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Medicare Set Aside


One of the issues that has been in the forefront in many workers’ compensation claims is the use of the Medicare Set Aside Trust or MSA.  This usually arises when the injured worker is currently eligible for Medicare benefits or will be eligible within 30 months.

 The general policy behind this requirement is to prevent the injured worker from shifting the burden of future medical expenses that are related to an on the job injury to the Medicare system.  In the appropriate case, prior to any settlement the parties will “guestimate” the expected future medical expenses and submit the proposal to Medicare (CMS or Center for Medicare Studies) for approval.  This process normally takes about 4-6 weeks.  It is not unusual for Medicare to disagree with the original estimate that has been submitted by the private carrier.   

 While it may be desirable for the parties to settle a case without an MSA, if a case settles without an MSA in place when one is required, the injured worker is left without the protection of Medicare benefits if the person becomes a Medicare beneficiary.  In that case the injured worker may lose Medicare protection but the parties who failed to submit the required MSA may be subject to penalties.