Misconceptions about Liability MSA’s

Liability Medicare set-asides are defined as money taken from a liability or automobile accident settlement that can be used to pay future medical and prescription drug payments. These payments are allocated in order to prevent these charges from being reimbursable to Medicare. LMSA’s are often a source of confusion for many people. This is due in part to a lack of clarity on how they should be carried out. Unlike Workers’ Compensation Set-Asides, for which the Centers for Medicare and Medicaid Services (CMS) has provided a reference guide, policies on liability MSA’s are more vague. This can cause a great deal confusion for attorneys and their clients.

To provide clarity, we will tackle a couple of common misconceptions about set-asides, including those related to liability settlements.

False: Liability Settlements Don’t Need to Consider Medicare’s Interests as Workers’ Compensation Settlements Do

While there are more establish guidelines for worker’ compensation settlements and set-asides, it doesn’t mean that Medicare’s interests don’t have to be considered in liability cases. According to 42 U.S.C. §1395y(b)(2)(A)(ii), when a workers’ compensation plan, liability or automobile insurance, or no-fault insurance is in place, Medicare is not to make medical payments. With that said, it’s vital to keep Medicare’s interests in mind in these situations.

False: MSA’s Should be Used to Reimburse Conditional Medicare Payments Before a Settlement is in Place

MSA’s including LMSA’s should only be used after the settlement is in place. MSA’s are meant to be used to take the cost of future medical expenses away from Medicare after a settlement.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

TESTIMONIALS

"I just want to thank Synergy for their great work in getting a health insurance lien resolved. The health insurance company refused to reduce their lien a penny from a motorcycle accident involving my client who was not wearing a helmet, a fact that would have hurt our award in front of a jury. Synergy put tremendous pressure on this company, and after months of bombarding this insurance company with statutory requests and threats, they were able to get them to give in and reduce the lien significantly. The cost was minimal in relation to the hard work they put in, and the savings my client received. Client was very happy, and it allowed me to close out a case that I had resolved over 6 months before. Keep them in mind if you are dealing with a smug insurance adjuster who felt confident he would not have to reduce a lien, like I was dealing with. Thank you very much Synergy."

Jeffrey A. Adelman, Esq.
Adelman & Adelman, P.A.

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Michael J. Winer, Esq.
President Florida Workers Advocates (FWA)

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