MEDICARE SET-ASIDE TRUSTS FOR WORKERS COMPENSATION
If you are settling the medical expense portion of a workers compensation case there are certain issues that you must be aware of:
The Center for Medicare and Medicaid Services (CMS) has stated that all workers' compensation cases where the injured party is a Medicare recipient or is expected to be a recipient within 30 months of date of settlement, or if the amount of settlement is over $250,000, Medicare' s interests must be considered. A Medicare Set-Aside Allocation amount is determined through the analysis of the particular case. Medicare considers the allocation to be the primary fund for paying Medicare covered expenses compensable to the injury. Once the allocation amount is exhausted, Medicare becomes the primary payor of the Medicare covered expenses for the compensable injury.
42 U.S.C. Sec 1395Y provides the following:
- The Centers for Medicare and Medicaid Services' interest be protected
- The Centers for Medicare and Medicaid Services have monetary rights against plaintiffs, plaintiff attorneys and plaintiff advisors when the services' interest is not protected
- The Centers for Medicare and Medicaid Services have double recovery rights against insurance carriers, their legal counsel and their advisors when the interest of the services' is not protected
The above can be achieved by depositing cash in a Medical Set-Aside Trust ("MSAT") equal to the present value amount required to adequately fund all future medical expenses.A structured arrangement in combination is also possible whereby payments are made on a defined schedule to cover expenses paid for future years. Structured settlement annuities with their rated age capabilities and inherent guarantees (annuities are a form of Insurance) make them ideally suited for the task of funding the life contingent future payments. .
In order to correctly perform this task one must obtain the following:
- Independent Medical Needs Assessment through a Life Care plan
- Independent Economic Present Value calculation based on generally accepted method of evaluation
We have relationships with other independent firms who assist in providing the services required to help keep you in compliance. Please contact us for details.
|
