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  1. #1
    Join Date
    Apr 2010
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    3

    Default MSA Too High to Settle

    My MSA came back at almost $900k. The Ins co sends a NCM, nurse case manager for the ins co to meet with my Dr along with my attorney to see about lowering the MSA to say half of the first MSA. Supposed they are going to get a 2nd msa and it should be about 1/2 of the first. To do this they got the Dr and myself(cause I really want to settle) to say I don't want a pain stimulator implanted in my back and the Dr to say I'm no longer a candidate, along with changing my meds to different,big time cheaper meds. My question is, is this a hoax to get the monthly bills they have to pay down and they have no intention of settling or is this something done regularly and they really want to settle? Because if it is a hoax, I can and will have my meds changed to better and newer stuff that really works but will be horrendously expensive. Also I was given horror stories from the NCM about pain stims coming out of backs and they not working and more trouble than they are worth.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
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    Default Re: MSA Too High to Settle

    They're stretching here.
    When a WCMSA is necessary to protect Medicare interests, a proposal is developed usually by a MSA vendor, and based on the last 2 or 3 years of your treatment records, as well as what your PTP SWAG/Scientific Wild Ass Guesses to the future medical care needs.
    CMS is not in the business of negotiating the amount of the MSA. And once they approve one, there is no appeal process. Just because there is some treatment/medication indicated in the proposal and CMS approves, does not mean you will seek that treatment or medication... or remain on the current medications.

    Whether the 900K is placed in a WCMSA setaside account, or paid directly to you in cash, doesn't change things.
    All the money is for future medical care, CMS/Medicare just want input, and know that a portion of that money will be accountable to them until it's gone. The law says you must take Medicare interests into consideration in a settlement, is doesn't say you must have a seperate account.

    I don't believe reducing that MSA proposal is going to change things.
    You can't force the carrier to cash out the medical in your claim. You might reduce the up front cost of the MSA by using a structured settlement. Annuities would fund the MSA, and the money you should be receiving for NON MSA medical needs. As well as another for the indemnity due.

    You cannot waive your rights to Medicare, so you can't waive your potential future medical care needs. You could wait 2 or 3 years, IF your condition changes significantly, you can try to get the current proposal declared stale, and adjust the figures.

    This is the problem with claims that carry high value medical. The carrier would rather leave the medical open, taking the bet you won't utilize those benefits over time to the extent of what a cash payment would cost.

    Also... IF CMS finds that Medicare interests have not been adequately protected in the settlement, there can be penalties on the parties...your atty, the carrier etc, of up to $1000/DAY... I wouldn't fool around with this issue if I were your atty, or the carrier.

  3. #3
    Join Date
    Apr 2010
    Posts
    3

    Thumbs down Re: MSA Too High to Settle

    Ahh, so it was a crock. All they they did here was reduce their amount to med cost NOW and in the FUTURE. They had no plan on settling because if the knew that the MSA was not open for appeal or change, they wouldn't have bothered except to reduce the cost now with absolutely no real want to settle. Hmmm, I wonder if my attorney knew this also because I asked if this was a crock or if they were really to try to settle and obviously knows the law and knew that no real change could occur now or in the near future unless there was significant change for the better only. Boy oh boy, you can't trust anyone. As for my condition changing in the near future say 2-3 years, possible but only for the worse, so the cost would only go higher, not lower. On the med being left open, my attorney said that the ins co does not like to settle indemity and leave meds open, they like to settle both thanks a million.

  4. #4
    Join Date
    Feb 2007
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    Calif
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    Default Re: MSA Too High to Settle

    Of course they would rather close out the claim entirely. That would reduce their exposure for further liability.

    YOU would be agreeing to become the "claims adjuster" and pay the bills out of pocket.

    They are allowed to have 20+ MSA proposals if they want to pay for it. Only one would be submitted to CMS. The total dollar amount of the claim is what triggers the need for submission to CMS. And, CMS does not have to review/approve the MSA. Depends on their case load. The law requires Medicare interests to be protected. A WCMSA is the recommended instrument to accomplish that goal.
    I don't know that there was/is a "crock" here... they are permitted to calculate the dollar amount any way they want to reduce the potential exposure... before submitting to CMS.

  5. #5
    Join Date
    Sep 2009
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    180

    Default Re: MSA Too High to Settle

    Quote Quoting BvIA View Post
    Of course they would rather close out the claim entirely. That would reduce their exposure for further liability.

    YOU would be agreeing to become the "claims adjuster" and pay the bills out of pocket.

    They are allowed to have 20+ MSA proposals if they want to pay for it. Only one would be submitted to CMS. The total dollar amount of the claim is what triggers the need for submission to CMS. And, CMS does not have to review/approve the MSA. Depends on their case load. The law requires Medicare interests to be protected. A WCMSA is the recommended instrument to accomplish that goal.
    I don't know that there was/is a "crock" here... they are permitted to calculate the dollar amount any way they want to reduce the potential exposure... before submitting to CMS.
    The medication part of the MSA proposal must use AWP pricing effective June 2009. This alone has caused MSA's to sky rocket in price.

    http://www.cpscmsa.com/Docs/April200...Memorandum.pdf

    I believe they want to settle but they want to cut the cost of your MSA.
    I feel you made a mistake in "negotiating" your pain meds to please the IC who does not give a rats behind about you or your future. Also it seems to me your Attorney is throwing you under the Bus. He should have stopped this crap instantly. He just wants a paycheck IMO.
    Cutting the cost of your MSA will cause you to start using Medicare prematurely. Then you have copays, deductibles, donut holes etc to pay.

    Good luck in getting the IC to agree to money for future MSA copays, deductibles, donut holes etc . Most IC's will NOT EVEN consider this in a settlement.
    The 3 annnuity settlement is a fantasy settlement that IC's will not agree to. Get ready to self administrte your MSA because the IC will not pay for a professional to do it for you. It is costly to hire someone to take care of your MSA.

    Prayer and fasting is the key to success.

  6. #6
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    Default Re: MSA Too High to Settle

    At the end of the day, when the WCMSA proposal is submitted to CMS for review/approval, they will determine what is adequate to protect Medicare interests.
    The law requires that the parties address/protect Medicare interests in any settlement that changes or closes the medical in the claim.
    If you don't do it, there can be penalties up to $1000/day. So all the spinning of the numbers is only prolonging the submission of the proposal.

    To say though that the structured settlement approach where annuities fund the indemnity and FMC is not going to happen is not true. Every claim and settlement would be addressed on its own merits. If this type of settlement was not possible, annuity brokers would not be in business, nor would Congress have made this possible and IRS go along with it.
    If it's in the carriers best interest, they'll go along with it...besides, it isn't up to the carrier. A C&R is a C&R. How the IW chooses to use that money is entirely up to the IW, not the carrier. Nor is it impossible to have a third party administer the setaside arrangement. There are states that will not permit the IW to self administer under their own insurance codes. There are fiduciary responsibilities, and investment strategies involved here an average IW would not be aware of.
    Good luck in getting the IC to agree to money for future MSA copays, deductibles, donut holes etc . Most IC's will NOT EVEN consider this in a settlement.
    The closure of FMC is a lump sum cash payment. How that money is allocated is determined by the need of a MSA, not ALL of a FMC is for Medicare protection. The IC has no input how the allocations are done.
    Those IW who close medical w/o the proper allocations, or sufficient funds to cover the future medical needs, aren't getting enough, and shouldn't do it.
    ''Prayer and fasting'' only serves to delay the settlement of a WC claim.

  7. #7
    Join Date
    Sep 2009
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    180

    Default Re: MSA Too High to Settle

    Quote Quoting BvIA View Post
    At the end of the day, when the WCMSA proposal is submitted to CMS for review/approval, they will determine what is adequate to protect Medicare interests.
    The law requires that the parties address/protect Medicare interests in any settlement that changes or closes the medical in the claim.
    If you don't do it, there can be penalties up to $1000/day. So all the spinning of the numbers is only prolonging the submission of the proposal.

    To say though that the structured settlement approach where annuities fund the indemnity and FMC is not going to happen is not true. Every claim and settlement would be addressed on its own merits. If this type of settlement was not possible, annuity brokers would not be in business, nor would Congress have made this possible and IRS go along with it.
    If it's in the carriers best interest, they'll go along with it...besides, it isn't up to the carrier. A C&R is a C&R. How the IW chooses to use that money is entirely up to the IW, not the carrier. Nor is it impossible to have a third party administer the setaside arrangement. There are states that will not permit the IW to self administer under their own insurance codes. There are fiduciary responsibilities, and investment strategies involved here an average IW would not be aware of.
    The closure of FMC is a lump sum cash payment. How that money is allocated is determined by the need of a MSA, not ALL of a FMC is for Medicare protection. The IC has no input how the allocations are done.
    Those IW who close medical w/o the proper allocations, or sufficient funds to cover the future medical needs, aren't getting enough, and shouldn't do it.
    ''Prayer and fasting'' only serves to delay the settlement of a WC claim.
    Annuities are good. I believe the 3 annuity approach you "preach" is absolutely great. I am saying that the majority of IC's will not settle with these terms . I come to this conclusion by reading this forum and others who have actually settled with a C&R and personal experience.
    The cost to have a vendor to administrate a MSA is expensive and generally the IC will not settle with this. If a IW pays to have this done, his Idemnity settlement will almost go negative after Attorney fees.

    Your 3 Annuity approach is absolutely the way to go but generally will stop the settlement process. Most IW's want the IC out of there life. I can understand this BUT no one can be forced to settle BUT the IC can "starve out" the IW. Many IW's need that Idemnity to save there assets and the IC knows the IW is vulnerable.
    Myself, I am a fighter and believe that prayer and fasting will bring a answer from a higher power who knows all and controls all. Why not tap into this resource?

  8. #8
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    Default Re: MSA Too High to Settle

    Like I said, and without complicating the issue, a C&R as you know is a cash settlement. That closes out the liability of the ER/IC.

    How the IW uses that money is entirely their descretion. Whether that is lump sum cash to pay off bills, or purchase a annuity, is not the concern of the ER/IC.

    FMC is calculated, and allocated to WCMSA, and non-MSA money. The non MSA money is not accountable to CMS/Medicare as the MSA money is. You can do what you want with that.

    Your 3 Annuity approach is absolutely the way to go but generally will stop the settlement process. Most IW's want the IC out of there life. I can understand this BUT no one can be forced to settle BUT the IC can "starve out" the IW. Many IW's need that Idemnity to save there assets and the IC knows the IW is vulnerable.
    There are more than one issue in your statement. Wanting the carrier out of your life has nothing to do the an annuity. Needing that money, has nothing to do with an annuity. Saving their assets may or may not be applicable.
    With a structured settlement, annuities funding the various needs of the IW, there can be cash payment up front, there can be periodic cash lump sum payments, it all depends on the needs of the IW.

    That's why I'm saying what you are providing is not generally the case, or entirely true.

    You are surely free to fast/pray and tap into any power you want. I haven't seen or ever heard of any miracles that helped an IW close their claim... certainly not something attributable to any 'saints'. None the less, I respect your choices. Just don't put too much faith in anything happening too soon to be effective.

  9. #9
    Join Date
    Sep 2009
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    180

    Default Re: MSA Too High to Settle

    [QUOTE=BvIA;137853]
    There are more than one issue in your statement. Wanting the carrier out of your life has nothing to do the an annuity. Needing that money, has nothing to do with an annuity. Saving their assets may or may not be applicable.
    With a structured settlement, annuities funding the various needs of the IW, there can be cash payment up front, there can be periodic cash lump sum payments, it all depends on the needs of the IW.

    That's why I'm saying what you are providing is not generally the case, or entirely true.

    Well, as standard, you try to "mumble jumble" the thread. You say things above that are totally irrelevant to what I said. Like saying Wanting the carrier out of your life has nothing to do the an annuity. Honestly, Do you think that a IW thinks that? Please get real.

  10. #10
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    Calif
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    Default Re: MSA Too High to Settle

    The ''reality" is that you are making blanket statements that are your opinion, and not true in the event there is a C&R to a comp claim.
    A structured settlement is in the carriers best interest. It reduces their cash outlay... WHY would a carrier not be interested in that... ?
    Your opinion is...Your 3 Annuity approach is absolutely the way to go but generally will stop the settlement process.. That is not true.

    Most IW's want the IC out of there life. I can understand this BUT no one can be forced to settle BUT the IC can "starve out" the IW. That may be true. That has nothing to do though with a C&R, which would come before any annuities were discussed or considered.

    Many IW's need that Idemnity to save there assets and the IC knows the IW is vulnerable. True. And as I said before...With a structured settlement, annuities funding the various needs of the IW, there can be cash payment up front, there can be periodic cash lump sum payments, it all depends on the needs of the IW.

    Sorry, I don't see any "mumble jumble'' there.

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