The Garretson Firm Resolution Group offers Medicare Set Aside services when settlements demand an analysis and "set aside" of the injury-related cost of care (treatment and medications) that Medicare would otherwise cover.

An MSA is a fund created in the settlement of a Workers' Compensation or liability case. It is established from a portion of the settlement amount that is to be used to pay for future medical expenses related to the job injury/illness that would otherwise be payable by Medicare. Funds must be established in insured accounts and may be managed by the claimant or set up in a custodial account.

In 1981 the Medicare Secondary Payer statute established that Medicare was to be a secondary benefit payer behind the responsible parties for Workers' Compensation claims. However, many claimants who were unaware of this statute received insurance company medical settlements and filed claims with Medicare, which was a violation of the statute. Medicare realized it was spending billions of dollars annually in claims it should not be paying. As a result, in July 2001, the Centers for Medicare and Medicaid Services, (CMS) declared that funds for future medical expenses be set aside in Medicare Set-Aside accounts for certain Workers' Compensation settlements. Failure to do so may result in CMS refusing Medicare coverage for all future medical treatments of claimant. Liability exposure exists with employers, insurance companies or Third Party Administrators if Medicare is not properly taken into consideration at time of settlement.

1. When the injured worker's settlement includes payment for future medical care.

1. If the injured/ill worker is at the time of settlement currently on Medicare and the total settlement value is over $25,000.
2. If the total settlement value is over $250,000 and the injured worker is reasonably expected to become entitled to Medicare within 30 months.

1. When the plaintiff is on Medicare and the plaintiff's settlement includes payment for future medical care.

The Resolution Group will assist in case evaluation to determine the necessity of a Medicare Set Aside.

Simply provide us with the following:

1. Completed Case Intake Sheet (PDF)
2. CMS release (PDF), Social Security release (PDF), HIPAA release (PDF)
3. Last 3 years of medical records & supporting documents
4. Last 3 years of medical & indemnity payouts, and pharmacy summary
5. Any medical documents stating Maximum Medical Improvement

Please contact our office for more information on the services and fees associated with Medicare Set Asides.