Medicare Beneficiaries Expected to Take the Federal Government’s Interests Into Account When Settling Injury Cases

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CMS requires those injured on the job and receiving workers’ comp benefits to set aside money for future medical care if they are also receiving Medicare benefits. Abrams Landau, Ltd. believes all claimants — including personal injury plaintiffs — should be aware of how federal benefits like Medicare will impact any settlements, even in the absence of a similar CMS rule regarding car crash, slip and fall, and other injury cases.

Workers’ Compensation recipients who settled their cases since 2001 have had to set aside money and/or make provisions for future medical care payments if they have also been receiving Federal Medicare benefits.

In the context of an on-the-job injury or disease claim, when a workers’ comp claimant settled their claim, and the settlement included money for future medical care, the government wanted to make sure its own interests were taken into account and that the Feds were not left “holding the bag.”

In other words, if the injured worker was receiving Medicare benefits (or would soon be getting these Federal benefits), then they could not simply pocket the cash and expect the government to pay for medical care for the workplace accident that was the subject of a Workers’ Compensation Commission AWARD Order.

The Center for Medicare Services (“CMS”) proposed rules for requiring the same protocols in car crash, trip and fall, and other accidental injury cases.

The American Association for Justice (“AAJ”) lobbied hard against the proposed rule which was issued in June 2012. The rule would have reduced access to civil justice for Medicare beneficiaries and would have left them without the benefit of Medicare coverage when they are sick or dying.   CMS has withdrawn the rule from review.

This means there currently is no future medical rule pending for negligence cases.

However, it is still important to consider future medical needs when settling any kind of injury case, and to talk with clients about coordination of benefits issues. Evidence tends to suggest that injured victims can still experience a denial of future injury-related care with or without formal regulations. Medicare has issued guidance in the past in the form of memos. It is all policy-memorandum driven.

Until CMS comes out publicly and says that injured victims do not have to worry about any of this, at Abrams Landau, Ltd. we will continue to be concerned about clients who are Medicare beneficiaries and receive settlement money towards future medicals.

According to personal injury lawyer Doug Landau, “We think it may not be a good idea for an injured plaintiff to “pocket” the settlement and then expect the government to pay for all of his or her future accident-related medical care needs.  In the “new reality” of government cut backs and austerity, we just do not think this is a viable option. At ABRAMS LANDAU, Ltd., we consult with our clients to understand what issues they are facing. We also try to advise in the context of personal injury law (or recommend outside legal counsel for other areas of legal advice such as lien negotiation or future long term disability or employment issues). And lastly, we ask that clients document their interactions with the Social Security Administration, CMS, and others who have an interest in the outcome of their accident and disability cases.”

If you or someone you know have been injured and there are questions as to how a settlement may interact with your Medicare benefits email or call Abrams Landau, Ltd. at once (703-796-9555).