Workers Compensation

Whenever other benefits are involved in a WC claim, questions arise.

If a client gets Vet benefits, is there a reduction?  If Service Connected, no. If Non-Service Connected, yes.

If client is getting UC & WC, will Social Security deny benefits?  Not necessarily. 820 ILS 405 Section 601(b)(1).

If client has another WC claim pending in Ohio as well as Illinois, what then?  Confusing since Ohio is a reverse offset State.

If client is going thru a divorce, does the spouse have an interest in the WC claim proceeds?  You betcha.

Does CMS require that a Medicare set-aside arrangement be  established in situations that involve both a WC claim and a third party  liability claim?  Answer: Third party liability insurance proceeds are also  primary to Medicare. To the extent that a liability settlement is made that  relieves a WC carrier from any future medical expenses, a CMS approved Medicare  set-aside arrangement is appropriate. This set-aside would need sufficient funds  to cover future medical expenses incurred once the total third party liability  settlement is exhausted. The only exception to establishing a Medicare set-aside arrangement would be if it can be documented that the beneficiary does not  require any further WC claim related medical services. A Medicare set-aside arrangement is also unnecessary if the medical portion of the WC claim  remains open, and WC continues to be responsible for related services once the  liability settlement is exhausted.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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Workers Compensation

REMINDER: Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where payment has been made or can reasonably be expected to be made under a workers’ compensation law or plan of the United States or a state, or under an automobile or liability insurance policy or plan (including a self-insured plan), or under no fault insurance. By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, state agency or private insurer [42 CFR 411.24(g)]. Accordingly, it is essential that all parties to personal injury insurance settlements ensure that Medicare’s interests are protected and therefore of the utmost importance for all attorneys, insurance company personnel and medical billing professionals to fully understand how and when the MSP applies in any given personal injury situation. Failure to meet your MSP obligations may have some very significant financial ramifications such as attorney personal liability as supported by the 3rd Circuit decision in U.S. v. Harris, or an insurer $1,000 per day per case fine for failure to perform MMSEA reporting.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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