The Official Medicare Set Aside Blog And Information Resource: Recent Comments

Comment on WCRC Contract out to bid

2010-03-04T18:04:22Z

Gould and Lamb has submitted a bid!!

Comment on CMS Wins Again

2010-03-03T20:55:12Z

I really just wanted to comment on this articles Option 5-Sue in Federal Court. I did have a successful #3 (Challenge through re-evaluation) which being conducted as we exchange blogged commentary. Item #4 is moot, as I do not believe for a split second that CMS is the actual culprit in the never ending delays and refusals of reaching a settlement. (SPECIFICALLY HOWEVER) on a WC Case with umbilical cord to the states (SIF), and ultimately Medicare's full interests.

Just to exclude the obvious, SIF DOES NOT under any circumstance provide relief for medical payments past current or future of any kind. What they can provide the Respondent however, is a determination (which can be argued later) that will provide an "impression" of a pre-existing injury (disability) to the work related injury, which in most cases, shall release the Respondent from the complete 100% PTD caused by the injury and post injury behavior of the Respondent.

The Respondent's Counsel is fully aware that the delays they produce appear to be costing their client's large amounts of financial losses. The truth, if the Respondent's Counsel could prevail in a full trial, why not have at it? The first reason is simply, THEY MAY LOSE. The second reason, the Respondent's legal strategies to delay settlement could indeed cost their clients (possibly) hundreds of thousands while the clock ticks on. The advantage is that Respondent's Counsel can convince their own client that by waiting the maximum statute of the particular States maximum timeline, the Respondent's client gets a "frozen in time and amount" future MSA lump sum figure. They pay the lump sum, they pay the indemnity due the Petitioner's lifetime, conditional re-payments, expenses, outstanding invoices etcetera (which they already know they own). But MED FOR LIFE is bought out by the WCMSA Approval, four or five years old, but frozen at the submission date formulary prices. The injured worker wants to close the case PERIOD. They accept a seemingly large lump sum indemnity payment, the medical bills they believe covered under Medicare Part D coverage. So they take the offer and their own Counsel presents it as a strong and fairly accepted DEMAND.

The checks begin to flow, the Respondent has been getting paid all along, saving decades worth of medical treatment and RX costs. Petitioner's Counsel gets 20% of a nice chunk of cash plus expenses. Everything seems fine until that LUMP SUM RX check is exhausted. Then yearly deductibles show up at the party, donut holes boogie right in, RX costs continuing to rise.

The Respondent is now fully FREE & CLEAR of any medical costs, and utilizing his/her part D begins the TrOOP until they die. and the petitioner still hasn't realized, Counsel has sold him out, and has been paid for same.

I have a made "prima facie" WC Case. I have a WCMSA Approval. I am way past Option 5, and it is NOT CMS. It's the DWC/Respondent arbitrary actions causing 100% PTD, I'm ready to sue. Are You?

Comment on Do I have to deal with the MSP?

2010-01-25T23:32:54Z

I'm glad to see that in discussing "exposures" -- which are important for toxic tort cases -- you are emphasizing the "released" part of the equation. From what we're hearing from our national clients, a lot of lawyers are telling corporate America that there is no reporting or obligation if the exposure was all before 12/5/80, and that isn't what CMS is saying. Can you imagine a company settling a large exposure case and NOT getting a release for all exposures, whenever they occurred? Seems to me that so long as this is the scope of the release, it includes exposures after the cut-off, and there's a potential need to report. And if the plaintiff's attorney broadly alleges exposure in the complaint, even if there is no way really that any exposure took place after 12/5/80, then it seems likely there is an obligation to report.

Comment on Do I have to deal with the MSP?

2010-01-24T20:41:42Z

Emigrating to Europe, how to administer Medicare Set Aside to pay for private treatment overseas. Multiple injury case, definite future surgeries and care needed. Not intending to reside in U.S. again, eligible but will not use Medicare. How would MEDVAL administer MSA? Cost? Annual reporting method?

Comment on Predictions for 2010

2010-01-21T21:57:18Z

Jim:

My apologies if you were offended. I enjoy poking fun at my competitors, CMS and humorless attorneys that have recently decided to enter into the Medicare Set-Aside business. Those that know me understand there is no malice intended (except maybe as it pertains to CMS and some of their outrageous policies). The tone is tongue and cheek as you suggest.

-Ryan

Comment on Predictions for 2010

2010-01-21T21:56:38Z

I know at least 8 of the 10 to be true already. The other two are just very likely.

Comment on Predictions for 2010

2010-01-21T20:10:24Z

Your predictions for 2010 are in bad taste. A lttle self editing would have been a good thing. You do better by providing excellent service to your customers than by poor mouthing the competition. Even if intended as "tongue in cheek," that tone doesn't translate in a blog.

Comment on Interesting call

2010-01-14T23:52:46Z

Future MSA considerations BEFORE you accept settlement

Comment on Interesting call

2010-01-14T23:47:26Z

It is exactly the point of why a Respondent's Counsel uses the strategy. The future MSA has a defined and specific cost (set aside assigned to it) it is based solely upon the future MSA when the proposal was submitted, and exactly the reason these claims last into 5-10 years, because if you settle the TRUE future medical costs will come out of your settlement award. The donut holes each year are your expense alone, and the A,B,C,D Tier of many prescriptions have varying co-pays which the Respondent has passed on to the petitioner and Medicare.

Comment on Interesting call

2010-01-14T23:41:16Z

At is not so far#fetched. Insurabce company lawyers fully anticixate the WCMSA Propsals being a 9-2 year prior assessment to the#current costs ob a condition that may have worsined due to "Ligal Strategy"'knowing paying gurrent monthly RX, would even|ually run it' own cyc;e, but the carrier'instead of beinc responsible fov medical treatment for life, ny complying wit` a 1-2 year old'Med/RX assessment. They simply wait it out and blatantly attempt to shift a life time of future medical costs to Medicare. Having the approval they stay on a hourly clock to their clients, expend resources for medical care out of their clients pockets, and almost "force" settlements from petitioner's that do not realize that their own out of pocket expenses never end, and a lifetime of donut holes are passsed on to the petitioner and Medicare.It is an unscrupulous legal strategy, but it works for their respective clients, when Counsel states to them "mateer of factly" we saved you 25-30 years of future medical/RX costs.