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  1. #1
    Join Date
    Aug 2015
    Posts
    9

    Default MSA Amount is More Than the Insurance Company Approved

    My workers compensation claim was made in the State of: MI. my MSA came back from CMS approved, but it is way higher than the insurance company proposed. what happens next??? and also the approval took almost 3 years to get. And now that we have it, we are supposed to be settling part 2 redemption and because it was so high the insurance company is playing games. REALLY FRUSTRATING. anyone with some suggestions would be appreciated......

  2. #2
    Join Date
    Aug 2015
    Posts
    9

    Default MSA

    My workers compensation claim was made in the State of: mi. Has anyone's MSA, came back higher and if so how has it handled????

  3. #3
    Join Date
    May 2010
    Posts
    641

    Default Re: MSA

    Quote Quoting otk View Post
    My workers compensation claim was made in the State of: mi. Has anyone's MSA, came back higher and if so how has it handled????
    Yes many of us have had shocking higher ones....

    Mine was guessed at 75k....ended up at 152k.....Wow was I shocked!

  4. #4
    Join Date
    Aug 2015
    Posts
    9

    Default Re: MSA

    yeah, they said mine was 23k and came back at 458k. insurance company tried to sneak it through CMS at a low ball figure....

  5. #5
    Join Date
    Mar 2010
    Location
    chicago
    Posts
    517

    Default Re: MSA

    yea mine was higher im sure the ic tries to pull a sneak medicare reviews them. they even game an itemized finding of how the money upgrade was figured out

  6. #6
    Join Date
    Aug 2015
    Posts
    9

    Default MSA

    My workers compensation claim was made in the State of: MI. if the insurance company doesn't fund the CMS approved MSA, what happens? does MEDICARE keep covering you until the MSA is funded ???

  7. #7
    Join Date
    Oct 1971
    Posts
    5,243

    Default Re: MSA

    Quote Quoting otk View Post
    My workers compensation claim was made in the State of: MI. if the insurance company doesn't fund the CMS approved MSA, what happens? does MEDICARE keep covering you until the MSA is funded ???
    Your case doesn't settle, the insurance continues to pay weekly benefits and medical until you either recover 100%, return to work or die.
    They could settle the indemnity side and leave the medical open, that probably won't happen.

    Medicare will not cover any medical associated with a work related injury until there is an MSA setup and exhausted.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  8. #8
    Join Date
    Aug 2015
    Posts
    9

    Default Re: MSA

    HI Tony, I did settle the wage loss portion, but it was a two part redemption. they held a portion of my money back, until they got the CMS approval. Now that we have the MSA approved, they don't want to fund it because it came back a lot higher than they proposed. So will Medicare keep covering me until the MSA is funded. They also are playing games with the money they held back.........

  9. #9
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,823

    Default Re: MSA

    No, because until you settle the medical on your claim, the comp carrier is still on the hook for it. Which means that Medicare is not.

    And it means that if Medicare pays any meds on your comp injury before you settle the medical, then someone---possibly you personally----- will have to reimburse Medicare out of pocket.
    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 and Board Certified Specialist in NC Workers' Compensation Law

  10. #10
    Join Date
    Aug 2015
    Posts
    9

    Default Re: MSA

    HI complwyr, Why would you say me. its not my fault the insurance company took almost three years to get the paperwork to CMS. We protected MEDICARE in my settlement proposal, that the insurance company agreed to also.

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