Saturday, October 31, 2009

H.R. 2641 May Help with WCMSA Problems

I have previously addressed WCMSA's or workers compensation medicare set asides. Essentially in this area there are very complex and bureaucratically driven rules. Medicare simply requires that some settlements in workers compensation cases be approved by them and set aside funds for use in treatment so that Medicare does not feel it is having to cover your workers compensation treatment. Now those cases where the injured worker returns to work appear not to be a problem but when someone is on medicare or could be soon on it sometimes they are requiring approval of a set aside amount. That means any such settlement must include Medicare (the agency is CMS or the Centers for Medicare Services) in its resolution of the case.

The problems that have come from this are significant. It delays a settlement by several months. The claimant and insurer may agree on everything but still must hold their breath that Medicare approves the deal. I attended a lunch yesterday where one attorney said he was stumped as Medicare was requiring more then the entire settlement be set aside to protect them. Yet the case was totally disputed on whether it arose from work activities. In other words the claimant could go to hearing and lose it all. Then he would go on Medicare and they'd have to pay 100% of the medical expenses. Still they were rejecting the compromise no matter how reasonable it was done. So a reasonable settlement could be shot down. But then do the parties have any recourse? Both sides want to settle and have negotiated a fair approach yet they are dead in the water forcing litigation which will hurt one side or the other. So in this area claimants and respondents are really on the same side. They seem to have no recourse if some bureaucrat decides without a hearing that the compromised amount is not the full amount needed to protect Medicare's interests. Sounds like a denial of due process doesn't it? Yet this is happening.

H.R. 2641 is a bill introduced in Congress to smooth out some of the problems. You can read about it here and here and here. You can follow its progress here. It takes all of us to try move this bill forward so consider doing something more then just reading about it. Support it and follow its progress. It does seem buried in all the major political things going on right now but when the disabled, the insurers and the attorneys are on the same side you have to say the Medicare policy should be made more reasonable and less bureaucratic. H.R 2641 seems like a step in the right direction if it can move forward.

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