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.
