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Considering Medicare’s Interests When Settling Your Workers’ Compensation Claim

Jay Johnson

Medicare and Workers' Comp

Medicare’s Interests and Your Workers’ Comp Claim

If you have a pending workers’ compensation claim and are a Medicare recipient or believe that you will be eligible for Medicare within 30 months from the date of your workers’ compensation settlement, you must consider Medicare’s interests when you settle your case.  This is true because Medicare does not want to pay for treatment that you may need in the future because of the work injury.  If you do not consider Medicare’s interests, you may jeopardize your future Medicare benefits for any medical care that you may need in the future.

There are three ways to consider Medicare’s interests if you have an open workers’ compensation claim.  You may settle your case and agree to keep your medical rights open.  If you settle your case in this matter, your workers’ compensation carrier would still have to pay for any future treatment that you need because of the work injury.  Most insurance companies do not want to settle a case this way because they want cases closed and off their books.

The second way to consider Medicare’s interests is to have your workers’ compensation case tried by the Arbitrator.  If the Arbitrator finds in your favor, your medical rights remain open as a matter of law in Illinois.  The workers’ compensation insurance company still would be responsible to pay for any future medical care that you would need.

The last way to consider Medicare’s interests is to settle your case with a Medicare Set-Aside account (MSA) included as part of that settlement.  An MSA is a special account that you create with funds from your settlement to pay for future treatment that you may need as a result of your work injury.  There are special rules to follow when setting up the account, using money from the account, and reporting the status of your account to Medicare.  The account must be interest-bearing.  The account must be segregated from all other money that you have.  The money in the account can be used to pay for treatment you need in the future because of the work injury only.  You cannot use it for any other purpose.  You must send in a yearly accounting to Medicare.

The amount of the Medicare Set-Aside account varies from case to case.  Typically, insurance companies hire an outside vender to do a price analysis tailored to your injury.  The amount of the MSA typically is in addition to any money that you get to compensate you for your permanent injuries caused by your workplace injury.

Settling your workers’ compensation case while you are eligible or about to be eligible for Medicare is a tricky proposition.  Consult an attorney to make sure that your rights are protected.

And of course, if you have any questions about Illinois Workers’ Compensation or injury law, call us any time at (866) 400-4450 or fill out our contact form. It’s free, it’s confidential and we cover all of Illinois. Workers Compensation Attorney Chicago, Aurora, and Champaign.

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