When a Worker’s Compensation Medical Set-Aside Arrangement is made, the worker should know several things:
- The worker cannot use the money for any other work injury or for items not covered by Medicare, like dental expenses. It’s best to review what expenses Medicare does and doesn’t pay with your North Carolina Workers’ or Virginia Compensation attorney.
- Medicare won’t pay any medical bills until the funds in the WCMSA are used up. If you are being paid in a yearly annuity, this could occur within a specific year.
- Workers should keep good and complete records of their hospital and doctor bills, expenses for medical devices, and prescription drug costs. These records are crucial in case there is any dispute years or decades down the line.
- If you are a current Medicare recipient, there is a one-page annual form that must be filled out and sent to the appropriate Medicare Office each year which recounts how much you have ‘drawn down’ on your MSA account for medical treatment related to your work injury.
- Workers should also know when they are eligible for Medicare. Medicare is usually reserved for older workers. There are some exceptions such as when a worker is getting SSDI (Social Security Disability Income).
Medicare payments when the injured worker’s claim is Denied.
The Medical Set-Aside report should also be distinguished from other double recovery issues. Sometimes an older claimant is immediately eligible for Medicare. When the claimant files for worker’s compensation due to a work injury, Worker’s Compensation may deny the claim. To make sure the worker gets medical treatment, he/she then uses Medicare to get the treatment. If the workers’ compensation decision later favors the worker and pays for medical treatment, then the worker may need to pay back to Medicare any medical bill payments that it essentially advanced on behalf of the injured worker. This area of the law can be confusing especially if the workers’ compensation insurance carriers says that only part of the worker’s medical bills were related to the injury. The carrier may argue that the other part of the worker’s medical bills were due to some preexisting condition.
North Carolina Injured Worker Lawyer Joe Miller Explains Workers’ Compensation and Medicare
Attorney Joe Miller has helped thousands of injury victims. He’s assisted North Carolina and Virginia injured workers for over a quarter century. He’ll make sure you get the right settlement and set up the right accounts to manage those benefits. Make an appointment with Joe Miller Law at 888-694-1671 and ask for me, Joe Miller, complete my online form or email me at jmiller@joemillerinjurylaw.com
