There are special rules for when a MSA is required on a case, but it is always required when an injured worker decides, and the insurance company agrees, to settle their right to future medical care while receiving Medicare benefits. The goal of an MSA is to protect Medicare (tax payers) from paying for medical treatment that was caused by the industrial injury. It used to be that injured workers settled claims for less than they were “worth” because they knew they could use their Medicare to pay for the work related treatment. this was not fare to the taxpayer.
Medicare (CMS) now requires that the insurance carrier either prepare a MSA or hire a company to prepare a MSA report in certain circumstances. 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. Medicare does not pay for all types of treatment or medications. Therefore, a skilled attorney will need to determine if your case requires an MSA and 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 covered costs) 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. Your right to use Medicare for your work injury is in jeopardy if you are not in compliance.
In addition to an attorney, you may often want to work with a structure settlement broker to maximize your settlement and protect yourself. Structure brokers are free to you because they are generally paid by the annuity companies. Do not rely solely upon the carrier’s broker since they will generally only have the carrier’s interests in mind. Work with your attorney to hire a broker that is skilled in workers’ compensation matters since brokers from other areas of law will not be aware of the all of the issues to look out for.