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  1. #1
    Join Date
    May 2008

    Default Payments Out of Settlement to Medicare and Medicaid

    My workers compensation claim was made in the State of: il
    I settled my wc and I thought it was a good deal but, after medicare/medicaid took 65% attorney took 20% and 4000.00 for fees. I still owe money. Its being garnished out of my ss check.
    I evan ask before I sighned. Do I have any leans. What about medicaid/medicare and he said I don't see none. Then I had open medical and I still needed a surgy but, my doctor kept saying I didn't so just kept giveing me meds. When msa came about it was little cause all iI did fore two years was meds. Then my doctor retired. Now I cant find a Doctor. I think they should of told me when I ask if I had to pay back medicare/medicade. Is'nt that against the law? I m talking about what my attorney did and wc. I know the ajuster planed it. I know now my aa just wanted the 20% Who would I tell it to. If I wanted to file charges where would I go. There hast to be a law. Its plain theif. Anybody got any ideas?

  2. #2
    Join Date
    Feb 2007

    Default Re: How Can This Be Legal

    Your attorney had an obligation to explain the settlement to you. If he did not then you are looking at legal malpractice.

  3. #3
    Join Date
    Oct 2006

    Default Re: How Can This Be Legal

    giving poor or bad advice is not criminal and you can't file criminal charges for that. you should start with an "ethics inquiry":
    Last edited by .SH; 05-14-2008 at 10:40 AM.

  4. #4
    Join Date
    Dec 2006

    Default Re: How Can This Be Legal

    Wondering, when EVER settling a claim and Medicare is involved, Medicare's interests MUST BE CONSIDERED BY ALL PARTIES, and that INCLUDES the CA. the IC, the DA, and YOUR attorney. IF a MSA WAS factored into your settlement for Future Medicals, then MEDICARE IS THE ONE WHO APPROVES THE AMOUNT, NOT the attorneys OR the IC...

    IN ADDITION, the settlement should have provided for any "CONDITIONAL PAYMENTS" that MEDICARE/MEDICAIDE made for your industrial injuries. This is called a "NEGOTIATED SETTLEMENT" concerning any conditional payments with Medicare, because SOMETIMES they WILL negotiate the AMOUNT that they REQUIRE for reimbursement. And, MEDICARE determines the amount that they will settle conditional payments for.

    ANY OTHER LIENS from OTHER providers that my have been filed against your WC claim should ALSO HAVE BEEN CONSIDERED IN YOUR SETTLEMENT, and COPIES of those Liens SHOULD have been contained in your WCAB file. Your attorney, and more than likely, the IC THEMSELVES should have performed "DUE DILIGENCE" to determine IF THERE WERE ANY OUTSTANDING LIENS, in ADDTION TO MEDICARE's conditional payments...(At least this is how its done in California).

    Even IF a third-party vendor prepared the MSA "PROPOSAL" on behalf of your IC, (or the IC prepared it, or the DA, or your attorney), Medicare REQUIRES the MSA proposal be SENT TO MEDICARE for THEM to determine "ADEQUACEY". Medicare (and the IC SHOULD KNOW) reviews the LAST TWO YEARS of your medical treatment costs, INCLUDING MEDICATIONS, PLUS whatever FUTURE MEDICAL has been recommended (like surgery, PT, and associated costs) when THEY are determining what amount of money IS ADEQUATE for Future medical that the IC will place in the MSA account.

    Did your attorney explain to you that when there is a MSA, that Medicare REQUIRES an "annual accounting" of HOW, WHEN , WHERE and HOW MUCH is being used out of the MSA for your Future Medicals? WHO is ADMINISTERING the MSA?? A third-party? Did you know that YOU can "self-admininister" the MSA? (Its a pain in the butt, but "do-able"), and you will NOT have to pay a third-party FEES for ADMINISTERING the account...

    IF/WHEN Medicare finds out that THEIR INTERESTS were NOT PROTECTED, and the MSA IS INADEQUATE, there ARE going to be some potentially VERY NEGATIVE CONSEQUENCES. Not only is your ATTORNEY LIABLE, but Medicare can hold ALL PARTIES LIABLE, including YOU.

    WHICH MEANS, the parties, including your attorney, better check to see if their MALPRACTICE INSURANCE POLICIES are PAID and CURRENT. Medicare does NOT FOOL AROUND.

    AND, when drawing up the settlement, your attorney should have made DAMN SURE that not ONLY were Medicare's interests were considered, but YOURS AS WELL, which means: WHATEVER "LUMP SUM" BENEFITS you received as part of the settlement, in the form of RETRO TTD, TTD, PD, VOC REHAB. etc., then the "Characterization" of these BENEFITS should have been WORDED in the settlement papers to reflect that the BENEFITS are MONTHLY BENEFITS PAYABLE for "X" amount of MONTHS between the DATE OF SETTLEMENT and your ESTIMATED LIFE EXPECTANCY.

    OTHERWISE, SSDI can AND WILL apply "OFF-SETS" and take out a HUGE CHUNK OF CHANGE, right off the TOP of the monies you received in the settlement. HOWEVER, by characterizing the settlement proceeds as MONTHLY BENEFITS payable , then SSDI potentially will be taking LESS OFF-SETS , IF ANY, out of your post-settlement SSDI checks.

    Now, it COULD be that if you were on SSDI at the SAME time you were receiving your TTD or other benefits from WC, etc while your claim was still on-going, and you did NOT report your weekly benefits to SSDI, then they MIGHT be taking "off-sets" for those NOW out of your SSDI NOW...or BOTH ( off-sets pre-settlement, and the post-settlement "chunk of change" subject to off-sets from your settlement).

    SSDI requires that you notify them when you are receiving ANY OTHER SOURCE OF INCOME, INCLUDING WC benefits, and that you notify them anytime your benefits STOP, so that they can CORRECTLY calculate WHAT off-sets, if any, will be deducted from your SSDI check each month.

    You MUST get ALL your ENTIRE FILE,copies of your Settlement papers, any and all correspondence you have EVER received from SSDI/MEDICARE, etc, and set up consultations with SEVERAL, EXPERIENCED LEGAL MALPRACTICE ATTORNEYS, ASAP. THe LAST thing YOU need is for YOU to potentially LOSE YOUR MEDICARE BENEFITS over this....

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