Employer and Insurance Company Disagree with CMS Amount

[Snippy65]

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

I just received my approved proposal back from CMS and the amount was approx. 5 times higher then what the IC proposed. They knew the low balled the amount because their attorney sent me an agreement to sign and it stated their amount and also included that if Medicare proposed a higher amount they would agree to it. The agreement was for the WC judge to sign. They never filed it. Obviously!

Well, I guess it was higher then imagined and now they want me to agree to their original amount, but as an ADVANCE. I've tried to contact the individual handling my case at CMS, but he is out of the office until next week. I need some advice. This is going on 11 years, and all I want is for them to be out of my life completely and for me to handle all of my medical decisions. How long does the carrier or employer have to make a decision regarding the proposal? I haven't been able to find the answer to that question.
Thanks in advance for any and all advice. BTW, I'm not thinking of jumping at the first proposal, even though the attorney was telling me I could have a check in my hand by next week. He was trying everything to get me to agree.

[BvIA]

There should have been a WCMSA vendor compile the proposal based on the past 2 years of your treatment records. Then the proposal is submitted to CMS/Medicare for review... just because the threasholds are triggered by the dollar -value of your claim/settlement doesnt' mean someone actually reviews the proposal...in you case, however it appears to have been the case.

Have said that... there is no appeal process once CMS has reviewed/approved the WCMSA... it stands as is. (I am going through the same issues right now... so I'm familiar with what I speak)

They knew the low balled the amount because their attorney sent me an agreement to sign and it stated their amount and also included that if Medicare proposed a higher amount they would agree to it. The agreement was for the WC judge to sign. They never filed it. Obviously!

If the carrier/CA and the DA signed, and you and your AA signed...that is an agreement and should be binding with/with out the judge. A judge usually only signs off on the final...final agreement to ensure your best intersts have been met, and the law held.

BTW, I'm not thinking of jumping at the first proposal, even though the attorney was telling me I could have a check in my hand by next week. He was trying everything to get me to agree.

Sounds like you have a substantial MSA here... if there is indemnity, or life pension to be paid, have you considered a annuity to fund the accounts...one for MSA, one for non-Medicare medical and one for the remaining indemnity un paid... (there is a second portion to the future medical.... an amount that is not accoutable to Medicare... has anyone discussed that with you ?)
Annuities would provde a guaranteed tax free stream of income forlife...its called a Structured Settlement. And you could very well be receiving more money in the long run vs a lump sum. Investment income from the lump sum is fully taxable.

[Snippy65]

Thanks for responding. Is there a time frame the carrier or attorney have to respond to CMS regarding their recommendation.

I was wondering if that agreement would hold up or not. I'm going to make more phone calls on Monday. Their attorney was acting very nervous and frustrated on the phone. I think he made a mistake by putting in the agreement his clients would accept any amount required to satisfy Medicare's interest.

I have two siblings that have their Master's in finance and will be assisting me with the direction of the funds when the carrier sends me a check. Thanks for the advice.

[BvIA]

There is no timeframe to respond to CMS... when the settlement is finalized, a copy goes to them, and that's about it. They don't approve the settlement, there only concern is the money set aside for you to pay the medical bills Medicare would normally be responsible for.

Talk to your siblings about a Structure including annuities... you cannot generate enough money by investing the lump sum of your indemnity to replace the weekly benefits you receive from comp. With the economic changes, inflation and the fact the income is taxable... you are far away ahead with an annuity to fund the indemnity, MSA and non-Medicare accounts.

You didn't answer my question re the non-Medicare future medical money... has anyone discussed this with you...not ALL of your future medical money should be in the WCMSA...

[Snippy65]

I settled my worker's comb benefits a few years ago. This is my MSA only.

Once this is finished, I'll sit down with my siblings to discuss how it where the money will be placed. But I think about that until I know they are going to pay. I'll make further inquires regarding the agreement.

I'm thinking about posting a new thread on the legal part of this forum. Either way I'll be making some calls on Monday.

Thanks again.

[BvIA]

Once this is finished, I'll sit down with my siblings to discuss how it where the money will be placed.

CMS/Medicare doesn't care where the money is deposited, as long as reasonable interest is accrued and used toward your injury ONLY.

There is acutally quite a bit to a WCMSA.. hopefully there is someone to advise you on the process and self attestation... as well as what the money can be used for. It's not as simple as keeping the receipts.