AIA Supports Legislation To Improve Administration Of Workers’ Comp Set-Asides


Washington, D.C. ( - The American Insurance Association (AIA) recently applauded the introduction of bipartisan legislation, “The Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012,” by Rep. Dave Reichert (R-WA) and Rep. Mike Thompson (D-CA). The bill aims to resolve the routine delays and confusion in the review of workers' compensation Medicare set-asides by the Centers for Medicare and Medicaid Services (CMS).

“This legislation will provide clear and consistent standards for the CMS administrative process,” said Melissa Shelk, AIA vice president for federal affairs. “The current CMS set-aside review process is both cumbersome and confusing. Representatives Reichert and Thompson understand that a legislative solution is needed to address stakeholders' concerns and to reform a broken system.”

Currently, CMS takes too long to review proposed set-asides, fails to provide consistent standards for determining amounts to be set-aside, and provides no avenue to appeal CMS determinations. This is a pervasive workers' compensation claims problem that impacts all stakeholders, injured workers, employers, insurers and state workers' compensation agencies, nationwide.

“Passage of this legislation will compel CMS to make timely coverage decisions and enable appeals when necessary,” said Shelk. “The bill also contains much needed provisions to address costly problems and delays that will benefit injured workers, employers and insurers alike.”

“The Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act of 2012” has been referred to the Ways & Means Committee for consideration.

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