Additional Medicare and Workers’ Compensation Issues

Posted on Friday, July 24th, 2015 at 10:02 am    

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

Medicare and Workers’ Compensation- Prevention of Double Recovery

Posted on Wednesday, July 22nd, 2015 at 9:59 am    

The reason for a Medical Set-Aside (MSA) is to prevent a double recovery. Simply, the federal government, through its Medicare program, believes that your worker’s compensation benefits are the primary source for payment of worker related injury expenses. Medicare wants to make sure injured workers are not paid twice, once by Workers’ Compensation carrier and once by Medicare. Medicare is supposed to be used when the Worker’s Compensation does not pay for the injured’s medical bills.

Medicare requires a Medicare Set-Aside Report, in cases with enough anticipated medical bills, to be prepared. The money that is calculated for future medical is then supposed to be put into a special account called a WCMSA (Workers’ Compensation Medical Set-Aside Arrangement). The money in this account is supposed to be used for medical bills only and just medical bills that are related to the work injury. Only when the money in the WCMSA is fully spent, can a worker then ask Medicare to step in and pay the bills for the injured worker.

There are different and complicated ways to fund these accounts such as through lump sum payments or annuities that an experienced Virginia and North Carolina Worker’s Compensation lawyer will explain. Know that the money for WCMSA only covers money Medicare would pay if the injury was not work related. If for example, a worker requires long term care, otherwise known as attendant care, that Medicare doesn’t normally cover, then the worker needs to be sure there is separate money put aside, as part of any settlement, to cover the long term future care.

North Carolina and Virginia Workers’ Compensation Lawyer Joe Miller Knows About MSA’s.

You only get one full recovery. Attorney Joe Miller has been advocating for clients for over 25 years. He knows how to maximize your benefits. This requires knowledge of State Workers Compensation Laws and the requirements of the Federal Medicare Laws as well. Contact Attorney Joe Miller at 888-694-1671 to discuss your case, email him at jmiller@joemillerinjurylaw.com or complete the online contact form.

What Is the Medicare Set-Aside Requirement (MSA)?

Posted on Monday, July 20th, 2015 at 9:53 am    

Part and parcel of any settlement calculation of a workers’ compensation claim is figuring the costs of future medical care. Ideally, the calculations will be perfect and the money the insurance company pays for your medical care matches what you actually need during your lifetime. Often, though, the calculation is not correct and you end up needing more money for future medical bills than you planned.

If you are already a Medicare Recipient, or if you are close to becoming a Medicare recipient—for instance if you are above age 63 or you have applied for and are receiving Social Security Disability, then the law says you cannot ‘double dip.’ You cannot obtain money from workers comp to cover your future medical care and then turn around and expect Medicare—and the U.S. Taxpayer—to pay for that same care.

To make sure Medicare has some protection against paying for every future work injury medical bill when the workers compensation insurance carrier really should pay, in some cases workers’ compensation and Medicare law require that the parties to a workers’ compensation settlement prepare a Medicare Set-Aside (MSA) report. The report is usually several pages and is prepared by companies who analyze your medical treatment and doctor recommendations to make an estimate of the cost of your future care related to your work injuries. It attempts to calculate, in detail, the worker’s future medical bills. It includes an overall monetary figure. The report is usually prepared at the expense of the defense side.

As an example, a 35 year-old worker may have a severe back injury that prevents him/her from working. The worker figures that he needs a certain sum for the medications and treatments needed to keep the back from getting worse. 35 years later, it turns out there’s a new medical procedure that will cure or vastly improve the back pain. The worker would like to get Medicare to pay for the procedure because the money from the settlement has run out.

In the example of the 35-year-old who wants Medicare to pay for his/her back surgery at age 70, Medicare will look to see if an MSA report was required, if it was properly prepared and if it was properly submitted at the time of the worker’s compensation settlement – 35 years earlier. If the report was supposed to be filed and it wasn’t, then Medicare would likely disapprove the medical procedure because Medicare’s interests were not properly taken into account.

In some cases, for instance if you are a current Medicare recipient, it is required that the MSA be sent to a special office at Medicare first for approval. Once approved, assuming you follow the Medicare rules for properly putting aside your funds in an appropriate account this should offer good protection against running into any problems with Medicare going forward.

North Carolina and Virginia Injured Worker Attorney Joe Miller Knows Medicare Set Asides

At some point, the worker may outlive the settlement money’s ability to pay for future care related to his or her work injuries. To make sure the injured worker is able to then utilize Medicare benefits to take over paying for the care related to his or her work injuries, the Worker’s Compensation and Medicare requirements both have to be met. Virginia and North Carolina attorney Joe Miller knows both sets of requirements. He’ll review the laws with you. Please give us a call at Joe Miller Law at 888-694-1671 and ask for me, Joe Miller, or email me at jmiller@joemillerinjurylaw.com