Florida Worker's Compensation - Help For Injured Florida Workers

• Florida Worker's Compensation - Quick facts about worker's compensation law, benefits and lawyer fees.

• Florida Worker's Compensation Resources - Links and resources for injured workers.

Results 1 to 6 of 6
  1. #1
    Join Date
    Mar 2010
    Posts
    4

    Default Workers Comp MSA, Settlement, and Recovery

    My workers compensation claim was made in the State of: FL

    the IC did 3rd party assessment , and set 500,000 for MSA. I understand that MSA is used for future medical. There is a procedure that i would like to get done for my injury that is not approved under medicare. What happens if i take money from msa to get this procedure done, and can return to work?

    At this point i have already "misused" the msa funds since its a non-covered procedure.


    1. Are there any legal repercussions of not using MSA funds properly, or misusing them, or buying a pair of sneakers?

    2. Are there any non-legal repercussions of not using MSA properly? ie black balled from other welfare programs.

    3. Same as above, but what if you close out the msa account and take the money yourself?


    I understand "medicare will not cover treatment relating to that specific injury". Is there any other downside aside from 'treatment for that specific injury" not being covered by medicare?

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Wcmsa , Settlement, and Recovery

    Medicare "recommends" you use a seperate interest bearing account to pay for medical services to your accepted body parts.
    There is no law that requires a setaside account... BUT... Medicare can and does track WC and PI claims/cases... and that settlement money, while technically 'yours', is to be used only for medical care, or you wouldnt' have rec'd that cash to begin with... you "agreed" in the cash settlement to assume liability for your injury... Medicare will not pay benefits to those body parts until you can prove you have spent all of that cash on medical services... and only those approved by CMS/Medicare.

    So... that is the repurcussion you'd face if you spend the money elsewhere... besides having to account to CMS every year where the money went... you cannot be fined, or otherwise prosecuted for using the money. You just won't be provided any Medicare covered services until you prove the money has been used appropriately.
    set 500,000 for MSA.
    That's a significant amount of money you have to prove you'd used appropriately... a significant amount in future medical care.

  3. #3
    Join Date
    Mar 2010
    Posts
    4

    Default Re: Wcmsa , Settlement, and Recovery

    Quote Quoting BvIA View Post
    Medicare "recommends" you use a seperate interest bearing account to pay for medical services to your accepted body parts.
    There is no law that requires a setaside account... BUT... Medicare can and does track WC and PI claims/cases... and that settlement money, while technically 'yours', is to be used only for medical care, or you wouldnt' have rec'd that cash to begin with... you "agreed" in the cash settlement to assume liability for your injury... Medicare will not pay benefits to those body parts until you can prove you have spent all of that cash on medical services... and only those approved by CMS/Medicare.

    So... that is the repurcussion you'd face if you spend the money elsewhere... besides having to account to CMS every year where the money went... you cannot be fined, or otherwise prosecuted for using the money. You just won't be provided any Medicare covered services until you prove the money has been used appropriately.That's a significant amount of money you have to prove you'd used appropriately... a significant amount in future medical care.

    Ok, that sounds good. So im "legally" safe to get a "nonapproved" procedure done [artificial disc replacement] with that money, and keep the rest in the msa.
    I do not intend to go buy a porche, i just want to get said ADR done.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Wcmsa , Settlement, and Recovery

    WCMSA money can only be used for those services Medicare would normally be responsible for.
    If you use the money for other services/treatment etc, Medicare WILL NOT begin to pay for ANYTHING until you have replaced that money.
    There are no penalties, no prosecution. Medicare does apply reasonable interest to those funds too.
    Frankly...Im suprised you have 500K in a interest bearing account...

  5. #5
    Join Date
    Aug 2011
    Location
    Georgia
    Posts
    800

    Default Re: Wcmsa , Settlement, and Recovery

    Quote Quoting mtdewthrowback View Post
    At this point i have already "misused" the msa funds since its a non-covered procedure.
    Here's my "take" on this. WCMSA is "recommended" for the IW, not required. It gets a bit confusing, however, because it is REQUIRED of the IC to do the set aside through CMS because of the Medicare Secondary Payor Act. In other words, the IC must adhere to the MSPA and submit a WCMSA, but the IW does not. (Rock and a hard place ?)

    What this boils down to, as I read it, is that Medicare can REFUSE to cover ANY medical treatment related to the work injury UNLESS the IW can prove that money from the WCMSA has been used for that treatment FIRST, and that there are no more funds available. Simply put.

    Thus, in my own analysis, if the procedure you're referring to is not Medicare approved, yet a viable medical procedure, accepted by the medical community, what's the harm in using those funds ? The only harm is that if it didn't work, and you needed more procedures, of which Medicare would normally approve, then, if the funds are not there, you're out of pocket because Medicare would deny coverage.

    Personally, I think the WCMSA is a scam. I say if you need medical care, and you have access to the funds - get what you need. Just my own opinion.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: Wcmsa , Settlement, and Recovery

    What this boils down to, as I read it, is that Medicare can REFUSE to cover ANY medical treatment related to the work injury UNLESS the IW can prove that money from the WCMSA has been used for that treatment FIRST, and that there are no more funds available. Simply put.
    That's right.

    However...
    Personally, I think the WCMSA is a scam. I say if you need medical care, and you have access to the funds - get what you need. Just my own opinion.
    You are not alone in your thought process... but, and this is IMHO... any settlement of future medical should -be calculated FIRST, before a MSA is considered... CMS recommends a "portion" of FMC be setaside in a WCMSA to protect Medicare AND the IW.
    IW's are not 'entitled' to FMC reimbursement money... and, as part of a C&R, the IW agrees to accept further liability for medical treatment to the injury...out of pocket. The MSA is just that... IW's out of pocket cash.
    That being said though... part of the "compromise" would be that no additional cash for FMC would be paid outside the MSA...
    If you don't want to accept liability, don't close the claim.

    Personally, I wouldn't settle without TWO annuities funding MSA and FMC... and, the cash for FMC outside the MSA is not accountable to CMS, or taxable.

Similar Threads

  1. Settlement for Workers Comp
    By tawnydoll in forum Disability Benefits
    Replies: 6
    Last Post: 10-07-2011, 03:03 AM
  2. Workers Comp Settlement
    By Marleesmom in forum New York
    Replies: 7
    Last Post: 10-14-2010, 10:18 AM
  3. Replies: 4
    Last Post: 11-02-2006, 06:05 PM
  4. Workers Comp Interfering with Recovery
    By Unregistered in forum West Virginia
    Replies: 0
    Last Post: 10-15-2006, 05:11 PM
  5. Full Recovery Settlement
    By new2this in forum Ohio
    Replies: 27
    Last Post: 01-02-2006, 11:34 AM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
 


Find a Lawyer