How Does Medicare Impact a Workers’ Compensation Settlement?

February 1, 2023

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Brent Eames

A very common question which comes up in our practice is what happens when Medicare benefits overlap with a workers’ compensation claim? As is anything which involves the Federal government, it can get quite complicated! This is especially true of you end up receiving social security disability benefits during the pendency of your claim. Keep reading to learn more about how to handle Medicare after you have suffered a work-related injury.

SOCIAL SECURITY DISABILITY BENEFITS

Social security disability benefits are provided by the federal government to qualifying individuals who are disabled from working. Given that these benefits can overlap with the benefits provided by the Illinois Workers’ Compensation Act, the rules set by the federal government provide a potential financial consequence for people collecting workers’ compensation benefits and SSDI at the same time in an attempt to avoid a double recovery for the disabled individual. These federal rules can be triggered even when an injured worker applies for SSDI but has not yet received a final determination regarding their eligibility. Accordingly, if you receive SSDI benefits, or have applied for SSDI benefits, you must communicate this information with your attorney to confirm that all federal rules are being followed so we can attempt to maximize your net recovery.

SPREAD LANGUAGE IN SETTLEMENT CONTRACTS

In many cases, the individual’s SSDI benefits will be reduced if they are receiving workers’ compensation benefits. To minimize the impact of this reduction, any settlement in the workers’ compensation claim must contain “spread” language in the settlement contract, which would help designate any lump sum payment as representing payments over a lifetime. The Social Security Administration will take this information into account when reducing your SSDI benefits, and hopefully minimize the offset. So, even if you have not yet applied for social security disability at the time of the settlement of your workers’ compensation claim, if you intend to apply for these benefits in the future, you will need to communicate that information with your attorney so we can attempt to include this necessary spread language into the settlement agreement.

MEDICARE SET ASIDE ACCOUNTS

Similarly, if you are a Medicare beneficiary, or you reasonably anticipate becoming a Medicare beneficiary in the near future, federal regulations require us to take necessary legal steps to protect the interests of the federal government by confirming that we will not be transferring the burden of paying related medical bills to Medicare. This applies to both benefits which Medicare has paid in the past, and benefits which Medicare is anticipated to pay in the future. Prior to settling your case, we may be legally required to establish a so-called “set aside” account for future medical benefits to avoid placing any future obligations onto the federal government which are related to your case. This account is funded by the employer in your case, and it often can present a large obstacle for the potential settlement of a disputed claim. This process can be complicated and contentious, so communication with your attorney is crucial to make sure these legal obligations are fulfilled if you are a Medicare beneficiary, or if you anticipate becoming a Medicare beneficiary in the near future.

CONDITIONAL PAYMENTS

One of the most important rules involving Medicare is that prior to settlement, Medicare MUST be reimbursed for any related payments which were made. This is a multi-step process which can take a long time to straighten out. Generally, it is the responsibility of the parties to contact Medicare and alert them of a pending claim. It is important to contact an experienced attorney for this process, so you do not end up owing any portion of your settlement to Medicare after your case has concluded.

When multiple laws overlap, it can create confusion and legal obstacles. Have you been injured at work and want to discuss your rights and legal options? You owe it to yourself to contact an experienced work comp attorney to navigate this process. Please contact our experienced attorneys who have been rated as among the best work comp attorneys in Chicago to discuss your rights.  If you have been injured, you should immediately contact Brent Eames for a free consultation to discuss your options.

The content of this blog is intended for informational purposes only and does not constitute or establish an attorney-client relationship, nor constitute legal advice. If you wish to discuss any further aspect of the material contained herein, please contact an attorney at Eames Law Group, Ltd. 

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