A new client, Ralph, came to talk with us about settling his workers’ comp claim. He wasn’t sure that he needed a lawyer, but since his friend urged him to call Johnson & Groninger, he figured that it couldn’t hurt. A workers’ comp consultation is free.
He met with Valerie Johnson to talk about his back injury: how he couldn’t get the medications on time, how the adjuster had said that they didn’t have to pay for the MRI since it was for a different part of his back, and how frustrated it was to have to go through this after he had worked at the plant for nearly 30 years.
“I just want to settle it, I guess.” Ralph wanted to know about how much the case was worth. Imagine how blindsided Ralph felt when I told him that what Medicare might be asked to pay for had to be considered, since he was 65 years old.
Medicare has been an invisible party in workers’ compensation settlements for many years. Medicare says that it should not pay for any charges that the workers’ compensation insurer should pay in the future, and in many cases requires a separate account be set up to take care of those charges. This often requires a separate company prepare a Medicare set-aside, the name for a document that lists doctors’ visits, medications and studies that will be needed for the employee’s work-related condition. Sometimes the document then must be submitted for approval by the Centers for Medicare & Medicaid Services (CMS).
Whether a set-aside must be submitted, and how much is reasonable, is a complex question. If you don’t get it right, Medicare may refuse to pay ANY charges, up to the amount of your full settlement! And some younger workers are eligible for Medicare once they have received Social Security Disability benefits.
When you have questions about Medicare or any issue in a workers’ compensation case, call Valerie Johnson at Johnson & Groninger. We are board-certified specialists, and we are here to help you with settling your case.