Category Archives: WORKERS COMPENSATION

#2| Since You Asked: Synergy’s Workers’ Compensation Medicare Secondary Payer Advice Column

September 9, 2021 Samantha Webster Structured settlements may be used to fund a Workers’ Compensation Medicare Set-Aside (WCMSA). Samantha Webster, Synergy’s Director of Case Management, addresses two common questions that come up about funding of a WCMSA with a structured settlement annuity. Question #1: “Are there different structured settlement options to fund a Medicare Set-Aside…

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Medicare Secondary Payer Compliance Challenges in WC Cases

March 11, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Medicare Secondary Payer compliance issues in workers’ compensation cases are generally straightforward when the parties seek review of the Workers’ Compensation Medicare Set-Aside (WCMSA) proposal and proposed settlement by the Centers for Medicare and Medicaid Services (CMS). Oftentimes the employer/carrier will elect to fund the CMS-approved WCMSA…

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Discussing the Workers’ Compensation Medicare Set-Aside with your Client

October 21, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F By now, most workers’ compensation practitioners are familiar with the Centers for Medicare & Medicaid Services (CMS) voluntary review process involving Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA). CMS is currently willing to review settlements that exceed $25,000.00 in cases involving a Medicare beneficiary. Settlements that involve…

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How the Advent of the Mandatory Insurer Requirement Causes Problems for Lawyers

October 13, 2020 As of April 1, 2011, a Responsible Reporting Entities/insurers (RRE), (liability insurer, self-insurer, no-fault insurer, and workers’ compensation carriers) must determine whether a claimant is a Medicare beneficiary (“entitled”) and if so, provide certain information to the secretary of Health and Human Services (hereinafter “secretary”) when the claim is resolved. This is…

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Structured Settlement: Peace of Mind for the Injured Worker

June 16, 2020 B. Josh Pettingill In these uncertain times, a structured settlement can provide a secure, low-risk source of compensation and the convenience of regular payments tailored to fit the injured worker’s specific needs. With all the market uncertainty and turmoil, now is the time for an injured worker to consider a structured settlement….

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Medicare Advantage Plans and Workers Compensation Medicare Set-Asides

March 25, 2020 B. Josh Pettingill We are oftentimes asked about injured workers who have a Medicare Advantage Plan (MAP) and if they still need to use their Workers’ Compensation Medicare Set-Aside (WCMSA) funds if the MAP will cover all their medical care. This brief post will explain Medicare’s position on this issue and then…

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Medicare Set-Aside Self-Administration: What is new?

B. Josh Pettingill Last week, the Centers for Medicare and Medicaid Services (CMS) issued the latest edition of their Medicare Set-Aside (MSA) self-administration toolkit. This toolkit is intended to serve as a guidebook or roadmap for how to properly administer a Workers’ Compensation Medicare Set-Aside (WCMSA) account. The statistics show that 99% of claimants elect…

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WCMSAs and Non-Submit Programs

B. Josh Pettingill Many carriers are moving to “non-submit programs” using Evidence-Based MSAs as the driving force for the change[i]. Getting approval of a Medicare Set-Aside is never required by any law or statute. There are times when not submitting the Workers’ Compensation Medicare Set-Aside (WCMSA) makes sense in order to achieve a resolution. Most…

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The Interplay between Medicare and Medicaid for Injured Workers

Jason D. Lazarus, Esq. This blog post will discuss dual eligibility for injured workers.  It will address exactly what it is and how Medicaid coordinates with Medicare for those that are dual-eligible.  Finally, it will talk about the techniques to preserve Medicaid and Medicare. Some individuals are “dual eligible” meaning they qualify for both Medicaid…

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Getting CMS Approval Faster

B. Josh Pettingill The Centers for Medicare and Medicaid Services (CMS) approval of a Medicare Set-Aside is a voluntary process but getting CMS approval has become the standard practice when resolving catastrophic workers’ compensation cases with Medicare eligible, injured workers. There are countless ways that an approval can be delayed. If any of the following…

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Settlement Language Can Make or Break a Workers Compensation Case

B Josh Pettingill Appropriate settlement language can make a significant impact on the total amount of the workers’ compensation settlement, as well as dollars that the injured worker receives. This brief article will provide plaintiff/applicant attorneys with the requisite settlement language to maximize the workers’ compensation recovery, as well as protect their respective firms and…

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