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MSA - Settlements- SSDI and\or RTW
#1

IC wants to settle at this point - I was recently awarded SSDI but havent started on medicare yet. A MSA is in process. I 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
 
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#2
there is no requirement that you be on SSDI and using your MSA simultaneously.
I do not know how and when CMS audits MSAs.
I suspect it will occur when your MSA is exhausted and you attempt to use medicare for your comp injury. It would seem to be more practical at that point to determine how much of the expenses to disallow and claim credit before picking up comp treatment.
detailed Medicare and MSA questions would be best answered by CMS.

Private insurance coverage varies; the particular carrier would be in the best position to explain their policies and procedures.
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
(02-18-2014, 12:53 PM)vinga Wrote: IC wants to settle at this point - I was recently awarded SSDI but havent started on medicare yet. A MSA is in process. I 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

If your medications are not covered by Medicare, They are not covered in a MSA. The purpose of a MSA is to protect Medicares interest.
The MSA is to be used for your work related injuries only.
If you need follow up surgeries,pain management monthly etc, This must be put in the Medicare Setaside or you will be held responsible.
Your Attorney is wrong when he tells you not to worry about your Future medical needs related to your work injury because YOU will be held responsible for this expenditure.

Also, You need to have spread language in your settlement so SSA will not get a offset from your WC settlement. Your Attorney needs to know WC laws of his state.

I have a MSA; I have SSDI. I received SSDI IN 2006; I settled with WC in 2012. I had no offset and my WC settlement with MSA and Indemnity pay was high 6 figures not including the 9 years WC paid me and all my bills.

I had to change Attorneys. A WC Attorney is worth its weight in gold.

Good Luck and God Bless.

Had a car wreck in 2003 while on the job. Settled in Jan. 2012 with Indemnity pay and a MSA. Approved for SSDI in March 2006. Was declared PTD at IME in 2009. Took approx 3 years to finalize the WC settlement. ALWAYS use spread language when settling Indemnity or SSA will nail your fanny.
 
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#4
(02-18-2014, 12:53 PM)vinga Wrote: IC wants to settle at this point - I was recently awarded SSDI but havent started on medicare yet. A MSA is in process. I 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

If you are considering returning to work full time a large MSA may not be a good idea. There are ways they can structure the MSA to cover things that Medicare will not cover. Ask your attorney about this.

I agree with Fatboy that there are ways to structure a settlement so SSDI does not take an offset and one way is to follow the Hartman formula. Your attorney will know about this, and is not he can find it on CAAA web-site.

There is much debate if those who C&R their work comp claim will be covered under private insurance under The Affordable Care Act.

When you wrote they will continue to deny treatment, does this mean they are denying part of your injuries, OR are your doctors treatment requests being denied by utilization review?
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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