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  1. #1
    Join Date
    Jul 2012
    Posts
    36

    Default MSA (Medicare Set Aside)

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

    Hello,

    My initial injury had occurred in 2005 and a second injury in 2007.

    My employment was terminated 2009.

    As my 3 year requirement (TN requires lifetime medical benefits remain in place for 3 years from settlement date) has arrived; the IC approached me on behalf of my former employer asking if I would be willing to settle lifetime medical benefits for each claim I have. I said I would entertain an offer, but would not commit to a settlement.

    I know that a MSA must be implemented in my case as I am receiving SSD benefits and have been since 2010. I was told by the IC that I would be contacted by a company (I won't mention the name, however I have found they are a non biased third party company) which I have been. This company examines the previous 2 years of medical costs for each claim, estimates cost for future care and then prices it at an amount that Medicare may or may not approve. This evaluation has since been completed.

    Sorry, I can be long winded sometimes but I thought some history may be warranted here.

    My questions:
    With an MSA being set up where do the funds come from for the account? Part of/subtracted from the overall settlement/buyout?

    Who has access to these funds to be dispersed for medical costs?

    Is the account made available to me for access to the funds?


    A couple of questions not directly related to the above:
    Upon negotiating/agreeing upon a potential value of the claims; am I correct in that a state WC judge would have to approve of the dollar amount?

    The judge has the power to strike down the amount should he/she believe it to not be an adequate amount?


    Being this would go to a Tennessee judge I have read that the judges within this state are not fond of anyone settling these types of claims.

    Once again, sorry for the looooong winded version! Any guidance offered will be much appreciated.

    AnotherGuest

  2. #2
    Join Date
    Sep 2009
    Posts
    190

    Default Re: MSA (Medicare Set Aside)

    My questions:
    With an MSA being set up where do the funds come from for the account? Part of/subtracted from the overall settlement/buyout?

    [I]MSA is a separate part of your settlement. It is not subtracted form your Indemnity buyout settlement. Generally the funds come from a Annuity set up by the IC. The sum of your MSA will be divided by your life span and seed money will be sent to you. Generally, You will receive 2 years of seed money in advance. The MSA could be distributed in a lump sum but doubtful.

    ------------------------------------------------------------------------------------------------------------------
    Who has access to these funds to be dispersed for medical costs?

    My checking account has my name and my wife's name on it. I have only one debit card that I tote. My wife is the beneficiary so I put the checking account in our name

    ------------------------------------------------------------------------------------------------------------------
    Is the account made available to me for access to the funds?

    Yes; You will have money sent to you and you must open a interest bearing checking account.
    ------------------------------------------------------------------------------------------------------------------

    A couple of questions not directly related to the above:
    Upon negotiating/agreeing upon a potential value of the claims; am I correct in that a state WC judge would have to approve of the dollar amount?

    Yes, At least in the great state of Louisiana
    ------------------------------------------------------------------------------------------------------------------

    The judge has the power to strike down the amount should he/she believe it to not be an adequate amount?

    Yes but doubtful. CMS(Medicare) will look at your projected Life Care plan and tweak it if necessary.
    ------------------------------------------------------------------------------------------------------------------

    Being this would go to a Tennessee judge I have read that the judges within this state are not fond of anyone settling these types of claims.

    Once again, sorry for the looooong winded version! Any guidance offered will be much appreciated.

    AnotherGuest

  3. #3
    Join Date
    Feb 2007
    Location
    Charlotte, NC
    Posts
    2,840

    Default Re: MSA (Medicare Set Aside)

    So Confused gave you pretty good answers, but I would not recommend putting the MSA account in the names of both the injured worker and the spouse. That is certainly not what CMS would want to see. The spouse has no right to that money unless and until the injured worker dies while married to the spouse. If you want to leave it to your spouse then you need a Will. If you are not competent to manage it or write checks on it, then you need a court-appointed guardian.

    CMS approves the amounts of the MSAs and the funding of them. State work comp agencies and judges have jurisdiction over future medicals, perhaps, but don't have jurisdiction over MSAs.
    The North Carolina Court of Appeals has held that "In contested Workers' Compensation cases today, access to competent legal counsel is a virtual necessity." Church v. Baxter Travenol Labs, Inc., and American Motorists Insurance Company, 104 N.C. App. 411, 416 (1991).

    Bob Bollinger, Attorney at Law

  4. #4
    Join Date
    Sep 2009
    Posts
    190

    Default Re: MSA (Medicare Set Aside)

    Quote Quoting complwyr View Post
    So Confused gave you pretty good answers, but I would not recommend putting the MSA account in the names of both the injured worker and the spouse. That is certainly not what CMS would want to see. The spouse has no right to that money unless and until the injured worker dies while married to the spouse. If you want to leave it to your spouse then you need a Will. If you are not competent to manage it or write checks on it, then you need a court-appointed guardian.

    CMS approves the amounts of the MSAs and the funding of them. State work comp agencies and judges have jurisdiction over future medicals, perhaps, but don't have jurisdiction over MSAs.
    Actually, My Attorney recommended putting my spouse on the Account in case I died prematurely. After a period of time to make sure all the bills are paid, she could then access the remaining funds with hopefully no resistance from the IC. I do understand your advice and the wife is in my will.

    As stated above, I have one debit card and I only have access to it. I have a check book that I only use. We are not tempted to use the MSA funds wrong because we are Financially stable.

    I doubt if CMS will ever know whose name is on the account and probably will not care as long as the MSA is managed properly. It is simple to manage IMO.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: MSA (Medicare Set Aside)

    With an MSA being set up where do the funds come from for the account? Part of/subtracted from the overall settlement/buyout?
    A C&R includes money for unpaid PPD indemnity, and to fund the MSA. Atty fees are generally awarded based on the full amount of the settlement. Which means...you get less as atty fees cannot be taken from the MSA allocation.
    Who has access to these funds to be dispersed for medical costs? YOu. and You must self attest annually to CMS to account for those services Medicare would normally be responsible for.

    Is the account made available to me for access to the funds?

    Yup...it's your money. The carrier must deposit the amount equal to the first TWO years. After that, annual deposits may be made. Or, the full amount of the MSA can be deposited at once. BUT... either way... once you have exhausted the MSA money, Medicare picks up and you WILL have out of pocket costs.
    I doubt if CMS will ever know whose name is on the account and probably will not care as long as the MSA is managed properly. It is simple to manage IMO.
    OH YES... CMS will know exactly who is on the account, and what the money has been spent for. You must attest annually to CMS on the MSA ....
    IF the MSA is funded by annuity... when you die, the payments die.

  6. #6
    Join Date
    Jul 2012
    Posts
    36

    Default Re: MSA (Medicare Set Aside)

    Wow!

    Talk about quick responses!

    Thank to all who contributed. The former employer and IC have been pretty decent to me so I'm hoping the past treatment will continue through this process.

    Thanks again folks!

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: MSA (Medicare Set Aside)

    any cash settlement is ALWAYS in the best interest of the ER/IC... not the IW. The only good comp file...a closed file.
    If you really feel a MSA is simple... think again, there are statutory legal responsibilities. Consult with your attorney before you make any decisions... message boards are generic at best and not specific to your situation. Regardless of what others may have experienced.

  8. #8
    Join Date
    Jul 2012
    Posts
    36

    Default Re: MSA (Medicare Set Aside)

    I realize nothing is simple, but the process for the past 7 years has been much better than the majority of the experiences I have read about within this forum. I'm still on the fence about settling.
    Thanks again!

    - - - Updated - - -

    To my last post; I now realize BvIA's last comment had been directed toward so confused.

  9. #9
    Join Date
    Sep 2009
    Posts
    190

    Default Re: MSA (Medicare Set Aside)

    Quote Quoting BvIA View Post
    With an MSA being set up where do the funds come from for the account? Part of/subtracted from the overall settlement/buyout?
    A C&R includes money for unpaid PPD indemnity, and to fund the MSA. Atty fees are generally awarded based on the full amount of the settlement. Which means...you get less as atty fees cannot be taken from the MSA allocation.
    Who has access to these funds to be dispersed for medical costs? YOu. and You must self attest annually to CMS to account for those services Medicare would normally be responsible for.

    Is the account made available to me for access to the funds?

    Yup...it's your money. The carrier must deposit the amount equal to the first TWO years. After that, annual deposits may be made. Or, the full amount of the MSA can be deposited at once. BUT... either way... once you have exhausted the MSA money, Medicare picks up and you WILL have out of pocket costs.
    OH YES... CMS will know exactly who is on the account, and what the money has been spent for. You must attest annually to CMS on the MSA ....
    IF the MSA is funded by annuity... when you die, the payments die.
    How will CMS know who is on the account? No where on the annual self attestation form does it even ask for any information about the bank account; It only ask for a breakdown of the annual medical services expense and prescription drug expenses. There are 3 categories an injured worker can fall in: 1) annual draw on money 2) exhausted your annual money or 3) if you have completely exhausted all monies in the WCMSA account.

    Have you ever seen a annual self attestation form? I will scan and email you one if you so desire.

    - - - Updated - - -

    Quote Quoting BvIA View Post
    any cash settlement is ALWAYS in the best interest of the ER/IC... not the IW. The only good comp file...a closed file.
    If you really feel a MSA is simple... think again, there are statutory legal responsibilities. Consult with your attorney before you make any decisions... message boards are generic at best and not specific to your situation. Regardless of what others may have experienced.
    Self Administrating a MSA is simple; I know because I Self Administrate MY MSA and nothing is complicated about it. It is possible it could get "Hairy" if a IW has severe ongoing injuries but for a IW who is stable like me meaning monthly Doctor visits and monthly prescriptions it is extremely simple.
    Last edited by so confused; 07-11-2012 at 03:20 AM.

  10. #10
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: MSA (Medicare Set Aside)

    Have you ever seen a annual self attestation form? I will scan and email you one if you so desire
    Of course I've seen the forms... what makes you think otherwise... ?
    Self Administrating a MSA is simple; I know because I Self Administrate MY MSA and nothing is complicated about it. It is possible it could get "Hairy" if a IW has severe ongoing injuries but for a IW who is stable like me meaning monthly Doctor visits and monthly prescriptions it is extremely simple.
    But then... we all know you are "unique".

    How will CMS know who is on the account? No where on the annual self attestation form does it even ask for any information about the bank account;
    You are assuming there is but one form filed. Ever hear of the IRS...? Ever hear of a MSA account earning interest... ever think about who's SSA numbers are on those accounts... Ever hear of gov't agencies sharing information..???

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