Sacramento, CA asked in Workers' Compensation for California

Q: Can you get a lump sum from workmens comp instead of medicare set a side for the rest of your living life.

Related Topics:
2 Lawyer Answers
Erin Gallivan
Erin Gallivan
Answered
  • Workers' Compensation Lawyer
  • Rutland, VT

A: If you eligible for Medicare or SSDI and your settlement is above $25,000, Mediare has laws saying that any payment for future medical bills for a workers comp injury must be paid into a Medicare Set Aside trust and not paid to the claimant directly in a settlement. Other money that is not for future medical bills can be paid in a lump sum to the Claimant.

Nancy J. Wallace
Nancy J. Wallace
Answered
  • Workers' Compensation Lawyer
  • Grand Terrace, CA
  • Licensed in California

A: A Lump Sum INSTEAD OF the Medicare Set-Aside?? No, that is an 'either/or" choice.

IF you are getting Medicare or Social Security, and you want a 'divorce' from the Comp Insurer for that Lump Sum ending to the case, there's going to be a Medicare Set-Aside (MSA).

The insurer wants an MSA to protect itself from the Social Security Administration in the coming years... rules say it's only for settlements above $25,000 but most insurers want the MSA for any Medicare recipient.

You cannot choose between a Medicare SEt-Aside or a Lump Sum because the MSA IS PART OF the Lump Sum settlement process.

You MAY CHOOSE between Stipulations that keep Future Medical open (no set-aside required!), or a Compromise & Release which closes Future Medical (set-aside required for Medicare folks).

IF YOU SETTLE with the Stipulations With Request For Award, it's sort of a marriage! You and the Comp Insurer are joined together to tangle over each Future Medical Treatment decision for life. Medicare stays out of this relationship*.

IF YOU SETTLE with the Compromise & RElease AGreement, it's a divorce. The Comp Insurer is buying your Future Medical rights from you for cash.

So, when Medicare is about to be paying your medical bills, Medicare wants a piece of that cash.

The piece of that Future Medical cash = Medicare Set-Aside (MSA).

Hope that clears it up a bit for you!

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.