Royal Medical-MSA Consultants



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Workers Compensation Overview As noted previously, enforcement of the MSP statute by federal authorities materialized on July 23, 2001, when a memorandum was circulated by CMS to the insurance industry, announcing required compliance to the MSP Statute on workers compensation cases, as known today. Through a series of subsequent policy memorandums, (available on our website) CMS provides guidance regarding when and how to consider Medicare"s interests and comply with the MSP. Consideration should be given to Medicare"s interest whenever future medical benefits are closed or settled. As it is not the intention of CMS to review every national Workers Compensation settlement in order to protect Medicare"s interest, a Medicare Set Aside (MSA) is required, on the following situations: Claimant is currently a Medicare recipient Currently 65 years or older On Social Security Disability for 24 months or longer Suffering from End Stage Renal Disease Claimant has a "reasonable expectation of Medicare entitlement within 30 months" following the settlement date Approved for Social Security Disability, however, is not yet Medicare eligible Applied for Social Security Disability though not yet approved Is 62.5 years of age or older Has End Stage Renal Disease but does not yet qualify for Medicare The subsequent FAQ"s memorandums posted by CMS (available on our website) require that certain Workers" Compensation Settlements, seeking to limit or close future medical benefits with a qualified claimant, obtain CMS Regional Office approval of the Medicare Set Aside (MSA) and settlement. CMS approval is required on settlements with qualified claimants (noted above) as follows: Claimant is currently a Medicare recipient: Total settlement value is greater than $25,000.00 Claimant has a "reasonable expectation of Medicare entitlement within 30 months" following the settlement date: Total settlement value is greater than $250,000.00 CMS has defined "total settlement" as wages, attorney fees, all future medical expenses, repayment of any Medicare lien, and total payouts of all annuities to fund the settlement. Additionally, any previously settled portion of the claim must be included in computing the "total settlement amount." Please contact Royal Medical-MSA Consultants at (800) 528-1002, or visit msa.royal-medical.com if you have any questions.