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Medical set aside
#1
NYS-for the last 2-3 years I’ve been discussing a settlement with my lawyer but because of medical procedures it never happened. Now we are getting closer to permanency the discussions have started again about 4 months ago. Every time I have talked to my lawyer previously he has thrown numbers around but nothing was set in stone. I talked to her yesterday and now she is telling me I can’t do a section 32 without a medical set aside. This has never been brought up in the past. She said that because I’m on Medicare I have to have a MSA. She knew I was on Medicare because her firm handled my SSDI case also. My wife’s insurance has given me a letter stating they will cover all my previous injuries as long as I don’t have a MSA. I just need to give them a letter from WCB stating my case has been settled and no MSA. Has anyone ever heard of this or know anything about this ? I went from getting a settlement that I could squeak by living with to a settlement that equates to one years salary prior to me getting hurt and I can never return to the line of work I was in. Thanks for the help
 
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#2
Never heard of a private insurance company denying a person medical treatment after their work comp case is closed. Why does it matter if you have a MSA to your private insurance company? I am curious. I would request copies of your policy to review what this person is telling you. Every insurance company is different. I just have not seen a private IC able to deny coverage after Affordable Care Act after a closed work comp claim, but I am no expert. Please check with your attorney.

Is your wife's private insurance considered primary and Medicare is secondary insurance? Curious about that too. Also, do you even use Medicare if this is the case? These are things you can consider.

Many injured workers settle their work comp case with a MSA, but do not have it approved by Medicare. There are different ways of structuring the MSA and it can be structured it so you are in control of it.

I don't know of any rules that state you have to have a MSA, only that you have to take Medicare interests into account. This could mean having a MSA and asking for the monies so you can control it. I am no expert and you should discuss with your attorney.

You can find a lot of things via google search do you need a medicare set aside when you settle for a lump sum in a workers compensation case. The risks of not taking Medicare's interests into account is that they may not cover injuries later if you did not have a MSA.
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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#3
MSA is not mandatory
https://www.workcompwire.com/2019/04/deb...ed-an-msa/

And here
https://www.workcompwire.com/2019/06/chr...-involved/
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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#4
Agree with 1171.

One of the largest grocery chains in California are only doing MSA proposals and not submitting to Medicare for approval. I recommend to do your research and discuss options with your attorney.

https://www.cms.gov/Medicare/Coordinatio...rview.html
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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#5
Thanks for the replies. California help my wife’s insurance isn’t denying me coverage they are saying that if I have a MSA I have to use all that money first and once it’s gone then they will cover my medical expenses. I’m not sure if Medicare or my private insurance is primary and which is secondary. I have the Medicare card but I have not used it for anything since I got it 8 years ago. I’m not sure if my lawyer said Medicare wouldn’t let me settle without a MSA or if workers comp wouldn’t let me. I will have to look at the links 1171 posted and do some more research. Thanks again I’ll update soon
 
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#6
Ueually when you have private insurance from your spouse Medicare is secondary coverage.

I am not sure it is legal what you are being told by your private health insurer. I would ask for a copy of her private insurance policy to see if it states you have to use your MSA before using your private insurance.

These are attorney's answering a question here on this link below for an injured worker.

https://www.avvo.com/legal-answers/can-i...80275.html
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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#7
If federal laws says an MSA is voluntary, new york state law cannot overrule it and make it required.
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
I’m going to email my lawyer for more clarification. The MSA he is saying I have to have is going to be a set amount each year for the rest of my life. I really don’t like the sounds of that either and don’t understand why it can’t be a lump sum. Would the amount of years I’ve been on workers comp make a difference about whether I need a MSA or not ?
Thanks guys
 
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#9
...No.
“Check with Medicare to learn your rights and responsibilities. Because Medicare is a federal program, the Workers' Compensation Board has no jurisdiction over it.”
http://www.wcb.ny.gov/content/main/Worke...orkers.jsp
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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#10
There are different ways to structure wc settlements and MSA's including giving the MSA monies to you to manage (lump sum).

If it is your settlement and not MSA he wants to have structured in payments, that is done sometimes so it does not affect your SSDI payments. https://www.disabilitysecrets.com/resour...fset-socia

I would get clarification from your attorney.
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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