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Settlement back to the dark side
#1
8 months ago at a Mediation, We came to agreement of the lump sum settlement contingent on the Medicare setaside being approved by all parties before it is sent to Medicare for there approval.

Two weeks after mediaition, the IC sent a proposed Medicare Setaside to my Attorney for our approval. It was a extremely low figure. We found in the proposal where they had left out and eliminated "much".

We ask for a new MSA Proposal with the obvious corrections. Without these correction, Medicare would get screwed IF they did not catch the errors themselves. The IC was trying to slide a low figure by Medicare IMO.

This is the last we have heard from them in 8 months. My Attorney says they refuse to send him another MSA Proposal.

Both sides at Mediation signed a binding contract concerning the lump sum amount and the contingency of the MSA. How long is this contract good for?

In the contract my Attorney had them put in writing that my weekly pay and benefits would continue until the MSA was approved by Medicare. They have honored this.

I know we cannot force them to settle. Why would they sit on a MSA(Medicare setaside)? Is the amount of the MSA greater than what they want to pay?

They continue to pay my weekly check and pay my medical bills 100%. This pay has no effect on my lump sum. Every check I get is extra above and beyond the Lump sum.
 
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#2
The way I've been told, that if MSA is approved by Medicare, for an amount. This gives them all the leave way they would ever need. I understand what you wish, but, if they got approved, it is now what they want.
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
Bad Boy Bad Boy Wrote:The way I've been told, that if MSA is approved by Medicare, for an amount. This gives them all the leave way they would ever need. I understand what you wish, but, if they got approved, it is now what they want.

The MSA has not went to Medicare for approval. The contingency was the MSA proposal be approved by ALL parties before it is sent to Medicare.
My Attorney did this to keep the IC from getting a low MSA by medicare.
 
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#4
Oh, okay, I see now...
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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#5
Free Bird, I Understand, as We have Discussed this Before on another Thread, but the Defense Attorney's, and also the Claimant Attorney's have found a Way to Reduce the Amount that Medicare will Accept, to get the Cases Closed Faster. It does Short Medicare, as You have Mentioned, but They Daily get Medicare to Accept These Low Figures, and Close Cases. MSA's have been on the Books for Many Years, and Never Used until I Believe the Last Ten Years or so, when Medicare Started to See what it was Costing Them to Overlook the Set-Asides. So They are Now Enforced, and this System They have found is Working for the Defense, and at Times for the Claimants Attorney's also. I also Understand that You wanted to Approve the Amount also, and when it was Presented to You, if I Remember Correctly, You Turned it Down as it was way too Low, and not Fair to Medicare, and You in the Long Run with the Deductibles You would Pay Over Time. Now this is Just My Opinion, as I Sat in a Hearings Room here in Pa., and in My Case, in Front of the Hearings Judge, The Defense, Judge, and My Attorney Discussed how They could get a Set-Aside Low Enough for the Ins. Co. to Pay, and just Enough for Medicare to Approve!! This was a Voluntary Mediation Conference for Me, and I sat and Listened to the Judge, My Attorney and Theirs, Off of the Record, Discuss how to Come to this Figure, so the Only Part We had to Discuss was the Monetary Payment to Me. That's when I had to Leave the Room, so They could Negotiate, and They came No Where Near My Figure, and the Judge Actually Stopped the Mediation, because They saw the Ins.Co. wasn't being Realistic, so I never got Close Enough to even Sign an Agreement. Sorry so Long, but My Point is, if The Ins. co. Attorney's come Up with a figure that Medicare will Accept for Your Set-Aside, and You don't Accept it, I Believe They are just going to Set on Your Case and Continue to Pay You Your TTD, and Forget about the Settlement, and Work on a Way to try and get You Out of the System!! You are doing the Exactly Correct Thing, and trying to be Fair to Medicare and Protect Yourself, but the System has found a Way around the High Set-Aside Figures, and are going to Use Them until they get Forced to do Something Else!! I Honestly think, from What Information You have given us, that the Hold Up in Your Case is the Ins. Co. is not going to Pay a Penny More than They have to for a Set-Aside, so Your Settlement sets in Limbo. Double Check This Info with Your Attorney, it's by No Means Fair, but They are getting Away with it Daily!!Wink
 
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#6
Still in Limbo Wrote:I Honestly think, from What Information You have given us, that the Hold Up in Your Case is the Ins. Co. is not going to Pay a Penny More than They have to for a Set-Aside, so Your Settlement sets in Limbo. Double Check This Info with Your Attorney, it's by No Means Fair, but They are getting Away with it Daily!!Wink[/color]

I believe you are exactly correct. IMO also, nothing else makes sense. The IC has no idea if the 1st proposed MSA is acceptable to Medicare.

We offered to let the 1st proposal go to Medicare with a "Guarantee" clause attached. You probably know this but a Guarantee clause is where the IC will have to accept whatever Medicare says is fair. Medicare could increase the MSA themselves or they might not even screen the proposal hard. The IC was not willing to do this neither.

Sometimes I just want WC out of my life. It has been over 6 years. I really thought we had a settlement 8 months ago but the IC is obviously hungup over the MSA Amount.

Ethically, I believe it is totally wrong to intentionally try and screw the Federal Gov, The IC is trying to do this by causing Medicare to start paying prematurely on my back by low balling my MSA.
 
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#7
You are Absolutely Correct Free Bird, it's not Ethical, nor Fair to Either the Injured Worker,or Medicare. What Confuses Me, and I'm Sure it does You also is Why won't They Submit the Original MSA Figure They came Up with. You are Very Wise going with the Guarantee Clause, I also would have had That in My Wording. That Allows You to get Your Sum Quicker, and Leaves the Ins.Co. and Medicare to Iron Out the Set-Aside. I have also Seen the "Wait the Injured Worker Out" Game come into Play, They May be trying that on You. I am a Little Over 5 Years in Myself, There has been 15 Hearings and 2 Appeals so Far, and another Hearing Coming Soon as They have not Paid Me Penalty Monies Due Me Since 4/08. I Wish I could get Out also, and I know I May not get what I want, but I'll be Dam**d if I'm giving My Case away Either, I'm 47, Totally Disabled, and have been so since '04!! I am Actually going Out of the w/c System to the Commonwealth Court as soon as the Last Appeal is Finished, which should be Soon. If I'm Successful There, They Will Owe Me Major Back Money, I will be at Max. Rate, and I don't Care if I Ever Settle!!! Best of Luck!Wink
 
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#8
Interesting article concerning this subject. This might be why my IC has went to the dark side.


http://www.intrustservicesonline.com/CMS...ril_09.pdf
 
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#9
Very Good Article, and You could be Absolutely Correct!! CMS is getting Wise to the Games I Mentioned Earlier, and putting a Stop to Them!!Wink Here in Pa., We can Leave Our Medical Open with the Ins. Co. and Settle,can You do the Same? It still Leaves You in Their System to a Point, and Leaves You Open to IME's every 6 mos. Here if They Choose to do so. Best of Luck to You and Thanks for the Article!
 
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