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  1. #1
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    Oct 2011
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    lykens pa.
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    Default Medical Settlement

    can you get pocket cash besides the medicare set aside when you make medical settlement

  2. #2
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    Default Re: Medical Settlement

    Quote Quoting george1 View Post
    can you get pocket cash besides the medicare set aside when you make medical settlement
    Medical Set Aside must go into an interest bearing account and be used ONLY for medical treatment related to the work injury.

    Any "pocket cash" you might get would come from an indemnity settlement for the injury.

  3. #3
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    lykens pa.
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    Default Re: Medical Settlement

    thanks for the answer. we have already settled for 40'000.00 back in 1989 but with medical for life.now insurance says if we settle medical part they will send 40'000.00 check to us and we can do what we want with it. we do not have an attorney.i had to tell them that before they made offer. now i see on here that we will not get the money it will be put in fund for set aside.we are on fixed income me 77 wife 68 it is wifes workmans comp. case we thought we would have some extra cash to help out if we settled but if it can only be used for her medical bills it will not help us. can we ask insurance co. that if we settle we want cash in pocket plus set aside money. thanks for your help. sorry new on here and gave a question to myself please somebody eles answer thanks toleglegl for first answer
    Last edited by george1; 10-23-2011 at 03:05 PM.

  4. #4
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    Default Re: Medical Settlement

    Quote Quoting george1 View Post
    thanks for the answer. we have already settled for 40'000.00 back in 1989 but with medical for life.now insurance says if we settle medical part they will send 40'000.00 check to us and we can do what we want with it. we do not have an attorney.i had to tell them that before they made offer. now i see on here that we will not get the money it will be put in fund for set aside.we are on fixed income me 77 wife 68 it is wifes workmans comp. case we thought we would have some extra cash to help out if we settled but if it can only be used for her medical bills it will not help us. can we ask insurance co. that if we settle we want cash in pocket plus set aside money. thanks for your help. sorry new on here and gave a question to myself please somebody eles answer thanks toleglegl for first answer

    The IC will not re-settle the indemnity portion of the claim that has already been settled. Therefore, any funds released to you would be earmarked for medical and subject to consideration for WCMSA (set aside) to cover exposure by Medicare. This would only apply on behalf of the injured party and only to Medicare-approved treatments related to that prior injury.

    Given your ages, this might not be a critical issue. First of all, CMS will use the CDC (Centers for Disease Control) tables in determining your wife's life expectancy. This, in turn, will come in to play in determining what portion of the medical settlement would have to be set up in the WCMSA to cover any potential exposure by Medicare for treatment related to the work injury. Typically, if the settlement amount is less than $25,000 there would be NO WCMSA required. Of course, that doesn't mean that the first $25,000 is exempt.

    Based on the currently used CDC Table 1 Life Expectancy, your wife is expected to live no more than another 16.8 years. (By the way, you have 10.7 years.) Because of this, CMS may either significantly reduce the amount to be used to cover WCMSA, or negate it all together. You could literally end up putting ALL of the medical settlement in your pocket.

    Now, theoretically, you could take the lump sum and NOT treat it as a WCMSA, but then, if your wife DID need any prescription drugs or medical treatment related to the work injury, Medicare would deny coverage and you'd have to pay it directly.

    Should you decide to go forward with the WCMSA, there is a newly formed non-profit agency that will help you administer the WCMSA at little or no cost to you. You can find them here: http://www.medval.com/2011/08/22/the...beneficiaries/

  5. #5
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    Oct 2011
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    lykens pa.
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    Default Re: Medical Settlement

    thank you so much. much help. god bless

  6. #6
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    Georgia
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    Default Re: Medical Settlement

    Quote Quoting george1 View Post
    thank you so much. much help. god bless
    That'll be $1.35 - you can email it to me.

  7. #7
    Join Date
    May 2010
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    420

    Default Re: Medical Settlement

    Quote Quoting LeglEgl View Post
    That'll be $1.35 - you can email it to me.
    can he claim the $1.35 as part of the medical set aside?

  8. #8
    Join Date
    Dec 2007
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    Tunkhannock, PA
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    Default Re: Medical Settlement

    Quote Quoting george1 View Post
    can you get pocket cash besides the Medicare set aside when you make medical settlement
    Yes you can get pocket cash in addition to the MSA. Workers' Compensation and Medicare are not equivalent benefits. Workers' Compensation pays for all reasonable, necessary and causally related medical expenses, while Medicare does not cover all forms of treatment, may have a co-payment, and also has the donut hole for medication. Since the money in the MSA is to pay for treatment related to the work injury which would otherwise be payable by Medicare, additional money beyond the MSA is frequently part of the deal. What you do with that money, is up to you.
    Timothy D. Belt, Esquire
    Helping injured workers in Northeast Pennsylvania.
    belt-law@belt-law.com
    www.belt-law.com

    DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.

  9. #9
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    Location
    Georgia
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    Default Re: Medical Settlement

    Quote Quoting Timothy Belt View Post
    Yes you can get pocket cash in addition to the MSA. Workers' Compensation and Medicare are not equivalent benefits. Workers' Compensation pays for all reasonable, necessary and causally related medical expenses, while Medicare does not cover all forms of treatment, may have a co-payment, and also has the donut hole for medication. Since the money in the MSA is to pay for treatment related to the work injury which would otherwise be payable by Medicare, additional money beyond the MSA is frequently part of the deal. What you do with that money, is up to you.
    Tim, are you referring to the indemnity portion of the settlement included with the WCMSA or is there a provision to provide additional monies when the indemnity was already settled ?

  10. #10
    Join Date
    Dec 2007
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    Tunkhannock, PA
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    Default Re: Medical Settlement

    I am referring to strictly the medical. You can potentially negotiate anything in a settlement including additional money beyond what is required for the MSA. In my humble opinion, it is foolish to settle a medical claim for just the MSA amount since the injured worker is left in a worse position then he would have been in if he did not settle his claim. Medicare does not provide the level of medical coverage an injured worker would receive while on WC, and additional money should be demanded to make up the difference.
    Timothy D. Belt, Esquire
    Helping injured workers in Northeast Pennsylvania.
    belt-law@belt-law.com
    www.belt-law.com

    DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.

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