San Antonio Legal Advice

The American Insurance Association and the Coalition for Medicare Secondary Payer reform both announced their support for the Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2012, introduced last week by Representatives Dave Reichart (R-Wa.) and Mike Thompson (D-Ca.).

The legislation is aimed at resolving the delays in the review of workers’ compensation set-asides for Medicare.

A Medicare Set-Aside Arrangement (MSA) is an account that is created when a workers’ compensation case is settled to protect Medicare from paying for expenses that are related to the worker’s injuries. Therefore, if a worker has to receive surgery, the MSA would be used to pay for it, rather than Medicare benefits.

“(The Centers for Medicare and Medicaid Services) takes too long to review proposed set-asides, fails to provide appropriate and consistent standards for determining amounts to be set aside, and provides no avenue to appeal CMS determinations,” Douglas Holmes, the coordinator of the Coalition for Medicare Secondary Payer Reform, said in a press release. “The process results in injured workers not receiving funds, additional costs for states and workers’ compensation payers, and additional liability for employers, insurance carriers, and attorneys. A legislative solution to this problem is needed.”

The coalition, which includes representatives for injured workers and insurance carriers, has been pushing for reform of this system for some time, and the Government Accountability Office released a report in March that included recommendations for improving these processes.

“In case after case, we hear of delays in approval, uncertainty of the amount to be reimbursed by injured workers, and changes in amounts to be set-aside after settlements have already been approved,” J.R. Boyd, the president of the Workers Injury Law and Advocacy Group, said in a press release.

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