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Thread: Settlement?

  1. #1
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    Default Settlement?

    Considering settling. Lawyer says amount is very good for RI WC.
    Presently I'm 58 and collecting ssi/SDI with WC.

    Questions;
    If settled, ssi/sdi picks up the loss of WC payment as long as Dr still says no work? SSI/SDI is deducting the WC $ from their allowable amount at present.
    If settled will this have ramifications with SSI?

    Part of settlement (approx 1/3) may or maynot be set aside for medicade. Lawyer seems to think it may not be required. Is this likely?

    Have medical coverage w/ wife thru her work. Understand RI has law on "prior injury exclusion". It does not exist in RI. Insurance covers any future direct problems from this injury by law. Is this correct?

    Not sure if it matters but, I've been out of work for slightly more than 2 yrs.
    Settlement would allow me to remain living in my house, keep warm, and pay off all my debts with some left over for rainy days. Without the bills, I could manage fair if I am carefull with money. If SSI picks up the loss WC$ it would appear wise to settle. Wife's insurance coverage is a blessing if what I was told is true.
    3 operations, much PT, much pain, financially scared to death, and not knowing anything about tomorrow has been very difficult. If all the above is true, then there is a light at the end of the tunnel.
    I'm just concerned that something else must be wrong,, or something about this is going to bite me in the end.


    While I'm at it, is there a site like this for SSI / SS?

    Thank you, any factual info on this is much appreciated.

  2. #2
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    Default Re: Settlement?

    While I'm at it, is there a site like this for SSI / SS?

    There is a LOT of information on SSA/SSDI under "Disability Benefits'' and you should setaside a few hours to begin reading about these issues...

    Questions;
    If settled, ssi/sdi picks up the loss of WC payment as long as Dr still says no work?wrong...

    SSI/SDI is deducting the WC $ from their allowable amount at present.
    If settled will this have ramifications with SSI?

    Have medical coverage w/ wife thru her work. Understand RI has law on "prior injury exclusion". It does not exist in RI. Insurance covers any future direct problems from this injury by law. Is this correct?

    I can't tell you what RI laws provide...in general WHY would any IC cover a work related injury where you have already been compensated in a settlement with consideration given to your future medical needs...?
    It won't... and IF you allow for this to happen, knowing you have been paid already,...it could be fraud. No matter what state you reside in...

    There are other issues regarding your wifes policy...

    I'm just concerned that something else must be wrong,, or something about this is going to bite me in the end.
    As you should be...your attorney is not explaining to you in depth how this is going to work, and you should NOT sign ANY settlement agreement until you are clear in what is going to occur.

    I'd like to help you with these issues...but first I'd like you to go to the Disability Benefits forum, and read through the WCMSA posts...especially this one...http://www.workerscompensationinsura...ad.php?t=32283, and please use the links I have provided there...
    There is a LOT of reading you have in front of you, and if you don't deal with this before you settle your claim, you could be facing some huge fines, along with your AA and the ER/IC CA...

    This deals with the Medicare Second Payor Act, and you must take the steps to protect Medicare interests... and since you are currently receiving SSA/SSDI benefits... you will be Medicare eligible within 30 months of any settlement... as such, you probably DO need a WCMSA... regardless of your atty opinion on this...

    We'll talk later after you finish your reading 'assignment'...PM me if you like...you are gonna have questions...lots.

  3. #3
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    Default Re: Settlement?

    Whoa! Something is way wrong!
    Some looking and leads to other sites, along with some specific searches, things look terrible no matter what I do!
    Proposed $120K settlement-
    Lawyer takes 20% -
    "$47K may (probably) get set aside for Medicare -
    SSDI will re-evaluate benefits dividing up the $120K into some sort of monthly reduction-
    Depending on how the settlement is worded, I could even possibly be required to pay back all I've received on SSDI?

    This brings me to less than ZERO?
    I may be loosing all around by settling? Sure looks probable from what I've been reading so far on this internet search. While many sites refer to different states,,, Fed is Fed first.

    SSA declared me "disabled" on 11-9-06, with "case review in 5-7 yrs"., monthly payments are $345/mo. Benefit amount is $1,412.00

    Lawyer has stated repeatedly;
    "your SSI payments will increase to the full $1,412.00 after paperwork from settlement is presented."
    "You will automatically be on medicare 24 mos. after your date of entitlement (May 2007) only for any medical problems coming from the WC injury."
    "I have it worked out with the insurance company to wave aside any requirement for a set aside for medicare because of your private coverage and age. The judge will probably go along with it."
    "If there is a set aside, you will still be handed a check for $97,000 ($120K minus his $23K) that you may need to bank $47,000 for medicare, but, you can invest it any way you want as long as you keep record of medical expenses. If you invest in CDs you keep the interest."
    " From that $47K you pay a reduced rate of co-pay with medicare, a relatively small amount of the total bill."
    "After 5 yrs, you can submit a request, or I (lawyer) can do it for you, to release part or all of the unused $47K previously set aside for your own use."
    "When you hit 65 it will all be released to you anyways, but you need to request it."

    We've had this conversation several times already. I am certain I've heard him correctly. I even asked if there were any catches, quirks, or any way there could be something to it other than what he was telling me. Of course he said "Absolutely not. There will be no problems whatsoever." Honestly. Those are bits of real conversations with the man. I'm certain I heard him correctly. Even asked about the $47K in the event of my death, can my wife get it? He said it would be in my account and if I left the account to her, it's simply "done". It's her's by inheritance. I may have problems from 3+ weeks of morphine and such,,, but I'm not that bad!

    This guy is part of a rather large group. Believe it's a national association. He has "been at it for over 30 years". The only stuff he deals with is WC cases in RI & Mass.

    How in the world could he be that,,, mistaken without being purposefully deceitful?
    What the Christ am I involved in?
    If I go along with this, and he's wrong, what do I do then? Spit bullets at him?
    I am not getting a warm / fuzzy feeling here.

    Should I be thinking of anouther lawyer at this late date?

    Something seems very wrong here.

    I'll go and do some more studying,,, but think my lawyer is missing something or,,,,,, something.

    There is nothing about any of this injury that is remotely good.
    Last edited by Gary; 11-12-2008 at 06:34 PM.

  4. #4
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    Default Re: Settlement?

    Update
    The set aside may very well be possibly waved due to the nature of the injury.

    Gotta say, I love this site!!!!
    Lots of info. I've been lost for hours!
    Track down an answer only to raise more questions. Then it starts to make sense.

    Maybe this lawyer does know his stuff?
    Last edited by Gary; 11-12-2008 at 09:30 PM.

  5. #5
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    Default Re: Settlement?

    1) SSA declared me "disabled" on 11-9-06, with "case review in 5-7 yrs"., monthly payments are $345/mo. Benefit amount is $1,412.00

    Lawyer has stated repeatedly;
    2) "your SSI payments will increase to the full $1,412.00 after paperwork from settlement is presented."

    3) "You will automatically be on medicare 24 mos. after your date of entitlement (May 2007) only for any medical problems coming from the WC injury."

    4) "I have it worked out with the insurance company to wave aside any requirement for a set aside for medicare because of your private coverage and age. The judge will probably go along with it."

    5) "If there is a set aside, you will still be handed a check for $97,000 ($120K minus his $23K) that you may need to bank $47,000 for medicare, but, you can invest it any way you want as long as you keep record of medical expenses. If you invest in CDs you keep the interest."

    6) " From that $47K you pay a reduced rate of co-pay with medicare, a relatively small amount of the total bill."

    7) "After 5 yrs, you can submit a request, or I (lawyer) can do it for you, to release part or all of the unused $47K previously set aside for your own use."

    8) "When you hit 65 it will all be released to you anyways, but you need to request it."
    1) Are you receiving SSDI and SSI...?
    SSI is 'asset based', and there could be some ramification/reimbursement issues where there is a lump sum settlement...

    SSDI, is yours to do with as you please, and is not subject to reimbursement.
    You are however subject to the"80% rule"...meaning, you total 'income' from all sources (with few exceptions) is limited to 80% of your wages when you stopped working. So, if you were earning a qualifying wage of $1000K/mo, your max income including WC/TTD, and SSDI would be $800/mo. (just example figures here...)

    2) If you are receiving SSI, and receive a lump sum cash payment from a settlement... as the benefits are asset based, or 'welfare', you may see your SSI benefits stopped all together. I don't see how the atty could word his way around this... the SSDI benefits however would be recalculated to allow for the pro-ration of the settlement on a weekly/monthly basis so as to co-ordinate your total benefits and not see any offset that is not necessary.

    3) True.. you will be Medicare eligible. BUT... you canNOT use the Medicare benefits for ANY treatment to your injury. The atty is wrong on this point, or you mis understood....The Medicare benefits can ONLY be used for NON work related treatment.

    4) Wrong... You CANNOT make any agreement to waive a WCMSA...that is due to the fact that the 'other insurance coverage' may not continue indefinately, and/or your wife may not continue working, or the private health coverage could deny treatment to the injury...there are too many variables..and CMS/Medicare will NOT allow for Medicare to be negotiated.

    5) Wrong again... IF there is a WCMSA, the money MUST be deposited into an interest bearing accout...NOT CD's, and you or an administrator must send an accounting to CMS each year to ensure the funds, including interest have been spent ONLY on Medicare approved treatment to your injury. ONLY on Medicare approved charges..and that means there could be out of pocket costs to you for co-pays, and deductibles Medicare doesn't cover.

    6) Your atty is full of mis information...he needs to do some research, or contact CMS/Medicare.

    7) Sorry...there is no more provision for any reduction in a setaside account...http://www.jjcelderlaw.com/August25-...emoMSABull.htm

    8) WRONG>.. A WCMSA is never 'released' to the IW... you must prove ALL of the money has been exhausted on Medicare approved treatment/charges BEFORE Medicare will pick up any cost to treatment to your injury.

    This site...http://www.jjcelderlaw.com/MSABulletin.htm contains SO MUCH information your atty should be knowledgable on... it would serve him, and you, well if he'd take the time to refresh himself on what CMS/Medicare demands.

    BEFORE you do anything to settle your claim, it is imperative that you get a WCMSA proposal, which would include the anticipated future medical needs to your injury, and get it submitted to CMS for a determination IF you need a setaside account, and HOW MUCH they will demand be deposited.
    You also should become VERY familiar with the process and demands of a WCMSA>

    IF you have not signed a release of information form for SSA to provide your records.. there is something wrong.
    IF you have not received a letter from CMS..to you, addressing and/or approving a WCMSA... then CMS/Medicare has NOT been taken into consideration in this settlement agreement...and should not be signed or agreed upon ..period.

    There should also be consideration given to a seperate amount of money to be provided to you for any co-pays and deductibles that you could face out of pocket.

    Even asked about the $47K in the event of my death, can my wife get it? He said it would be in my account and if I left the account to her, it's simply "done". It's her's by inheritance.
    I would ask WHO MADE the determination on how much money...47K, is to be deposited into a setaside account ?
    I ask, because ONLY CMS/Medicare can make that decision. I know of a IW now who's AA/CA thinks about 60K would be enough for the future medical... when the proposal came back from CMS...they demanded over 150K...the agreement was done...so, the extra money had to come from the IW's indemnity money...certainly not from the AA's fees...

    If I go along with this, and he's wrong, what do I do then? Spit bullets at him?
    IF your AA and the ER/IC CA do not take Medicare interests into account before the settlement, as per the Medicare Secondary Payor Act, they could be facing fines of up to $1000/DAY for not involving CMS and doing what is required by law.
    Go to the link I provided...and read the bullitins.. these guy teach Medicare issues...they don't make this stuff up.

    You can also read about setasides and the requirements a www.cms.gov
    Or www.ssa.gov

    DO NOT negotiate or settle this claim until you have a complete understanding of the process...http://www.jjcelderlaw.com/SettlementProcessMSABull.htm, it would not be in your best interests.
    I know that lump sum of cash looks very attractive... but what do you do when it runs out...?

    You should also consider a Structured Settlement to this claim... you would receive more money in the long run, your benefit from SSA/SSDI would be protected and the money from the annuities would be TAX FREE both fed/state. AND, there could be a estate left for your wife...
    I don't think from what you are providing your best interests are being addressed adequately here...and you need to step in.

    Keep posting your questions...
    Keep in mind that Federal law over rides RI law...every time.

  6. #6
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    Default Re: Settlement?

    Please excuse me for sounding stupid,,, I honestly feel I am getting stupider by the second (on this).
    Knowing I was over my head with all this stuff is WHY I hired a lawyer. Probably one of the first stupid things I did was call a TV Adv. XXX & Associates. Anyways, that's old history now.

    "1) Are you receiving SSDI and SSI...?

    I believe it is Social Security Disability Insurance ONLY. However I'm looking over the paperwork and see no clear cut reference to either one. I did not file myself, A social case worker handled it for me from CT. Nothing was required as for evaluating "Assets" the way I see it. No checking / savings / stocks / etc. was req'd in any detail. Only most direct contact with Adm. was going to see their Doctor. I was "Awarded" the first time at bat. Retro back payments excluding the first "5 full calender mos."

    2) ... the SSDI benefits however would be recalculated to allow for the pro-ration of the settlement on a weekly/monthly basis so as to co-ordinate your total benefits and not see any offset that is not necessary.

    That sounds very familiar! (oops?) I think it sounded like the impact would be insignificant enough that I may have ignored any impact.

    3) True.. you will be Medicare eligible. BUT... you canNOT use the Medicare benefits for ANY treatment to your injury. The atty is wrong on this point, or you mis understood....The Medicare benefits can ONLY be used for NON work related treatment.

    Hmmmm, Perhaps I'm mistaken. Not too sure of that though, but maybe.

    4) Wrong...
    5) Wrong again... IF (How does"IF" come into play?)
    there is a WCMSA, the money MUST be deposited into an interest bearing accout...NOT CD's, and you or an administrator must send an accounting to CMS each year to ensure the funds, including interest have been spent ONLY on Medicare approved treatment to your injury. ONLY on Medicare approved charges..and that means there could be out of pocket costs to you for co-pays, and deductibles Medicare doesn't cover.

    Interestingly, Your info is in very direct contrast to his. From my researching,, I'd say you are correct and he is mistaken on this. We were discussing the potential of the amount of interest I could receive from this in various ways. So I know I heard him right on this.

    8) WRONG>.. A WCMSA is never 'released' to the IW... you must prove ALL of the money has been exhausted on Medicare approved treatment/charges BEFORE Medicare will pick up any cost to treatment to your injury.

    This site...http://www.jjcelderlaw.com/MSABulletin.htm contains SO MUCH information your atty should be knowledgable on... it would serve him, and you, well if he'd take the time to refresh himself on what CMS/Medicare demands.

    Read this part;
    " In addition to rescinding its earlier policy on early termination of MSAs, CMS reiterated its position that “[t]o protect the Medicare Trust Fund, a set-aside arrangement should be funded based on the life expectancy of the individual unless the State law specifically limits the length of time that WC covers work-related conditions.” CMS will continue to allow life expectancy to be based upon rated ages, but now limits “acceptable proof” of a rated age to rated ages shown on the letterhead of an insurance company or settlement broker (apparently, a physician’s statement regarding reduced life expectancy will no longer be acceptable). Further, the submitter must include a statement that all rated ages obtained for the claimant have been disclosed.
    Interesting how the Feds always seem to add an exception to the rule.

    IF you have not received a letter from CMS..to you, addressing and/or approving a WCMSA... then CMS/Medicare has NOT been taken into consideration in this settlement agreement...and should not be signed or agreed upon ..period.

    Nothing,,, nada! Hmmmm?

    I ask, because ONLY CMS/Medicare can make that decision. I know of a IW now who's AA/CA thinks about 60K would be enough for the future medical... when the proposal came back from CMS...they demanded over 150K...the agreement was done...so, the extra money had to come from the IW's indemnity money...certainly not from the AA's fees...
    Interesting how you brought that up.
    my initial "visit" to the hospital I saw part of the billing for. Spent almost a month there, nearly 3 weeks in intensive care. Hospital bill alone was over $286,000! Did not include Doctors / Specialist and what-nots. Remember going to surgery 3 seperate times that one visit. To date, I've had 2 additional "visits".

    Okay, new question.
    Being stupid, I already signed a bunch of paperwork. Having confidence in my lawyer working for me, it seemed the thing to do at the time.
    Lawyer expected a hearing by mid October. something happened and the hearing is yet to be scheduled. Reason why is very muddy. Now I've word that it should be this week or next. (yup, I'm a late bloomer here, but, better late than never? I admit, STUPID!)
    So If it goes to court before I get my ducks in a row, can the judge elaborate exactly what is what in the settlement(?) for me? and what happens to what? Can I change my decision to settle right then and there?

    Frankly, with all the bill collectors, etc. I don't appreciate having to watch over someone that is suposed to be watching out for me in a professional fashion!
    Honestly, I just want all this done and over with. I want my legs back. I want to get on with my life, job, hobbies, living.
    Sadly,,, none of this is looking like it's going to happen.
    I need some time to step back and take a big breath. That's not going to happen either.

    Hope you know I really, really appreciate your taking time like this to steer me in the right direction for finding answers to questions I didn't know I had.
    God bless & thank you.
    Gary

  7. #7
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    Default Re: Settlement?

    Okay,,,,
    Just called my lawyer.
    Asked about what is with CMS & WCMSA.
    His reply;
    "We went over that. It's all taken care of. Under $250,000 settlement, it is all purely voluntary. That is why we offered $47,000 as a voluntary set-aside. Keeps everyone happy."
    Asked is there any way I can get in trouble with medicade / medicare / social security / etc. later on?
    Reply, "Absolutely not! You are well taken care of. The judge will tell you when you ask him....."
    He went on to explain that the judge will go over all that at the hearing to be sure I understand it. And yes he said I can ask anything I want to clarify.

    Now, from what I've been looking into, I saw nothing of any "voluntary" anything. I'll look some more............

    Frankly,,, I'm scared to death on this!
    Last edited by Gary; 11-13-2008 at 09:57 AM.

  8. #8
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    Default Re: Settlement?

    Found this;
    http://www.cms.hhs.gov/WorkersCompAg....asp#TopOfPage

    Maybe what my lawyer is looking at? (or something simular)

  9. #9
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    Default Re: Settlement?

    Ok,...go here...http://www.wcc.ne.gov/legal/medicare...guidelines.pdf, and follow the chart...
    And, IF you think it's necessary, print the chart and give it to your atty.

    So far... your Atty is patently wrong on nearly everything he's telling you regarding the WCMSA...

    As you'll see from the chart, as you ARE Medicare eligible... and receiving SSDA benefits the therashold is $25K...that number includes ALL the money for whatever benefit you receive in a settlement.

    IMHO... I would stop all of the discussion regarding any type of settlement until you have addressed the setaside, and a WCMSA proposal has been submitted to CMS for review.

    At the VERY LEAST you need to sign a release of information for SSA to provide a record of your benefits, and acertain IF Medicare has made any advance payments..which is entirely possible...and the atty nor CA has taken the opportunity to even check.
    The sheer fact you are currently receiving SSDI is reason enough to check with SSA/CMS on the requirements.

    Ask you atty too, about who is going to pay the co-pays, and deductibles where you receive treatment though the setaside account...?
    The setaside money can ONLY be used for what 'Medicare would normally be responsible for'...
    Your attorney does NOT fully understand SSA/CMS/Medicare OR what is involved in a setaside account.

    Ask too... WHY have you not discussed a Structured Settlement...as the IRS provides this to create a tax free stream of income...for life...from the annuities...one for the PD indemnity, one for the setaside, and one for the Workers Compensation Medical Custodial Account... THAT is the account that pays the amounts the setaside cannot pay, and you should not be paying for treatment to your work injury...

    It appears there is SO much that has not been adequately addressed in your potential settlement. The atty is not looking out for your best interests.

    IF you go to the judge/hearing... you can ask these questions there, if front of the judge and see what the atty has to say...when you ask a question that begins with 'Why hasn't....?"...it will be interesting to hear the answer.

    "We went over that. It's all taken care of. Under $250,000 settlement, it is all purely voluntary. That is why we offered $47,000 as a voluntary set-aside. Keeps everyone happy."
    There is nothing 'voluntary' about any of this. Attys don't really like it when a IW make application for SSDI,... it takes much more effort and consentration to do a settlment...and it can also affect the fees paid to the atty.

    One other thing... CMS will determine how much money needs to be deposited in the setaside... IC's will attempt to pay the future medical in 'todays dollars'... they take a discount for paying the money up front...CMS will NOT allow for a commutation of the setaside money.
    I don't believe the $47K is enough for your medical... you're 58...life expectancy for a male now is around 80...so you have 22 years left...that leaves $2136 per YEAR for your medical needs...CMS is not about to approve that figure..based on what you say here...

    I am around your age.. neck injury... My setaside proposal includes a MRI each 5 years... PT 18/year, Ortho 1/year, Psych/pain management 12/year (that amounts to nearly 10K in 'todays dollars)....plus the $1800/month medication..
    Which by the way, CMS requires a seperate accounting of the Part D drug anticipation for the setaside...did the atty say anything about that ?

    You don't need to be ''scared to death''...but also, you don't need to settle this claim until you fully understand the concept...you are not being jeapordized in your benefits right now... so don't let this atty or anyone else try to 'force' you into signing a settlment agreement you don't like, or aren't sure your interests are covered.
    So far...it does not appear that they are...

    Keep reading...keep asking your questions...
    There is so much that hasn't been touched upon in your negotiations...

  10. #10
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    Default Re: Settlement?

    He may be looking at paragrahp 4 on the chart in your last link.

    I am around your age.. neck injury... My setaside proposal includes a MRI each 5 years... PT 18/year, Ortho 1/year, Psych/pain management 12/year (that amounts to nearly 10K in 'todays dollars)....plus the $1800/month medication..
    Which by the way, CMS requires a seperate accounting of the Part D drug anticipation for the setaside...did the atty say anything about that ?

    YIKES! I'm not nearly as messed up as that.
    May want some drug store Asprins from time to time is it.
    All I have now is check ups.
    RI passed a law about insurance companies can not operate in this state IF they have any "prior condition" clause in their contracts. There are some exceptions, but I meet all the minimum requirements. Mostly involves time laps between coverage.
    My private insurance can pick that up now.

    I'm gonna keep looking because it's interesting and still have questions generated by answers.

    Only the Goverment can make something so basicly simple and complicate the crap out of it.
    Last edited by Gary; 11-13-2008 at 09:37 PM.

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