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Workers Compensation Medicare setasides (WCMSA)
#1
A MSA is money setaside to protect medicares interest. The Qualifications are;
A WCMSA may be submitted to CMS for review in the following situations:

The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000; OR
The claimant has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.
Here is some information:
http://www.cms.hhs.gov/workerscompagency...taside.asp

http://www.affiancepartners.com/faq.php


http://www.intrustservicesonline.com/CMS...ril_09.pdf

http://www.ringlerassociates.com/news/ne....asp?id=36
 
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#2
I'm sure many will find this to be very good reading.
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#3
FreeBird, I was wondering, if you would wish to speak of your travels with the Medicare Set-Aside Fund that you, and your attorney had to tackle?
Reply's are intended solely for informational purposes. They are based on personal opinions, experience, or research and are "not to be taken as fact or legal advice", otherwise, always consult an attorney or a doctor.
 
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#4
When My Attorney and I Discussed the Mediation Settlement Conference that I Attended a Couple Months Back, He told Me of the "Loop Hole" or "Trick" that is being Used to get the Set-Aside Amounts Lowered, which does Help to Close Settlements Faster, but in the Long Run Hurts Medicare Greatly! As many of You know there are Companies that Prepare the Medicare Set-Aside Figure and Submit it to CMS for Approval, because there are too Many for Medicare to do Themselves. And of Course when the Ins. Co.'s become Involved, the Games Begin! As an Example: Unless a New Procedure becomes Available to Help Me, I am going to have to Use Opiates for the Rest of My Life, and an Emergency Surgery May be Needed as I Age, and that is Clearly known by Both Sides. What these Companies will do is Tell Medicare that There is a Very Good Chance that I will be Weened Off of My Opiates and Anti-Inflammatory Meds within a Matter of 2 to 3 Years, and I will Only be Using OTC Meds. from that Point on, and the Set-Aside Amount should be Placed at $50-$60k, to be Used Over a Five Year Period, the Extra 2 Years just in Case it takes Longer to Ween Me from My Addictive Meds. The Defense is Happy to Lie, they have to Come up with Less, and the Claimant's Attorney is Happy to also, because that Means More of a Pay Day for Both Them and Their Client! Is this the Correct Way to do it, NO! Is it being Done, DAILY! And Medicare is Accepting these Low Figures on Chronically Injured Patients, They are being Bombarded with Set-Aside Paper Work, and they just want to Close the File, and get on to the Next! It's No Where near Correct, but being Done to Expedite Settlements!!Wink
 
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#5
Still in Limbo Wrote:When My Attorney and I Discussed the Mediation Settlement Conference that I Attended a Couple Months Back, He told Me of the "Loop Hole" or "Trick" that is being Used to get the Set-Aside Amounts Lowered, which does Help to Close Settlements Faster, but in the Long Run Hurts Medicare Greatly! As many of You know there are Companies that Prepare the Medicare Set-Aside Figure and Submit it to CMS for Approval, because there are too Many for Medicare to do Themselves. And of Course when the Ins. Co.'s become Involved, the Games Begin! As an Example: Unless a New Procedure becomes Available to Help Me, I am going to have to Use Opiates for the Rest of My Life, and an Emergency Surgery May be Needed as I Age, and that is Clearly known by Both Sides. What these Companies will do is Tell Medicare that There is a Very Good Chance that I will be Weened Off of My Opiates and Anti-Inflammatory Meds within a Matter of 2 to 3 Years, and I will Only be Using OTC Meds. from that Point on, and the Set-Aside Amount should be Placed at $50-$60k, to be Used Over a Five Year Period, the Extra 2 Years just in Case it takes Longer to Ween Me from My Addictive Meds. The Defense is Happy to Lie, they have to Come up with Less, and the Claimant's Attorney is Happy to also, because that Means More of a Pay Day for Both Them and Their Client! Is this the Correct Way to do it, NO! Is it being Done, DAILY! And Medicare is Accepting these Low Figures on Chronically Injured Patients, They are being Bombarded with Set-Aside Paper Work, and they just want to Close the File, and get on to the Next! It's No Where near Correct, but being Done to Expedite Settlements!!Wink

I agree with what you are saying except the part that Medicare is being bombarded with MSA paperwork. I have found one Individual who actually has a MSA on another Forum. How many individuals do you know that have a MSA? ANYONE ON THIS FORUM HAVE A MSA?

I know Medicare is bombarded but try and call Medicare and ask about a MSA. Most of the representitives you talk with do not have a clue what a MSA is.

Anyway, this scenerio has already happened to me. The IC had a 3rd party vendor to work up a proposed MSA, This vendor did and they low balled my MSA at least $90K.
What saved my booty was My agreement states that the proposed MSA cannot be sent to CMS until ALL parties approve it first.

We did not approve it. We showed the obvious errors and asked for another MSA proposal and we have been on hold for 4 months since.

They try and "slip" a low figure by Medicare like you state above. Anyone who will have a MSA IN THERE FUTURE MUST OVERLOOK THERE MSA PROPOSALS BEFORE IT IS SENT TO MEDICARE SO YOU CAN CATCH THESE "ERRORS". THE IC WILL SCREW YOU DRY!!!!

When the MSA is sent to Medicare and approved, thats it! When it runs out, you turn to Medicare where YOU THE IW ARE RESPONSIBLE FOR deductibles/ prescription donuts ETC, ETC.

It is so important to get what you deserve, Watch your Attorney also! He wants to close the case so you have to be somewhat knowledgeable yourself that is the IW or you will get screwed!

There is a lot involved in settling a WC Claim especially where a MSA is in the C&R settlement.
 
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#6
http://www.namsap.org/pdf/Settling%20WC%...n%2006.pdf
 
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#7
http://sevarino.lawoffice.com/MedicareSet-Aside.shtml
 
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#8
Freebird, the Medicare Set-Aside Laws have been in Effect since the Mid 80's, but have Only been being Pushed within the Last 5 Years or so, when Medicare Started to See how Many People were Using Medicare for Work Related Injuries, and No Se-Aside was Done. That's why CMS has Hired these Third Party Companies to Handle the Set-Aside Figure, because as You Say not Many at Medicare know Much about it! I Know Ohio for Instance was was making Injured Workers wait almost a Year just for a MSA Figure to Settle. If You are on SSDI and want to Settle, and the Ins. Co. wants out completely, its going to Take a MSA to do it! What I Posted about Playing Games with the MSA Figure is only Info. I Received from My Attorney, and it was Discussed in front of a Judge and the Defense Council, so it's the "Dirty Little Secret" that's going on Right Now. My Medicare Supplement Ins. Co. (Even though I was Only 43 when Approved, AARP Allowed Me in Their System, Backed by United Health Care) Provides "Donut Hole" Protection for Me. Thanks for the Websites, I'll Look at them when I have a bit More Time!!Wink
 
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#9
The WC IC'S hire 3rd party vendors to draw up a proposed MSA. I actually had a Life Care plan drawn up where they eliminated 2 of my medications, cutting back on MANDATORY PM visits to 6 times a year as 2 examples of screwing me.. I have to go monthly since I am on Schedule 2 narc. They tried to get my Attorney and myself to accept this ridiculous proposal. They have not submitted another prposal since and that was over 3 months ago. I believe the MSA is to high for them but besides the fact of screwing me they would be screwing the Federal Gov.(On Medicare prematurely "low balling the proposed MSA) and the haed working tax payers.
Would CMS have caught these errors?
Probably not and in realty Medicare is screwed which screws the Federal gov. which screws WE the tax payers because I would be on Medicare prematurely.

If you have a MSA in your future, Please get knowledgeable so the IC will not screw you. Medicare has plenty to deal with financially but the WC IC's will screw Medicare and never blink a eye. Require in your settlement that the MSA proposal is critiqued by yourself and your Attorney because they will screw you bigtime.
 
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#10
freebird Wrote:The WC IC'S hire 3rd party vendors to draw up a proposed MSA. I actually had a Life Care plan drawn up where they eliminated 2 of my medications, cutting back on MANDATORY PM visits to 6 times a year as 2 examples of screwing me.. I have to go monthly since I am on Schedule 2 narc. They tried to get my Attorney and myself to accept this ridiculous proposal. They have not submitted another prposal since and that was over 3 months ago. I believe the MSA is to high for them but besides the fact of screwing me they would be screwing the Federal Gov.(On Medicare prematurely "low balling the proposed MSA) and the haed working tax payers.
Would CMS have caught these errors?
Probably not and in realty Medicare is screwed which screws the Federal gov. which screws WE the tax payers because I would be on Medicare prematurely.

If you have a MSA in your future, Please get knowledgeable so the IC will not screw you. Medicare has plenty to deal with financially but the WC IC's will screw Medicare and never blink a eye. Require in your settlement that the MSA proposal is critiqued by yourself and your Attorney because they will screw you bigtime.

If I have a medicare set aside and few days after my settlement I need to see a doctor and that doctor sent me to a specialist or therapy...etc would it be covered? or the Ic pre-decides as to what you are allowed to use it for? what if every set aside is not used what happens to the rest of the money?
In God I Trust
 
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