New Medicare Set-Aside Rules Could Affect Workers’ Comp Claims

The Centers for Medicare and Medicaid Services (CMS) are considering whether to issue new rules for Medicare set-asides in liability claims. Some experts opine that the new rules will affect workers’ compensation claims by making it more difficult to settle claims.

How Do Set Asides Impact Workers’ Comp Claims?

When a worker is injured on the job and the settlement includes future medical expenses, the settlement need to “set aside” funds to pay future medical expenses related to the injury that would have been paid by Medicare.

Currently, CMS has a voluntary approval process for Medicare set-asides used to pay future medical costs for Medicare beneficiaries who settle workers comp claims for less than $25,000. Review and approval is mandatory, however, for worker’s compensation settlements when the claimant is already eligible for Medicare or will be eligible for Medicare within 30 months of the settlement date and the total value of the settlement is greater than $25,000.

Failing to submit cases for review when they meet the current requirements means that the injured will likely be denied future Medicare coverage for work-related medical expenses.

Affects of the Proposed Rule Change

The proposed new rules would change the current process from voluntary for claims less than $25,000 to mandatory. A move that some experts think will increase the time and costs needed to settle these cases.

If you are injured at work, you may be eligible to receive workers’ compensation benefits. Obtaining the workers’ compensation benefits you are entitled to receive is not an easy task. An experienced worker’s compensation attorney is recommended to guide you through the process.

Source: Business Insurance, “New Medicare set-aside rules could impact workers’ compensation,” Sheena Harrison, July 29, 2012.