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Iowa Med Settlement or not?
#1
Hi;

New here and read through some threads and thought this would be a good place to ask a question as it appears there is some wisdom within the board.

I had an injury (whole body fractured back) and received a 100 week settlement for said injury. I left the medical open and now the WC Company has asked me if I would be willing to settle for lump sum pmt for future med bills.

I am 54 and was trying to become educated on the MSA or do I even have to do an MSA since I am not on SSD or planning on leaving my job until I reach SS age. Just for the sake of it, they threw out 20K and while I know that would not cover much since I take pain meds daily and each injection (2 times yearly) and x-ray cost a good chunk of change.

Question is, if I settle for (whatever $ amount) will this be subject to Medicaid since I am not within the 30mos of filing for SSI or whatever.

I feel for you guys who are suffering in such a way that you can't work at all and I have been told that I should not be doing what I am doing but I can't stand not doing anything and I would rather hurt at work than hurt while being at home.

I know there is a risk when you settle the medical as you never know what happens as you get older and if I move a certain way, it can put me down for a few days to a week until whatever heals enough (nerve inflammation).

As a matter of information, they could not do surgery because my fracture had fused together before all the initial filings could be done and they said that re-fracturing and doing surgery could cause more damage than what I already had.

Thanks in advance if anyone can answer the Qs within. Best wishes to all of you who are suffering with injuries, it truly sticks to live with constant pain!
 
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#2
all settlements are subject to the Medicare secondary payer provisions.
however your situation does not seem to meet the standard for prior review and approval by CMS.
more in their reference guide
http://www.cms.gov/Medicare/Coordination...rview.html
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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#3
Depends on how much money you need now -v- later. Any IC will balk at ever paying for any work on your WC injury forever.Since you let it heal on its own it will always give you some problems. So you have to decide let WC fix it or take the chance that you can live with it and pay for it yourself down the road.Many of us went back to work still broken and made it worse. When your raised to work for what you have or want its hard to sit at home and do nothing you drag your fanny out and suck it up for as long as you can. Sit down and write up what you would have to pay out of pocket for a year multiply it by how many years you plan on living or till you reach I believe 67 now to retire and get medicare.Is what they are offering worth it? Take it and pay off your home or high interest credit cards...It may be what you need to make life easier for now....Never take the first offer, counter with what you want plus a few extra thousand give them wiggle room and maybe you will both be pleased
........I love cats, I just cant eat a whole one by myself......







 
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#4
Everybody has to figure out what they can live with. For me my meds run around $16,800 a year and normal doctor bills around $15,000 a year. In another few years they will need to replace my SCS and that was $100,000 to put it in so I'm not sure what it costs to replace. Now I'm on SSDI so a set-a-side would have to be done in my case so they will never make me an offer to buy out medical but those are the things you have to figure out. You said you have meds so figure out what that will run you and take that out of the money they offered, doesn't take too long to go through $20,000 and then the rest will be out of your pocket. And make sure when you are figuring that out the price is what it would cost you and not what the insurance is paying because some times they get a better deal then you might
 
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#5
Hey guys;

Thanks for the feedback, I really do appreciate it. My injury is such that I can tolerate the pain (at least right now) with pain meds. Yes, there are times I can't even rotate my butt out of bed but usually that is because I over do it. My (medical need) situation right now is pretty dormant because other than injections a couple times a year and some light pain meds, it does not appear that there are any procedures I can expect to have done that will remedy my ailment! Thus, my projected medical bills probably are not staggering (I would guess)? I suppose that the injections, office visits, and that funky machine they put me in so they can see the needle going into my spine area without hitting a nerve or causing more damage is all expensive but I don't see the bills so I don't know for sure.

I am at a loss as to what to calculate would be fair because there is really nothing anyone can do to "Fix" my issue (I have been told by 3 different back specialists). The first thing I have to do is determine if Medicare will look at a med settlement (if taken) and require me to set aside or reimburse Medicare for medical needs if I ever go on SSDI for this issue when I reach the age of 65 or 67?. I know there is no way of knowing what the future holds (1, 2, 3 years down the road) but if my pain remains the same as it is today, I can still be productive at my work place and will not accept or regulate myself to being incapacitated. I am in hopes that in 10 years this remains to be the case anyways!

The way I read the Medicare regs it appears that my medical settlement if under 250K total, or if less than 25K and SSD not filed within or up to 30 months after settlement, that it would not be subject to a the MSA requirements. In other words; if I settle today and I can maintain my working status for 3 years +, then if later (say when I am 65) I have to file for SSDI, the funds I got through the settlement would not be subject to SSDI being reduced.

I do thank you all, wish the best for each of you who are also in pain and hope things turn out well for you and your families. As for me settling for a specific dollar amount, well, as each of you who are suffering already know, no amount of money can replace feeling good and it has been a very long time since I could move around without pain or without having to think about my movements before I do something that those who are healthy take for granted.

I will swing back in and read any additional thoughts this weekend or tonight if I get time.

God Bless All;
 
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#6
To have my pain doc put a needle in my back and do just an injection runs between $2000-$4000. You could burn thru the $20,000 in 4-5 years and that is not counting your daily meds. To do RF where they burn the nerves in my back runs between $6000 and $7000 a side. One thing to think about is your probably going to require more pain management as time goes on. What ever they are offering is going to be less then they figure the bills are going to cost them, remember they are looking to save money.
 
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#7
"Further, Medicare is prohibited from making payment where payment has been made (that is, where the beneficiary obtains a settlement, judgment, award, or other payment). Medicare remains the secondary payer until the settlement proceeds are appropriately exhausted. In many situations, the parties to a WC settlement choose to pursue a CMS-approved WCMSA amount in order to establish certainty with respect to the amount that must be appropriately exhausted before Medicare begins to pay for care related to the WC settlement, judgment, award, or other payment."

from page 3 of the CMS reference guide.

in other words you can never pocket medical settlement $$ and have medicare pay for comp injury treatment.
even if you don't get an MSA, CMS can legally require an accounting of your settlement $$ before deciding to pick up coverage of your comp treatment.
whether they will or not is unknown.


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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#8
Thanks again guys;

OK 1171

That is the definitive answer to the issue (in my opinion) as I am in no way going to settle for "ANY AMOUNT" because what good or positives come from me doing that?

If this WC med settlement has to be accounted for prior to receiving SSDI (if I ever need to do so), then I am better off leaving it open throughout time. Not sure how long it can stay open though?

Thanks,
 
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