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  1. #1
    Join Date
    Apr 2007
    Location
    Kansas
    Posts
    416

    Default Open Medical vs MSA

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

    I am scheduled to return to court Monday for a settlement conference.



    The settlement offers started Friday, Dec 17th. Told my attorney what I am willing to settle for. I could ask for a higher amount but with the offset with social security disability there really is no reason to as the offset (amount) would only increase.

    I only will settle with future medical, the insurance company said if medicare does not agree with the proposed MSA, they will keep my medical open.

    I didn't realize they could do open medical instead of a MSA.

    My task loss is 100%, with a whole body rating of 85% and combined at 92%.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Open Medical vs MSA

    CMS/Medicare doesn't control the ER/IC ability to continue liability for medical care.
    Only IF you change/close the medical in a WC claim must Medicare interests be protected.
    If the ER/IC does not agree with a MSC proposal as reviewed/approved by CMS... they can't be forced to fund a WCMSA.

    It is always in the best interests of the ER/IC to close out the medical in a WC claim.
    If you agree to a C&R that closes the medical care, you are agreeing to accept further liability for treatment out of your pocket. That is facilitated with the money you receive for FMC/Future Medical Care... the MSA is there to protect Medicare interests...it is entirely possibly for the IW to have out of pocket costs as well.

    You can use the MSA money ONLY for services MEdicare would normally be responsible for.
    That's why it is very important that the dollars be negotiated BEFORE the MSA proposal is submitted to CMS. There should be money for non-MSA as well as those dollars to fund the WCMSA.

    I don't remember if KS provides for life pension... meaning the indemnity benefits continue to life, or a predetermined number of weeks. But with anything less than 100% PTD/Permanent Total Disability as a final rating...you'll be capped at a number of weeks definite.
    If you negotiate a lump -sum payout... don't expect the full value of your indemnity. They may opt to pay in "todays dollars".
    I could ask for a higher amount but with the offset with social security disability there really is no reason to as the offset (amount) would only increase.
    That's not necessarily true. You ALWAYS go for and accept the highest dollars in any settlement.
    Depending on your own specific numbers...you may not have a offset at all.

  3. #3
    Join Date
    Oct 2006
    Posts
    9,076

    Default Re: Open Medical vs MSA

    it is not always in the carrier's best interest to payout more then they would be liable for if there was no settlement.

    kansas has limits:

    Total amount payable is $100,000 for a work disability and $50,000 for a functional disability. WC
    benefits subject to UI and Social Security benefit offsets.
    Maximum period for an unscheduled injury is 415 weeks.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Open Medical vs MSA

    it is not always in the carrier's best interest to payout more then they would be liable for if there was no settlement.
    That's not what I said.... easy for you to twist it.
    The fact remains however, it is always in the best interest of the ER/IC to close out the medical in any claim.
    There is no way to tell what the liability might be with out a settlement, your statement makes no sense. Unless of course the carrier/CA has .SH "esp"...

    Where an IW triggers the need for WCMSA, at the very least, the carrier relieves itself of the administrative costs in continuing to cover the medical in an open claim, shifting that to the IW. The cost of continuing to delay/deny medical care is worth bucks to the IC. Not to mention the release of reserve dollars.

  5. #5
    Join Date
    Apr 2007
    Location
    Kansas
    Posts
    416

    Default Re: Open Medical vs MSA

    In Kansas total perm disabled is $125,000, according to my attorney few qualify for this amount.

    According to the IME doctor I am totally perm disabled and will not return to work.

  6. #6
    Join Date
    Oct 2006
    Posts
    9,076

    Default Re: Open Medical vs MSA

    yes, permanent total pays more then permanent partial.

  7. #7
    Join Date
    Apr 2007
    Location
    Kansas
    Posts
    416

    Default Re: Open Medical vs MSA

    I thought I would give an update to this thread.

    A settlement agreement was reached Janurary 5th, 2011.

    In the past the insurance company & their attorney have made a number of threats on the conditions of settlement. One was having me sign a statement as a condition of settlement saying the need for the knee replacement was not related to the work injury. Nothing was in the settlement paper work, my attorney checked and rechecked the documents.

    The settlement agreement says I will receive open medical if CMS does not approve the MSA. My attorney says CMS will not approve the MSA as it is written, it was only for a total of $4,000.00. He said open medical is a better deal for me.

    The settlement amount was not the max allowed in my state, but if was a fair amount and I am happy with it.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,941

    Default Re: Open Medical vs MSA

    That would be true...if the carrier is not happy with CMS decision on the MSA, and they will provide the figures to what they want to see to protect Medicare interests... you can't force them to fund the WCMSA.
    They are free to leave the medical open, subject to the same procedures you face now.

    The settlement amount was not the max allowed in my state, but if was a fair amount and I am happy with it.
    That's because when you take a lump sum vs the weekly benefits, they commute the money to "todays dollars". If you depost that in a interest bearing account, you'd be likely earning over time the full amount of the indemnity due based on your PD rating. Minus the atty fees of course.

    As long as you are happy, thats all that counts. IMHO... if you require additional medical care, you are much better with open medical vs the MSA.

  9. #9
    Join Date
    Apr 2007
    Location
    Kansas
    Posts
    416

    Default Re: Open Medical vs MSA

    Thank you BvIA.

    I likely will require future medical.

    The right knee was rated 75% after the replacement. I received a 10% rating on the other knee, a TKR will be needed in the future on this knee.
    I was rated 10% whole body for the lumbar spine.

    I have a task loss of 85% and wage loss of 100%, combined at 92.5%

  10. #10
    Join Date
    Jan 2012
    Location
    Joliet IL
    Posts
    2

    Default Re: Open Medical vs MSA

    Just to clarify my interpretation, it is possible to settle your claim with the medical left open? You can still receive the indemnity portion, without agreeing to close the medical?

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