSA an d most IC want a MSA but states are different.

SSDI and WC are 2 totally separate identities.
 
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#3
The problem was with the MSA. I was told if I tried to go for a fourth attempt at getting SS, the insurance company would wait to see if I got the approval and what SS would say the MSA would be. If the amount that I was given was different than what SS states it would be, then SS and the insurance company would have to work out an agreement as to what the MSA would be so either party would not get scr3w3d. The estimated time for all this to happen would be 9-14 months. In the mean time, the insurance company said it would just continue to pay the PPD payments. So the estimated time the case would be closed would be about 2 years per my attorney. This is why he stated the above. I also thought the two were unrelated, but the MSA amount connects them.
 
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#4
(03-02-2012, 05:03 PM)Collins Wrote: The problem was with the MSA. I was told if I tried to go for a fourth attempt at getting SS, the insurance company would wait to see if I got the approval and what SS would say the MSA would be. If the amount that I was given was different than what SS states it would be, then SS and the insurance company would have to work out an agreement as to what the MSA would be so either party would not get scr3w3d. The estimated time for all this to happen would be 9-14 months. In the mean time, the insurance company said it would just continue to pay the PPD payments. So the estimated time the case would be closed would be about 2 years per my attorney. This is why he stated the above. I also thought the two were unrelated, but the MSA amount connects them.

Medicare (CMS) has to approve your MSA under ,most circumstances. This is from the CMS website

Approval from CMS and approval for SSDI have NOTHING to do with each other. DO NOT wait for your MSA to be approved before you file a 4th time for SSDI.

You are being mislead or do not understand. I would have high concerns about my Attorney if what you say is accurate.


A WCMSA may be submitted to CMS for review 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.


https://www.cms.gov/WorkersCompAgencySer...taside.asp
 
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#5
Here was the senario I was told:
If I got approved for SSDI (which would take 6-8 months to get my 4th review), I would get the SSDI 2-3 months after approval.
MSA would be reviewed. If it was not the same amount given the insurance company, then they would get together to come up with an agreed amount (this would take 9-14 months). During all this, I get my SSDI and my PPD together (about 8-11 months from now), which would equal 1200.00 per month (again, if approved).
The insurance company will not settle until all this with SS is done. At a minimum this would be 2 more years in WC.

OR

Not go for a fourth try, settle now, then reapply for SS in the future. The MSA, when paid in a few months, would go into a savings account, the permanent disability and lifetime pension paid at 83% whole body, that settlement would get paid in 6-8 weeks.

I chose door number 2. Has anyone had a simular situation?




 
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#6
I also have never heard of SSDI amounts and set aside amounts being related.
one is a disability payment--the other medical. as far as I know they have little to do with each other and are not figured in the same way or for the same purpose.
why would SSDI want or need a future medical expense estimate?
but that's not your question....

Compromising & Releasing a claim that includes a set aside amount is very common -- it's rare that those that fit the set aside criteria get settled without one.

unfortuanately the amount medicare calculates often exceeds what the carrier estimates they will have to pay and then they decide not to settle.

because of this problem there are a growing number of claims that are being settled without having a set aside.


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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#7
(03-02-2012, 06:21 PM)Collins Wrote: Here was the senario I was told:
If I got approved for SSDI (which would take 6-8 months to get my 4th review), I would get the SSDI 2-3 months after approval.
MSA would be reviewed. If it was not the same amount given the insurance company, then they would get together to come up with an agreed amount (this would take 9-14 months). During all this, I get my SSDI and my PPD together (about 8-11 months from now), which would equal 1200.00 per month (again, if approved).
The insurance company will not settle until all this with SS is done. At a minimum this would be 2 more years in WC.

OR

Not go for a fourth try, settle now, then reapply for SS in the future. The MSA, when paid in a few months, would go into a savings account, the permanent disability and lifetime pension paid at 83% whole body, that settlement would get paid in 6-8 weeks.

I chose door number 2. Has anyone had a simular situation?

Honestly, I think you are confused. You need to better understand WC and a MSA and SSDI. Do some homework because IMO you are mislead or do not understand. I have settled a upper 6 digit settlement with WC in a C&R with a MSA 2 months ago AND I have been on SSDI since 2006.

 
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