One of the hard ‘facts’ of a Pennsylvania workers’ compensation settlement is the ‘requirement’ to resign from employment to accept a settlement. Is it a requirement under the Pennsylvania Workers’ Compensation Act? No. It is usually a requirement of the workers’ compensation insurance carrier and/or the employer. Pennsylvania workers’ compensation settlements are done by Compromise and Release Agreements. They are negotiated with the insurance carrier and employer. They value each case differently based on a multitude of factors. You can…
In Pennsylvania, injured workers are not entitled to a settlement. That is the quick, easy answer. However, most Pennsylvania workers’ compensation cases in litigation do indeed end with a settlement. There are two critical points to remember when we talk about Pennsylvania workers’ compensation settlements. First, no employer, insurance carrier, attorney, or Workers’ Compensation Judge (WCJ) can force an injured worker to settle their case. If you do not want to settle your case then you do not have to…
Many of the law firms you see all over TV simply want those big fees from settling your workers compensation case. I have had clients contact me after settling their case elsewhere, because they need additional treatment or their medical condition is worsening. The main premises to take here is this --- if you settle your case in Pennsylvania, you are done! There is virtually no chance to reopen your case. If you settle, it is over forever. That is…
You may have heard about Medicare Set Aside agreements when it comes to Workers Compensation lump sum settlements. They are complex and confusing too many. Let me try and help explain a little about this complex area of law.
First, when is a Medicare Set Aside agreement required as part of a structured workers compensation settlement? Generally, with a worker’s compensation settlement, federal law prohibits Medicare from paying for injury-related medical expenses or medications that an employer is responsible to pay. In essence, other insurance coverage exists for those medical expenses. To achieve that purpose, Federal government regulations require that a portion of settlement funds be “set-aside” in an account to pay for future medical expenses related to the work injury. So what specifically triggers this process? Here are the general criteria when a settlement should be submitted for CMS review.
CMS will only review new WCMSA proposals that meet the following criteria:
The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or
The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00
So, what is the important words in here — “is” and reasonable (more…)