Synergy Blog

AAJ Announces that Regulations Regarding Medicare Set Asides are Coming

From the AAJ’s CEO:

Dear AAJ Members,

As you may have heard, the Centers for Medicare & Medicaid Services (CMS) will likely be moving forward with the process of developing new regulations that will address payment of future medical costs in liability cases. At this point, we anticipate that CMS will issue a Notice on Proposed Rulemaking sometime before the end of the year. Currently CMS has guidance in place on how to treat future medical expenses in workers’ compensation cases. There has never been similar guidance or regulations regarding liability cases.

In June, 2012, CMS issued an Advanced Notice on Proposed Rulemaking (ANPRM) that proposed regulations to govern how and when an injured individual who receives a judgment, settlement, or award would need to pay for any future medical care needed as a result of the accident, illness, or injury in question. AAJ filed lengthy comments in opposition to the ANPRM stating that:

“requiring payment for future medical care from liability settlements is far too attenuated, has an inequitable impact on Medicare beneficiaries, in particular severely sick or injured beneficiaries, and also has a chilling effect on the ability of parties to bring and settle liability claims.”

AAJ remains in opposition to rules governing payment for future medical care in liability cases. As the process continues, and in order to achieve the best advocacy for members of the American Association for Justice, we will establish an advisory committee that will provide substantive input into the new CMS proposal. AAJ Vice President Larry Tawwater has volunteered to lead this committee.

When CMS issues this expected Notice on Proposed Rulemaking, there will be a comment period during which interested stakeholders can comment on the substance of the proposed rule. CMS then must review those comments before any rule can be finalized and become effective.

If you have questions concerning this issue please email

We will continue our strong advocacy in this arena. We know it is of utmost importance to you and your clients.

Best Regards,


Linda A. Lipsen
American Association for Justice


Synergy’s team makes it easy to deal with all of the issues we hate at the end of the case. Dealing with Medicare, ERISA liens, keeping eligibility intact for Medicaid and complicated planning for the client’s recovery. The experts we work with regularly at Synergy do a great job of making sure I am protected as are my clients.

J. Clancey Bounds
Bounds Law Group

"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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