With Medicare’s increasing involvement in insurance settlements, information obtained at the time of case intake can make it easier (and hopefully faster) to address Medicare compliance issues. Jon Gunter, Executive Vice President at MEDVAL, recommends plaintiff attorneys ask the following questions up front in every injury or workers’ compensation insurance settlement case. I think you’ll find the information very helpful.
Is the injured party on Medicare or Social Security Disability now? If yes, request the Social Security and the Health Insurance Claim numbers from the client. Conduct a Medicare conditional payment inquiry to determine if Medicare has made or is making payments for treatment related to the injuries/conditions in the case. Medicare’s conditional payments have a statutory priority right of recovery over all other payments in the settlement.
Not sure if the injured party is on Medicare or Social Security Disability? Obtain the party’s signature on SSA Form 3288 to complete an inquiry directly with the Social Security Administration (SSA). The SSA will provide the current Medicare, Social Security Disability and Medicaid status if needed. This is a definitive way to determine an individual’s true entitlement status, and it provides a discoverable piece of evidence for your file.
Do the parties anticipate a need for future medical care (related to this case) beyond the settlement date? If so, is it reasonable to expect that medical treatment will be needed on or after the injured party becomes Medicare entitled? If yes to both questions, the case should be red-flagged for a potential Medicare Set-Aside (MSA) referral. The injured party should consider signing a general medical release form to allow your firm to obtain the past 2 to 3 years of medical treatment records related to this case, along with the final treating physician’s medical report outlining the specific future medical needs of the injured party. These medical records are used to calculate the MSA amount recommended for your client’s settlement.
If you have any questions on this matter, please give me a call. E-mail me personally at email@example.com or call 800-734-3910.
Jon Gunter is also available at 949-203-3021, firstname.lastname@example.org.