Last week, we took a look at how Workers Compensation claims can affect other government benefits, such as Social Security Disability (or SSDI), Medicare, and more.
One thing we just touched on in that post was how your access to and benefits from Medicare can be affected.
Today, we’ll go a little more in-depth and answer the question, “What happens to my Medicare if I settle my Workers Compensation claim?”
As we mentioned last week, you are able to ask Medicare to step in if your claim is initially denied by Workers Compensation, and they may help to cover the cost of treatments and services in the interim while you contest the denial. If your claim is then approved, you may need to repay Medicare for the coverage they provided with some of your Workers Compensation payout.
If you are interested in settling your Workers Comp claim, you should ask your lawyer to contact the recovery contractor as soon as possible. Settlements are handled a little different than they would be for a no-fault or liability insurance claim, so you’ll want to ensure that everyone involved is aware as early as possible of your plans to settle.
As part of settling your Workers Compensation claim, you will be responsible for repaying Medicare for any Medicare payments made for claim-related services and treatments you received.
In most cases, a Workers Comp settlement involving Medicare will include a Workers Compensation Medicare Set-Aside Arrangement, or WCMSA.
While it does not occur in every single case, a WCMSA will often be utilized in Workers Comp cases that involve Medicare. When you settle your claim, you must use the portion of the settlement money allocated for future medical treatment to pay for the workplace-related injury care you are receiving before Medicare will agree to pay for any related care again. Often, one way in which this is worked out includes a WCMSA.
The Workers Compensation carrier insurance agent will ask Medicare to approve a certain amount of money to be set aside to pay for future medical needs related to your workplace injury or illness. Medicare will look over medical documentation in order to decide what amount it will approve from the settlement to be used for this care.
This money must be used up first before Medicare will again pay and any related care that would normally fall under Medicare coverage.
While the WCMSA isn’t necessarily required and isn’t needed in every single Workers Compensation case — and is totally voluntary — Medicare requires that their interests be considered when resolving the future medical treatment portion of a workers comp claim. A WCMSA is often a sound strategy to help ensure the amount needed for services is set aside and to preserve your future Medicare eligibility.
If you are interested in settling a Workers Compensation case and currently utilize Medicare as supplementary or total insurance for your own care, ask your legal representative about whether a WCMSA may be requested or agreed-upon in your case.
BNTD Law has experience with South Carolina’s Workers Compensation statutes, and we would be happy to sit down with you to discuss your situation and help you to decide what next step is right for you. Reach us by phone at (803) 779-7599 or contact us online at any time to request your FREE consultation.