Medicare Set Asides in Georgia Workers’ Compensation Cases


[music 00:00:00 – 00:00:15] Hello. I’m Jodi Brenner Ginsberg with Ginsberg
Law Offices. Today I want to speak with you a little bit about what’s called
a Medicare Set Aside, when you settle a worker’s compensation case. They
are typically referred to as MSA’s, so I’ll refer to them as an MSA. What we have in an MSA is a situation where
currently, as the Medicare guidelines require us to do in a settlement,
in certain situations, and again, you must consult your lawyer to determine
whether or not you need to have an MSA in your case, but in certain situations,
what we are finding out from the Medicare or CMS, Center for Medicare
Services, is that they do not want the burden of paying for a worker’s
compensation injury. Meaning, you cannot just settle your worker’s compensation
case in certain cases, and then turn around and apply for social
security disability, thereby getting onto Medicare and having Medicare
take over the responsibility of your worker’s compensation injury. Now, it is not applicable in every single
case. There are certain threshold guidelines that CMS requires us to have an
MSA or some way of dealing with the medical aspects of the future costs of
your medical care down the road. So let’s say you settle your worker’s compensation
case and you have simply just applied for social security disability,
not even gotten onto social security disability. Or, settled your case
for at this current time, $250,000 amount. In either of those cases, Medicare will require
us to get an MSA, and that is a third party company who is hired to go
out and accumulate all of your medical records and your prescription drug
information and then do a projection about what it will cost into the
future to take care of you medically. And the two situations where a person has
simply applied for social security disability, or is going to sell their
worker’s compensation case for over $250,000, there is a threshold requirement
that Medicare set aside should be done. However, it doesn’t necessarily
have to be done, because there are other ways to deal with the medical.
You could, potentially, in those situations, settle your case in a lump
sum amount and then leave the medical open under worker’s compensation,
and again, that’s part of the negotiation that we have with the worker’s
compensation insurance company. The other way that you also can deal with
the medical is to say a portion of the lump sum settlement, without doing
an MSA per se, is going to be placed in the settlement and that portion
of a lump sum might be utilized, simply say, that must be used for your medical
care. So, there’s a lot of discussion about what is required by CMS in
terms of what is required of an MSA, every attorney who is practicing in this
area has been dealing with these issues for the last several years or
should be dealing with them. In our office, we deal with them a great deal,
and we are happy to advise you on whether you need an MSA, whether leaving
medical open might be an option, or a portion of your lump sum settlement
can be stated in the settlement documents that might cover a future
period of open medical. The point is, it’s a rather complicated area,
and it’s not advisable to get into settlement discussions without having
the advice of counsel. If you’d like to speak with me more about this very
complex area, please give me a call at 770-351-0801. Thank you.

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