Search

Everyone Should Learn a Little about Law

Is There A Workers' Compensation Medicare Set-Aside Arrangement In Your Future?

1 February 2016

Kaylee Wells

If you have been seriously injured on your job, and may not be able to return to work, you may need to apply for social security disability in the near future. If this occurs, and you are currently receiving workers' compensation benefits, there may come a time in which you may need to create a workers' compensation Medicare Set-Aside Arrangement or Trust. What is this arrangement, and what does it have to do with your workers' compensation benefits? This is something you will need to know before you agree to settle your workers' compensation case.

What Is A Workers' Compensation Medicare Set-Aside Arrangement?

When you have sustained a serious injury, you will often have medical appointments, medications, therapy appointments, and other associated medical services that may last for a long period of time. These needed services may be required for the rest of your life. Because of this, and as a part of your settlement that you may receive from workers' compensation, you may need to create a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA), which is sometimes referred to as a Workers' Compensation Medicare Set-Aside Trust.

This is a financial arrangement that will create a special account out of the funds that are designated by your settlement to cover any ongoing medical or future medical services you may need. The funds in this account must be used in full before Medicare will pick up the tab for any of your medical treatments that are directly related to your injury. The amount of money placed in your account will vary on a case-by-case basis and will depend upon the terms and agreements contained within your settlement agreement.

Why Is A WCMSA Necessary?

If you have Medicare, or will soon qualify for Medicare, and you have some other type of insurance, each of them has a certain responsibility to pay your bills. The one who pays first is referred to as the primary payer, and the other is the secondary payer. Your bills are first submitted to your primary payer, and then any balance that is left is submitted to your secondary payer. Some of these other sources may include:

• Private insurance
• Workers' compensation insurance
• Veteran's Administration benefits and more

Because insurance companies, including Medicare, try to preserve their assets and not pay claims they do not have to pay, they will often deny coverage for charges they feel should be paid by someone else. If your settlement will specifically grant you money to help to pay for any future medical expenses you will incur as a result of your injury, Medicare wants to ensure that these funds are paid by the primary payee prior to Medicare beginning to cover these expenses. These funds can be used for the following:

• Prescriptions
• Doctor's visits
• Medical procedures
• Medical supplies
• Adaptive Equipment and more

This means that, anytime you incur injury-related expenses, you will be expected to draw upon these funds and not file a claim with Medicare. If this is not done correctly, you may find yourself having to pay Medicare back.

What Do You Need To Do?

If you are working with an experienced and knowledgeable workers' compensation attorney, your attorney will be able to tell you if you will need to set up a Medicare Set-Aside Arrangement as a part of your settlement agreement.

WCMSAs are normally required under the following scenarios:

• If you are currently eligible for Medicare and your settlement is for more than $25,000
• If you settle for more than $250,000 and you may be eligible for Medicare in the near future 
• If your settlement specifically approves funding for future medical care of the injury

There may be other cases in which an account is required as well. Your attorney will be able to advise you on this as well as how to draw down any medical funding you will need in the future. Ask them to give you this important information in writing for your future reference.

For more information about filing workers compensation claims and dealing with the aftermath, contact a firm like Hardee and Hardee LLP.

Share