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Workers’ Comp Summit: Sept 23-25, 2020 – Samoset Resort, Rockport, ME

PLENARY: Maine Trends in Medicare Set-Aside Accounts

Tuesday, August 27th, 2019 @ 9:30 am - 10:30 am

Impact on Settlements, Impact on the Parties

What’s it all about? Aside from any new legislation this year, one of the big topics for Comp Summit is a divergence of opinion on the direction of Medicare set-asides. As our attendees know, a Medicare Set-Aside is the portion of settlement earmarked for the injured worker’s future work-related medical expenses. It is a significant element of most settlements and of keen interest to employees, insurance carriers and any third-party administrators, and of course Medicare, which seeks to protect its interests in cases involving injured workers’ at or approaching Medicare age or qualifying for Medicare on a disability basis. Some carriers have set-aside analyses professionally done and submit them to Medicare for pre-approval. Medicare then approves either the proposal or some other amount, and if the employee’s post-settlement, work-related expenses turn out to be higher than what Medicare approves, Medicare covers the additional expenses, provided the employee has set the money aside into a separate interest-bearing account and complied with all of Medicare’s rules about how to administer that account. Some carriers are employing third parties to administer these accounts. Other carriers are taking a different approach to the set-aside analyses, by not submitting them to CMS for approval, which they have the option to do. Instead, they are paying for professional administration and taking their chances if the professionally administered set-aside account has run out of money. In these scenarios, the carrier will litigate with Medicare. What happens to injured workers whose Medicare set-aside accounts become exhausted is unclear and should be the topic of a spirited discussion.

Why you’ll want to participate in this session.

  • Discover recent trends and the divergence of opinion on whether to opt in or out of the CMS Medicare Set-Aside approval process.
  • Discuss the implication of these choices on the well-being of the injured worker.
  • Discuss the implication of these choices on an insurance carrier’s risks and consequences.
  • And, discuss the implications for the workers’ compensation system in Maine.

Approved for 1 CCMC and Maine Attorney CLE Credit.