Atlanta, GA asked in Workers' Compensation for Illinois

Q: How long does it take to set up a WCMSA with medicare? Will it take months before I know something?

Related Topics:
1 Lawyer Answer
Charles Candiano
Charles Candiano
  • Workers' Compensation Lawyer
  • Chicago, IL
  • Licensed in Illinois

A: If the question you mean to ask is how long does it take to get approval for an MSA, the answer is that it depends how you go about it. If you have the ability and resources to do it yourself, it is possible to get approval in 45 to 60 days. If you use a third-party provider, it could take 6 to 9 months. You also need to understand that if inaccurate or incomplete medical records are provided to CMS, they may request an MSA that is higher than the Respondent is willing to pay. When that happens, the Respondent may need to supply more records or even have the Petitioner re-examined for Dr. to make the specific finding necessary to satisfy CMS. As you can see, when this is necessary, it could easily add several months to the timeframe. That said, this should not be of any concern to you because it is possible to settle the case where the Respondent agrees to be responsible for funding an MSA as ordered by CMS. You don't own the MSA and you cannot spend the money on anything other than care related to your injury that is approved by Medicare and bill that Medicare's rates. If you use the money for any other purpose, Medicare will become aware of that fact in an annual audit and your Medicare benefits will be suspended until the benefits that Medicare would otherwise be obligated to pay exceed the shortfall in your MSA.

All of this is to say that the terms of an MSA should be between your attorney and the Respondent's attorney and CMS. You don't have any say in it. If the MSA is to be self-administered, you would receive instructions but the logistics of funding it really have nothing whatever to do with you or your settlement.

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.