Settling Your Workers’ Compensation Claim Before Medicare Eligibility

Understanding the Timing of Settlement

The decision of whether to settle your workers’ compensation claim before becoming eligible for Medicare depends largely on timing. It is important not to settle or close your claim until you are prepared to forego further medical treatment or have other means of receiving care outside the workers’ compensation system. If you are already a Medicare recipient or expect to enroll within the next 30 months, the specifics of your claim may require obtaining a Medicare Set Aside (MSA) before you can settle for a lump sum payment.

What Is a Medicare Set Aside?

A Medicare Set Aside involves a comprehensive review of your medical records, current treatment plans, and anticipated future treatments conducted by a third-party company. This review results in a monetary amount that designates a portion of your settlement funds specifically for future medical care. In some situations, the MSA must be submitted to the Centers for Medicare & Medicaid Services (CMS) for final approval. Regardless of the case, you must exhaust the funds in the MSA before Medicare covers any medical expenses related to your work injury. Once these funds are depleted, you may then use Medicare for those treatments.

Benefits of Settling Before Medicare Eligibility

Typically, it is advisable to settle your case before Medicare becomes involved. The process of securing a Medicare Set Aside and awaiting CMS approval can take several months or longer, which may delay your ability to receive a lump sum settlement. Additionally, the MSA can sometimes present a significant obstacle to settlement if the insurance carrier believes the required amount is too high, potentially leading them to keep the case open and refrain from making settlement offers.

The Importance of Experienced Legal Guidance

It is essential to have an attorney who is knowledgeable about the complexities of the Florida Workers’ Compensation system and the frequently changing requirements surrounding Medicare Set Asides. Mr. Masnikoff has spent twenty-seven years advocating for Floridians injured on the job, ensuring they receive the benefits and financial compensation they deserve.

Contact Us for Guidance

If you or a loved one has questions about your rights under Florida’s workers’ compensation law or the value of your case, we encourage you to contact us. We offer free consultations and practice throughout Florida. You can reach any of our offices at (561) 598-7120(561) 598-7120.