Legal Question in Workers Comp in Virginia

If i settle my WC case and recieve over 250k, is it mandatory for a medicare set-aside?

It looks like when i read the rule it says have to looking to file fof medicare in next 30months and settle for over 250k. Does this mean both requirements are neccessary or does just one qualify?

I will not be looking to get medicare in next 30 months but do stand to get more then 250k back at settlement. Does this mean i still will need to establish a medicare set-aside?


Asked on 2/19/13, 5:50 pm

1 Answer from Attorneys

Michele Lewane Injured Workers' Law Firm

This is a much more complicated question than can be answered here. You really need to speak to your attorney to coordinate all your benefits properly and get the correct legal language in the petition and order . The other side will not protect you, but will try to protect just the insurance company with the language in the settlement documents.There is the issue of designating part of the proceeds toward future medicals protecting any potential future social security disability benefits and mandatory MSA requiring Medicare's approval. Also the 30 month rule is triggered when you file for social security disability- not Medicare . Your attorney should be getting an analysis done by a life care planner or at least an MSA analysis from Gould and Lamb or another vendor. Either triggers the mandatory MSA which is taking Medicare almost a year to approve.if you want more information, you can go to my website at injuredworkerslawfirm.com and order my free book which has a chapter on coordinating benefits. There may also be some general information on the website as well.

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Answered on 2/20/13, 6:54 am


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