Tuesday, March 31, 2009

Medicare Set-Asides

I am not sure how many of you are personal injury attorneys who are reading this, but if you are, keep reading for some good news.

Come July 1, 2009, CMS (i.e. Medicare) is implenting new reporting requirments for liability insurance companies regarding personal injury claim settlements. Many attorneys contemplated whether the new law would also require Medicare set-asides in personal injury settlements where there is a reasonable likelihood of future medical treatment. The good news is, from my research on the subject, there is still no requirement for a personal injury attorney to create a set-aside with respect to a personal injury settlement.

For those unfamilar with set-asides, they are a creature of worker's compensation claims. Medicare does not like paying for treatment that should be covered by a third-party. Therefore, they require, as part of a settlement, a quasi-trust to be exhausted for medical treatment before Medicare benefits kick in. Essentially the worker's compensation attorney drafts a proposed set-aside amount and Medicare decides whether they agree or disagree with the proposal.

While the new law does not mandate Medicare set-asides for PI cases, this is not to say that this will always be the case. Indeed, the fact that they are requiring liability carriers to forward settlement information for all Medicare and soon to be Medicare recipients certainly suggests that they are considering set-asides for personal injury claims in the future.

I still do not see how set-asides could ever work in a personal injury case. Here's why. Suppose you have a Medicare recipient who is severely injured in a motor vehicle accident. His medical specials total well over $100,000.00. However, the tortfeasor has a $20,000.00 policy and the plaintiff has no UIM (underinsured motorist) coverage. Exactly how can an attorney negotiate a set-aside when there is no money to set-aside? Once the insurance company exhausts its limits, their obligation is complete. Perhaps the federal government should simply mandate minimum policies of $100,000.00. I guess that is a little too logical.

1 comment:

Terence O'RIAIN said...

Your motor accident compensation is astonishing. In Australia in all states a car is not registered without evidence of unlimited personal injury cover. The few cars that are unregistered or unidentified involved in claims are covered by Nominal Defendant funds. Your politicians should step up and legislate for proper cover. Our health insurance system is fully indemnified in claims so the tortfeasor and his insurer pays not the taxpayer. We live in a very lucky country.