| If a claim involves both a personal injury (PI) and a workers’ compensation (WC) claim, is it possible to have conditional payments under each? YES! This is important to note, because a conditional payment search through CMS under the workers’ compensation claim will elicit conditional payments which were paid by Original Medicare under the WC claim number, and there could be other conditional payments paid under the personal injury claim, a Part C (Medicare Advantage Plan) and/or a Part D (Prescription Drug Plan). Personal injury attorneys may not be aware that there could be separate conditional payments under varying Medicare plans from the PI claim that should be addressed prior to settlement. On the workers’ compensation side of things, the WC carriers are typically involved in the conditional payment searches since they are considered the Responsible Reporting Entity (RRE) to CMS. However, Part C and Part D plans have their own conditional payment recovery process, and therefore, it behooves attorneys for the injured worker to make sure the carrier has run a complete conditional payment search to cover all applicable plans, which may change during the life of a worker’s compensation claim. Both the WC and PI sides should investigate whether or not conditional payments apply, and determine how those will be approached at settlement. Settlement documents for each claim should address how Medicare’s interests will be considered and protected, and if applicable, state how conditional payments will be handled. Further complicating a dual claim is that the WC MSA may include specifically denied items that the PI side alleged as related in their Life Care Plan/ future medical assessment. Therefore, it is important that the settlement documentation in a workers’ compensation claim accurately state the diagnoses being settled and the amount of settlement money that is allocated for future medical related to those diagnoses. We specialize in helping you identify and accurately value future medical for admitted injuries, while understanding the exposure value of items and services that may be denied or excluded from an MSA in order to leverage that information to optimize settlement negotiations. Do you have questions about MSAs, how to value future medical care or posturing your cases for future medical settlement? Contact us for more information! |
Our step-by-step process to get MSS working for you couldn’t be EASIER:
- Use our client portal at medicalsettlementspecialists.com to
complete a case intake form and upload documents. - On our intake form, tell us your settlement goals (for example, understand the medical exposure, help educate your client regarding their potential risks/benefits of settlement, review an MSA for accuracy, identify non-Medicare covered items, review contested body parts that may be related, etc.)
- Once you receive your draft report, schedule time to learn the best ways to utilize this powerful TOOL we have built for you!