There are special rules for when a MSA is required on a case, but it is always required when an injured worker decides to settle their right to future medical care while having a right to Medicare. The goal of an MSA is to protect Medicare (tax payers) from paying for medical treatment that was caused by the industrial injury. Medicare (CMS) requires that the insurance carrier either prepare a MSA or hire a company to prepare a MSA report. The MSA report calculates how much medical treatment we expect you would use with your Medicare Card over your lifetime, if you were to use it. You should never use it for work related injury treatment. Medicare does pay for all types of treatment or medications. Therefore, a skilled attorney will need to look over the MSA to determine how much more money should be provided by the insurance company to make sure all of the future costs (Medicare and Non-Medicare) are included in the settlement. Don’t settle by agreeing to receive only the MSA amount, especially if the carrier indicates you don’t need MSA approval from Medicare before getting the settlement approved by the workers’ compensation Judge. There are a lot of pitfalls during this process and many options. Seek help.
In addition to an attorney, you may often want to work with a structure broker to maximize your settlement and protect yourself. Structure brokers are free to you as they are paid by the annuity companies. Do not rely on the carrier’s broker only since they have the carrier’s interests in mind. Work with your attorney to hire a broker that is skilled in workers’ compensation matters since it is a specialty skill.