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Set Aside Delays
#1
I am in California.

I have received a settlement for the Worker's Comp part of my case, but in that agreement the medicare set aside part of the case was left open for future settlement. 
In May 2017, CMS proposed a set-aside amount, a copy of which was sent to me. Since then I have heard nothing. I don't know if this part of the settlement is progressing, nor am I able to find out, either from my lawyer, who seems to be as in the dark as I am, nor from CMS. 

Right now I’m paying for meds out of pocket, which I can ill afford to do. If someone could throw some light on if or when I might expect to receive the set aside funds, or how I might expedite the process of securing them, I would be very grateful.

Many thanks in anticipation.
 
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#2
If your treatment was not settled,then the carrier is still liable--- not you.
As long as you keep paying there is little incentive for them to do anything.
Sounds like you need to to have the comp court set a conference to find out how to end it.
Either that or a hearing.
I suspect your atty got paid as well so they won't be interested in doing anything much either.
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
(03-12-2018, 05:06 PM)1171 Wrote: If your treatment was not settled,then the carrier is still liable--- not you.
As long as you keep paying there is little incentive for them to do anything.
Sounds like you need to to have the comp court set a conference to find out how to end it.
Either that or a hearing.
I suspect your atty got paid as well so they won't be interested in doing anything much either.

"Sounds like you need to to have the comp court set a conference to find out how to end it.
Either that or a hearing.
I suspect your atty got paid as well so they won't be interested in doing anything much either."

Thank you! That's exactly how I see the dilemma. My attorney was paid and now he seems to have lost interest. Although, technically, he still represents me, he's asleep at the wheel.
You mentioned having the comp court set a conference to find out how to end it. Either that or a hearing. Do you have any suggestions as to how I might go about doing that?

Thanks again. It's great to be able to talk to someone who understands the issue. I'm in California by the way.
 
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#4
of course, your early clue about a less then adequate representation was your first post when your atty was incorrect about the treatment appeal procedures.

as to your current problems: as long as you are represented you have to go thru your atty in comp matters. since most of the fee has been paid it might be difficult to switch. there are request forms to file for a conference or hearing.

as a last resort you might have to represent yourself but since you know little about the procedures and process that alternative should be avoided for as long as possible.

if you want to check out other experienced attys, you can use the search feature here
caaa.org.
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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#5
P.S. send your medical receipts to the carrier and request reimbursement and notify your medical providers to bill the carrier directly from now on.
send a copy of everything to your atty and keep a copy.
do this every time you have have to pay out of pocket. keep everything in writing and keep a regular paper flow to both the carrier and your atty.
the legal system loves paper. whoever has the most wins!
bombard everyone--maybe after long enough they'll be willing to do something to stop having to deal with your mail.
when you don't have any bills just send everyone a note that you are still waiting and won't go away.
be their pain.....
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.
 
Reply
#6
(03-13-2018, 06:02 PM)1171 Wrote: P.S. send your medical receipts to the carrier and request reimbursement and notify your medical providers to bill the carrier directly from now on.
send a copy of everything to your atty and keep a copy.
do this every time you have have to pay out of pocket. keep everything in writing and keep a regular paper flow to both the carrier and your atty.
the legal system loves paper. whoever has the most wins!  
bombard everyone--maybe after long enough they'll be willing to do something to stop having to deal with your mail.
when you don't have any bills just send everyone a note that you are still waiting and won't go away.
be their pain.....

Many thanks once again for the advice.
 
Reply
#7
Unfortunately it looks like you have very little other leverage to use.
Be well.
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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