{"id":4809,"date":"2019-10-30T10:19:59","date_gmt":"2019-10-30T14:19:59","guid":{"rendered":"https:\/\/joemillerinjurylaw.com\/?p=4809"},"modified":"2019-10-30T10:20:18","modified_gmt":"2019-10-30T14:20:18","slug":"medicare-vs-workers-compensation-who-pays","status":"publish","type":"post","link":"https:\/\/joemillerinjurylaw.com\/medicare-vs-workers-compensation-who-pays\/","title":{"rendered":"Medicare vs. Workers\u2019 Compensation \u2013 Who Pays"},"content":{"rendered":"

Many older workers who are injured on the job or suffer an occupational illness are entitled to both Medicare and Worker\u2019s Compensation benefits.<\/span><\/p>\n

There are two general issues involving Medicare. The first involves the regular medical submissions from doctors and other health providers while the employee is getting treatments so they can return to work \u2013 or know if they can\u2019t return to work. These payments are paid until the worker reaches maximum medial improvement \u2013 the point at which future medical treatments won\u2019t help the worker\u2019s health improve.\u00a0<\/span><\/p>\n

The second issue involves the settlement of the claim after the worker has reached maximum medical improvement. In a settlement, funds need to be allocated ahead of time, often before the worker is eligible for Medicare, to account for what Medicare will pay and what workers\u2019 compensation<\/a> will pay. This is discussed in several places on this website and is known as a <\/span>Medicare Set-Aside (MSA)<\/span><\/a>.\u00a0<\/span><\/p>\n

Workers\u2019 compensation is managed by the state where you work. Medicare is a federal program. Generally, the bills for work injuries are submitted to the insurance company for your employer. If they refuse to the pay the bill with 120 days, then Medicare should pay the bill \u2013 conditionally. This means Medicare pays the bill \u2013 but reserves the right to be reimbursed if it is agreed that the workers\u2019 comp carrier should have paid the bill or there is a ruling that they should have paid the bill.\u00a0<\/span><\/p>\n

The medical bill should be something that Medicare covers. Complicating matters is that Medicare normally only pays 80% of hospital and physician services. Supplemental insurance pays the other 20% if the worker has supplemental insurance. The issues get more complex if the worker has reached the age of Medicare eligibility before he\/she has reached maximum medical improvement.<\/span><\/p>\n

A Workers\u2019 Compensation Medicare Set-Aside Agreement is used to pay future bills in a settlement. Typically, before any long-term settlement is reached, the lawyer for the employer will contact a company who specializes in estimating the future medical costs of the injured worker in relation to their work injuries. That company will usually then prepare a detailed Medicare Set-Aside report which sets forth, in great detail, the estimated amounts of the injured worker\u2019s future treatment for his or her work injuries.\u00a0<\/span><\/p>\n

If the injured worker is a current Medicare recipient, the employer\u2019s attorney must then submit that report to Medicare\u2019s CMS Office to get approval for any funds that are set aside to pay Medicare in the future. This is money that is set aside is first used to pay the future medical expenses in relation to the employee\u2019s work injuries.\u00a0 Once approved by CMS, the settlement can then proceed.\u00a0<\/span><\/p>\n

\u00a0Only when the set-aside amount is used up can the worker request that Medicare pay for any other future medical bills. To ensure that Medicare isn\u2019t paying more than it should, if the worker is a current Medicare recipient, he or she must obtain the OK from Medicare for set-aside amount.\u00a0 Sometimes the set-Aside arrangement will be lump sum, other times it will be an initial seed amount, followed by yearly payments for a set number of years to the worker. In addition, sometimes the Medicare money is \u201cself-administered\u201d by the employee, and other times, it is administered by a Medical Management Company.\u00a0<\/span><\/p>\n

If the injured worker is not a current Medicare recipient, but the settlement is over a certain amount and the worker has applied for Social Security Disability (SSDI), it is recommended that a Medicare Set Aside be done privately by the employee as part of settlement, and that the amounts set aside be recited in the settlement agreement. This is to make sure Medicare\u2019s interests are protected, because a worker who is deemed disabled by the Social Security Administration will automatically qualify for Medicare at 24 months from his or her date of disability. Although such arrangements for non-Medicare recipients do not have to be reviewed in advance by Medicare, they are advisable to avoid any problems down the road.\u00a0<\/span><\/p>\n

The bottom line is that the law wants to prevent \u201cdouble-dipping.\u201d Medicare does not want to see a worker receiving a settlement which includes money for future medicals for his or her injuries, and then see that same worker turn around and hit up Medicare for those same bills.\u00a0<\/span><\/p>\n

Experienced workers\u2019 compensation lawyers know how to review Medicare-Set Aside plans to help determine what your future medical needs such as continued therapy, medication, or diagnostic procedures a will be. Once a settlement is made, the employee can\u2019t go back and ask for more. That being said, the beauty of a formal Medicare Set-Aside is that once the money is used up, the worker can then turn to Medicare to cover his or her treatment related to the work injuries.<\/span><\/p>\n

Virginia and North Workers\u2019 Compensation Attorney Joe Miller Esq.\u00a0 knows his way around the rules pertaining to authorized physicians as well as Medicare.\u00a0 He\u2019ll help you come up with legitimate strategies to find a solution if the company doctors are more interested in rushing you back to work than in treating your injuries or illnesses. He\u2019s helped thousands of employees get the full workers\u2019 compensation awards and settlements they deserve. For help now, call lawyer Joe Miller at <\/span>888-694-1671<\/a><\/b>. or fill out my <\/span>contact form<\/span><\/a> to make an appointment.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Many older workers who are injured on the job or suffer an occupational illness are entitled to both Medicare and Worker\u2019s Compensation benefits. There are two general issues involving Medicare. The first involves the regular medical submissions from doctors and other health providers while the employee is getting treatments so they can return to work … <\/p>\n

Read More<\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","footnotes":""},"categories":[13,96,95,10,97,31,98,94],"tags":[],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false},"uagb_author_info":{"display_name":"Joe Miller","author_link":"https:\/\/joemillerinjurylaw.com\/author\/jmiller\/"},"uagb_comment_info":0,"uagb_excerpt":"Many older workers who are injured on the job or suffer an occupational illness are entitled to both Medicare and Worker\u2019s Compensation benefits. There are two general issues involving Medicare. The first involves the regular medical submissions from doctors and other health providers while the employee is getting treatments so they can return to work…","_links":{"self":[{"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/posts\/4809"}],"collection":[{"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/comments?post=4809"}],"version-history":[{"count":0,"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/posts\/4809\/revisions"}],"wp:attachment":[{"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/media?parent=4809"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/categories?post=4809"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/joemillerinjurylaw.com\/wp-json\/wp\/v2\/tags?post=4809"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}