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  1. #21
    Join Date
    Oct 1971
    Posts
    5,299

    Default Re: MSA Self Administer or Professional Administrator

    jerry68
    Best thing for anyone to do if they get hurt at work is to not say anything and get your treatment through your own insurance and not get mixed up in this vicious circle.
    That's called fraud, also private insurance won't pay for a work related injury.
    Also, who's going to pay wage loss?

    The best thing to do is inform the employer at the time of the injury, afford them the opportunity to provide treatment and pay wage losses if necessary.
    At the first sign of problems, don't argue with the employer or carrier and lawyer up - follow your lawyer's advice and keep your mouth shut.

    I rewrote the addendum myself and deleted "check" and only put in wire transfers.
    Wire it to what account - did you already set up a Medicare Set Aside account?
    The carrier doesn't have to agree to anything but the original agreement approved by the commission, any changes made without their approval or your lawyer's knowledge could void the entire agreement.

    The norm is they mail you a check - you then open an interest-bearing checking account named Medicare Set Aside and deposit the check into that account.
    You should be going through your lawyer to make any changes, you chance screwing up everything.

    I think they were trying to get one over and would be able to say we sent the check, if you didn't get it well sorry!.
    They could say the same thing about a direct deposit or wire - we sent it, if you didn't get it sorry.
    This scam would never fly nor would they be stupid enough to try it

    All you'd have to do is ask for a copy of the cashed check.
    This stuff is done with oversight - Their bank would have a record of the cashed check with your signature on the back to prove they fulfilled their obligation. Plus they send it certified mail - meaning you'd have to sign for it.

    If the check was lost the postal service could trace. If you notify the carrier or your attorney you didn't get the check they would check their bank records to verify then void it and issue another one, they can't pull that scam if they wanted to.
    In the past 25 years I've never heard of one case of them trying such a stupid stunt - they'd never get away with it due to the paper trail.

    Tony
    Last edited by tony; 09-16-2022 at 09:29 AM.
    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.

  2. #22
    Join Date
    Feb 2007
    Location
    831 East Morehead St., Ste 355, Charlotte, NC 28202
    Posts
    3,831

    Default Re: MSA Self Administer or Professional Administrator

    I am familiar with Ametros. They are excellent. I personally know a lot of the people there, and they are good people. They can keep you out of trouble with Medicare. I recommend them to my clients frequently. Most injured workers have a hard time doing the annual MSA paperwork for Medicare.

    Ametros will do all that for you and do it right and yo will not have to worry about screwing it up and getting into a mess with Medicare (the Federal government).
    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

  3. #23
    Join Date
    Jun 2022
    Posts
    34

    Default Re: MSA Self Administer or Professional Administrator

    There was no agreement with the carrier at all about how the funds would be given to me. And the commission did'nt say it either, Just said there would be a set aside. Everything was done and agreed upon and then the carrier wrote the addendum which was different than the original agreement. My lawyer said it wasn't a big deal so I told her it was to me and I needed to be protected and the wording wasn't accurate.

    Thanks! the ametros has different options to choose from and most seemed really good, but the one they were putting me in was similar to WC in that I had to pay out of my bank account and send them receipts to be paid back from the Ametros account. I just didn't want that again. I asked for the option of having a debit card through them but the carrier say no.

  4. #24
    Join Date
    Oct 1971
    Posts
    5,299

    Default Re: MSA Self Administer or Professional Administrator

    My lawyer said it wasn't a big deal so I told her it was to me and I needed to be protected and the wording wasn't accurate.
    Before you change documents or go against your attorney's advice, it might be a good idea to know what you're talking about.
    These people handle hundreds of cases a day, they have to go by the law, not by what you want - here's a few facts to clear things up.

    I rewrote the addendum myself and deleted "check" and only put in wire transfers
    They can't wire transfer to an account that doesn't yet exist - They first have to issue a check - you then have to open an interest-bearing checking account named Medicare Set Aside and deposit the check into that account.

    in that I had to pay out of my bank account and send them receipts to be paid back from the Ametros account.
    I asked for the option of having a debit card through them but the carrier say no.
    That's not how it works, they don't give debit cards - you'll receive a CareGuard insurance card to use when you go to the doctors.
    Read the below.

    How Ametros can help
    Technical Answer: Ametros’ service, CareGuard, helps individuals manage and make the most of their settlement funds. CareGuard is a full professional administration service, where we take care of everything for
    the injured party. The MSA funds are placed in an interest-bearing account under the injured party’s name,
    and we act as the custodian of the account.

    The injured party receives a CareGuard card that works like a traditional insurance card, and by showing it
    at doctors or pharmacies, it automatically ensures that the injured party will receive maximum discounts
    through our group purchasing discounts, and all the bills will be sent to us. We pay all the bills on behalf of
    the injured party and ensure 100% compliance with Medicare by completing all required reporting.
    With CareGuard, the injured party can treat with any doctor or pharmacy that they would like to without
    undergoing any utilization review. In addition, CareGuard has a team of Care Advocates that provide the
    injured parties with 24/7 support to help coordinate their care
    https://ametros.com/wp-content/uploa...8/MSA-FAQs.pdf

    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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