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  1. #1
    Join Date
    Feb 2016
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    2

    Default How to File a Complaint Against a WCMSA Manager

    I have been trying to file a complaint against the company managing my Workers Compensation Medicare Set-Aside Account for years. I have contacted the Department of Justice, Better Business Bureau and Medicare. Everybody tells me there is nothing they can do to this company. The manager of my WCMSA is in Florida and according to my settlement they are to send me quarterly statements for my account. They do not do this, I only get a statement at tax time and that is always late. They underpaid my former doctor and I ended up being sued for over $100k. This was after I sent them letters requesting verification that they were paying him the correct amount. They finally admitted to making a mistake after the lawsuit was started against me. They also sent a letter to Medicare stating that I was deceased which ended up causing some confusion. My settlement states that the only way I can gain control of my WCMSA is by them relinquishing control of my account or the insurance company turning control over to me. The insurance company wants no part of all this and the manager of the account enjoys being paid for doing next to nothing. I have considered hiring an attorney but I already spent a considerable amount of money on an attorney when I was sued by my former doctor. Any suggestions would be greatly appreciated.

  2. #2
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: How to File a Complaint Against Wcmsa Manager

    I have been trying to file a complaint against the company managing my Workers Compensation Medicare Set-Aside Account for years.
    Who arranged this deal, do you have a lawyer?
    Is this a custodial or a Medicare Set Aside trust (“MSAT”) agreement?
    Unless you set this up in a trust agreement, you may have problems.

    Here's a good blog on this topic, below is an excerpt.

    Most professional administrators of set asides provide the service through a custodial arrangement. These custodial arrangements are contractual agreements and don’t create the same level of fiduciary obligation on the part of the administrator as is possible with a trust. One problem with a custodial set up is the protection afforded to the monies in the event of a bankruptcy of the set aside custodian. Would the funds be lost? Would the funds be exposed to bankruptcy creditor claims? Before entering into a custodial arrangement, you as counsel for the injury victim, should investigate the financial security of the custodian; status of bond or insurance on performance as custodian; whether the injury victim’s MSA funds will be fully insured; past performance of investments and whether there is any history of legal or financial problems related to set aside administration.

    A better alternative, in my opinion, is the creation of a Medicare Set Aside trust (“MSAT”) agreement. An MSAT is a formal trust agreement administered by a corporate trustee typically paired with a professional Medicare Set Aside administrator. With an MSAT, you get a trustee that has a fiduciary duty paired with a set aside administrator who can handle the intricacies of managing set aside funds and reporting to CMS. If the trustee or administrator can no longer perform their duties, a new trustee or administrator may be appointed but the fidicuciary obligations and creditor protections of the trust remain. Trusts are covered by state trust and fiduciary laws. Typically custodians don’t need any type of licensure whereas trust companies or banks do, which is another layer of protection for the injury victim’s funds.

    Medicare Set Asides – How are they Administered?
    http://www.specialneedsfirm.com/post-detail.php?id=159

    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.

  3. #3
    Join Date
    Feb 2016
    Posts
    2

    Default Re: How to File a Complaint Against Wcmsa Manager

    Hi Tony, Thanks for responding. This was set up as a custodial MSA. I had an attorney when I was on workers compensation and settled with my former employer. I was injured in 1996 and settled in 2006. The attorney that represented me during this time was great in the beginning of my case but when it came time to settle, he pushed me into a settlement that I did not want. I had 2 lumbar surgeries and 1 fusion before we settled. I know for a fact that my attorney did no investigative work concerning the MSA management company. I had considered suing the manager of my MSA when I had been sued by my former pain doctor. The attorney that represented me at this time told me it wasn't worth it, even though they did admit to not paying the doctor the correct amount. The blog you sent me states that the professional manager must make sure that the set aside pays at the proper rate. The manager paid the doctor according to Florida worker comp laws, where their office is, and not Wisconsin, where I reside. The Department of Justice told me that since the manager was not an insurance company there was nothing they could do. I do have to say that the individual that helped me was fantastic. He spent a lot of time researching this and contacted me quite often. I just don't know what to do next, other than hiring another attorney. I spent a considerable amount of money on attorney fees when I was sued.

    Carl

  4. #4
    Join Date
    Oct 1971
    Posts
    5,193

    Default Re: How to File a Complaint Against Wcmsa Manager

    I believe this arrangement is voluntary on your part.
    The money in this MSA belongs to you - you have every right to control who manages it.

    You have a right to terminate this agreement and self manage or reassign a new manager of your MSA at any time.
    This comes down to contract law, it has zero to do with the MSA.
    If you can, contact the attorney who arranged this deal and ask for his assistance in terminating this contract otherwise proceed on your own.

    Look at your Custodial Agreement and Disclosure Statement. (your contract with this manager)
    Some where in there, there should be a section concerning "Termination of Agreement, Resignation, or Removal of the Custodian."
    Read, understand and apply the rules as stated.

    I believe you just have to notify them in writing that you wish to terminate the contract and it should be a done deal.
    They have a right to bill you for any costs associated with terminating the agreement.
    If they refuse to comply, hire an attorney.

    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.

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