Case Study

Jesse Thomas

Summary of Case

On May 9th, 2017, Jesse Thomas was involved in an automobile accident
in Florida when he was struck by a Freightliner truck while riding a
motor scooter. Immediately after the accident, he was transported by air
ambulance to a local hospital for multiple serious injuries including a
spine fracture with a spinal cord injury, multiple rib fractures,
neurogenic shock due to traumatic injury, traumatic hemorrhagic shock,
displaced fracture of the left tibial spine, closed fracture dislocation
of left sacroiliac joint, acute respiratory insufficiency,
leukocytosis, acute tubular necrosis, acute blood loss anemia, acute
respiratory acidosis, hyperglycemia, hemothorax, lacerations, open
fracture of the lower leg, head injury, respiratory failure, cardiac
arrest and shock. Mr. Thomas was hospitalized for 63 days from May 9th,
2017 through July 11th, 2017 during which time he underwent multiple
surgical procedures including spinal surgery and a left above-knee
amputation. As a result of the accident, Mr. Thomas was rendered a
paraplegic. Due to the injuries he suffered, he requires 24/7 care and
assistance with all of his activities of daily living.

Issues Presented to Synergy:

  • Resolution of $600k+ in liens
  • Medicare eligibility preservation
  • Medicaid eligibility preservation
  • Protection of the seven-figure financial recovery

How did Synergy help?

Liens

Synergy handled five liens and obtained significant reductions and/or
waiver by using specialized arguments and disputing claims. Our
Medicare team handled a Medicare asserted interest of $144,976. It was
reduced to a final demand of $0. Our ERISA/private lien resolution group
handled four Medicaid liens.

  • FFLLTC asserted a lien of $65,855 and we reduced to $2,563.54.
  • Wellcare asserted a lien of $115,906 and we reduced to $17,885
  • FLMMA asserted a lien of $103,829 and we reduced to $16,656.57.
  • Magellan asserted a lien of $133,621 and we reduced to $200.72

Total liens handled by Synergy equaled $564,187. After Synergy’s involvement, total reimbursement to liens equals $37,304.

A very substantial 93% total reduction that stays with Mr. Thomas for his future!

A Florida Conduent Medicaid lien was also reduced by 80% from $121,870.81 down to $24,374.16.

Medicare Compliance/MSA

Mr. Thomas was a Medicare beneficiary at the time of settlement which
implicated the Medicare Secondary Payer Act and future care (Medicare
Set Asides). Synergy prepared a liability MSA allocation in this case.
The MSA recommendation for future Medicare covered services related to
the injury totaled $665,761.37.

A reduction analysis was also prepared to address the compromised
nature of the settlement. The analysis looked to the ratio between the
full case value and the client’s net recovery. Synergy’s reduction
analysis resulted in a recommendation that 11.8% of the MSA or
$78,559.84, be funded from the net settlement. This allowed Mr. Thomas
to retain a greater portion of his settlement funds while simultaneously
considering Medicare’s interests.

Settlement Planning

Since this case involved a seven-figure net settlement and a
catastrophically injured client, Synergy was asked to assist with
settlement planning to protect the financial recovery to make sure it
lasted the rest of his life. The plan involved funding two different
trusts created to preserve government benefit eligibility. Structured
settlements were set up to fund the Medicare Set Aside and Special Needs
Trust. Our case management team coordinated with the Synergy settlement
planner working on the matter and counsel on the amount for the
structure that would pay into the trust and the duration of the payments
(plan design).  Synergy quoted, shopped the final plan, locked in the
in the rate, verified the trust for payments including beneficiary and
commutation (in the event of premature death), and coordinated/reviewed
settlement documents working with the defense.  With a daily rate, we
were able to improve the annual payment paying into the trust for the
selected premium.

Trusts

To protect the client’s government benefit eligibility, two trusts
were set up both with the Settlement Solutions National Pooled Trust.
One was a special needs trust to preserve Medicaid and one was a
Medicare Set Aside/special needs trust to keep Medicare eligibility in
place. Settlement Solutions National Pooled Trust administers these two
trust sub-accounts for Mr. Thomas to protect his eligibility for public
benefits and preserve money for his future care. He has a sub-account
with our pooled special needs trust, which can be used on a wide range
of expenses for his care and to supplement his benefits. When the trusts
were established, Mr. Thomas was in a skilled nursing facility, but has
since transitioned to a home which was purchased using the funds in his
special needs trust. He also used funds in his trust to purchase a
handicap-accessible vehicle and hire caregivers. He also has a
sub-account in our pooled Medicare-Set Aside special needs trust, which
is used for injury-related, Medicare-covered care, to comply with
Medicare Secondary Payor act and protect his future Medicare
eligibility.

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