[Cali Gal]

Hi All,

I'm fairly new here and so glad to find this community. I think I was on here few years ago, but lost my password. Lol!

A little about me. I live in California, have multiple injuries, which are healing. I recently retired from my job after several surgeries, chronic pain, etc. I'm about to Settle my case (few weeks!). I have no clue how much though? I guess it's decided at the settlement conference. I'm on SSDI and soon to have Medicare.

My attorney informed me about my future Medical options; including the medicare Set-aside acct. ugh! I've been doing some research, and it sounds daunting! I had hoped to be done with WC system...especially anyone deciding my course of treatment, or who I see. There is the possibility of future surgeries and I believe I have high impairment ratings.

So, I totally understand why Medicare doesn't want to be on the hook for Industrial Injuries, but Self-administered, really?? I asked my attorney if we could just give medicare the pot of money, but he said No. I'd just love to spend a month at a Wellness Rehab for WC survivors and be done with it.

So, here are my questions:

1. Is it better to take a Lump-sum or Staggered settlement for the MSA. (Attorney said employer will "Sweeten the Pot" if I take the latter.)

2. I prefer Alternative Healthcare (chiropractor, acupuncture, massage, holistic...). I've had many surgeries and frankly I'm done. Can I use the MSA for holistic medicine, if they accept Medicare rates?

3. What if i see a Doc for several problems during one visit, both industrial and non-industrial. How is that billed for, or do I pay for it with the MSA?

4. Are there systems or spreadsheets for tracking the expenditures. It's not my strong point (never balanced a checkbook!).

5. Also, any suggestions for the Perm Disability settlement? I think it's based on ratings and paid weekly or monthly. I hope it doesn't interfere with my SSDI though. He said I'm also getting a Voucher for School or re-training, if I want.


Thank you very much!!!

Wishing everyone Healing and Ease on this wild journey.

[1171]

your questions are pretty general so my responses are generic.


the alternative to a lump sum is periodic permanent disability payments and open medical.
in rare cases there can be an annuity purchased in what is often referred to as a structured settlement. not sure what is meant by a staggered settlement.

you should check with medicare as to what types of treatments are covered. there is no universal answer; it would depend on each type of treatment.
yes there are many budgeting and expense account programs. many even run on smart phones or tablets. different ones for different operating systems. it also depends on what information needs to be captured. none that I know of specifically for workers comp set-aside administration.
permanent disability awards are paid at a much lower rate then Temporary disability but are paid every two weeks like TD.
yes it will interfere with your SSDI-the 80% threshold still applies.

download and review the WCMSA reference guide for help with the MSA process
http://www.cms.gov/Medicare/Coordination...rview.html

for SSDI offset information
http://www.socialsecurity.gov/pubs/10018.html

PD rate information
http://www.dir.ca.gov/dwc/WorkersCompens...nefits.htm

[Cali Gal]

Thank you 1171.
Oops, I meant the Structured Annuity (which is what they're suggesting) vs. lump sum.
At this point I'm not interested in the Open medical due to all the treatment delays I experienced.

I'll look at the links you provided. Perhaps, when I find efficient tracking tools for expenditures, get clear on what's covered under Medicare, along with reimbursement rates, it will get easier. Oh, and willing Providers too.

Thanks again!

[1171]

if you are looking seriously at a structured settlement, the devil is in the details --especially how far out the payments are.
make sure it is clear as to what happens should a payment down the road be skipped or there is a delay/failure to pay at some point.
you don't want to be left high and dry in 5 or 10 years when your atty is gone or the payor goes out of business.
it is generally better to shorten the payout period to reduce the chance of problems.
if you have family or dependents or debts, make sure there is a guarentee so there is a lump sum should something unexpected happen to you.

also
if there are particular treatments you are interested in, get those pre-apporved from medicare and/or clarified in writing before you agree to a settlement--do not assume and then get denied after the settlement when it's too late to change.

keep things in writing. if there is a conversation clarifying a critical point follow it up with a confirming letter and keep a copy.

Be well.

[California_Help]

(02-17-2014, 04:43 PM)1171 Wrote: if you are looking seriously at a structured settlement, the devil is in the details --especially how far out the payments are.
make sure it is clear as to what happens should a payment down the road be skipped or there is a delay/failure to pay at some point.
you don't want to be left high and dry in 5 or 10 years when your atty is gone or the payor goes out of business.
it is generally better to shorten the payout period to reduce the chance of problems.
if you have family or dependents or debts, make sure there is a guarentee so there is a lump sum should something unexpected happen to you.

also
if there are particular treatments you are interested in, get those pre-apporved from medicare and/or clarified in writing before you agree to a settlement--do not assume and then get denied after the settlement when it's too late to change.

keep things in writing. if there is a conversation clarifying a critical point follow it up with a confirming letter and keep a copy.

Be well.

You should ask for an appointment with your work comp attorney to discuss settlement options.

There are reasons why getting payments vs lump sum can be better, and this is due to an offset from your SSDI payments. You do not want that to happen as you can lose money. There is a formula applicant attorney's often use to avoid this, and give you payments monthly, and this is called Harman formula. You can google it.

There are ways to include in a settlement monies that Medicare does not have you keep track of. This is for co-pays and things not covered by Medicare such as messages etc. Ask your attorney about this.

I have an opinion and it is my own that having a large settlement and the smallest MSA can be beneficial. You can only use the MSA for your injuries and once that is up, Medicare will take over your work related injuries. Your settlement money is for your own use. Do you understand how I view this?

These are decisions you should make depended upon your condition and other factors.

[Cali Gal]

Hi California_Help,

Totally agree with you on hoping for a larger settlement and smaller MSA, and wish I could just hand it over to Medi-care. (Especially since I have multiple body parts involved, numerous docs and want to simplify things.) However, it seems the amount is largely determined by Medi-care after they review my future medical needs. I'm going in for a final PQME soon and I'm inclined to downplay the need for future surgeries, etc.

I don't know anything about Offsets or the Harman formula and will discuss that with my atty.

As far as monies for co-pays, massages... Is that separate from the MSA funds? Sounds good since I prefer alternative care... (which isn't covered by Mcare).

Thank you so much for taking the time to reply.

[1171]

you cannot legally avoid the offset but you can have the disability portion of the comp settlement pro-rated over the time period.

[vinga]

Hi Cali\1117

IC wants to settle at this point - I was recently awarded SSDI but havent started on medicare yet. A MSA is in process. I too have multiple injuries to several body parts and my concern is if I settle, which will include giving up future medical what happens A - If I RTW at some point and am no longer on SSDI? I know I will need meds, follow-ups and possible future surgeries. I already have chronic pain, depression etc... When I checked the medicare website they dont even cover 2 of the meds I am on and they are $$$. If the meds I am on are not covered by medicare will I be able to use MSA to purchase them and will they count as valid use of MSA?? Also i would be interested in going back to accupunturist for more treatment but typically this is not covered by insurance so I assume I couldnt use MSA money for that as it would not meet the medicare standard.

If I end up going back to pvt insurance at some point what will they cover if you had surgery from a work injury in the past but develop arthritis or need more surgery? That could get real expensive and then I will be stuck. Atty's tell me not to worry about future to concentrate on today and that the IC will continue to deny treatment until they get a judgement that sides with their position. I have not been rated yet nor MMI

[1171]

you should start a separate thread for a separate topic and not hijack another; otherwise you confuse the many that search these posts for help.

[vinga]

(02-18-2014, 12:01 PM)1171 Wrote: you should start a separate thread for a separate topic and not hijack another; otherwise you confuse the many that search these posts for help.

OK - I will you can delete this then - I dont want to hijack anyone.