Is there a requirement for A Medicare set aside (MSA) In a auto accident claim?

Asked 8 months ago - Orange, TX

Agreement to settle on 11/15/2013 for $55,000.00. Last and final medical treatment was on 09/01/2011 all of my physician have release me from further treatment for the accident that happen on 09/29/2009. Why is a MSA required? Why is my $55,000.00 used for this MSA? Can I collect interest if the $55,000.00 is not paid within 30 day as stated in the Agreement to Settle? I am 68 years old I did not used my Medicare benefit to pay the medical claims for this accident. My claims was paid by ML Health care (195,000). My attorney quit, I represented my self at mediation and I currently do not have attorney. (Is this true? He cannot recover any fee (even quantum merit) if he withdrew without good cause or his misconduct (usually meaning an ethic rule violation) led to the breakdown of the

Attorney answers (5)

  1. Daragh John Carter

    Contributor Level 14

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    Answered . Good for you for representing yourself at mediation and negotiating a $55,000 settlement, sounds like you are the right kind of stubborn.

    Regarding the MSA, the best online resource I was able to find was Atlas Group's web site:
    http://www.atlassettlements.com/pages/abmsa_FAQ...

    Here is a quote from the FAQ portion of their site:

    Of note, on September 30, 2011, CMS at the national level did issue an initial memorandum regarding the management of liability MSAs. If a beneficiary’s treating physician can certify, in writing, that treatment for the alleged injury related to the liability insurance settlement has been completed as of the date of settlement, and that future medical for that injury will not be required, Medicare considers its interest with respect to future medicals for that particular settlement satisfied. If the beneficiary receives additional settlements related to the underlying illness or injury, he/she must obtain a separated physician certification for those settlements. Please find the memorandum in our “Medicare Compliance Updates and Resources“ section. 9/30/11 Memo, Charlotte Benson, Acting Director, Financial Services Group.

    Ultimately I think you only need to comply to the extent the other side wants you to comply in order to release your settlement funds. If you can show the other side the above memorandum and get a letter from your physician, maybe that will satisfy them.

    Since you attorney withdrew from your case I would say your attorney is not entitled to any fee.

  2. Richard Kurt Arbuckle

    Pro

    Contributor Level 18

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    Answered . Sometimes there is a requirement and sometimes there is not. You have to go through the procedures, which is way beyond answering general questions on the internet. As to the attorney fee, it does depend on why the attorney quit, but that is also a complicated area in Texas law and depends a great deal on the details.

    This is not legal advice. You should always discuss the specifics of your issue in person with an attorney. Be... more
  3. David Ian Schoen

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    Answered . Ouch. These are some of the issues that you have to work out beforehand and why you should never do this without an attorney. There is certainly a strong argument to be made that there should be no set aside, but you might have difficulty convincing the insurance company of this and they may not release a check to you without proper documentation from medicare. And medicare is impossible to deal with even for those of us that deal with it all of the time.

  4. Jennifer H. Seate

    Contributor Level 13

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    Answered . Technically yes a set aside can be required and probably why the insurance carrier is requiring it. You could call Medicare and see if one of the representatives can help walk you through it. They aren't the most useful though. The other thing you can do is contact and pay one of the firms who handles dealing just with Medicare from a settlement They can work out the details of an MSA if it is required, or they can get the documentation you need to state one is not. Two groups are called the Garretson Resolution Group and the Center for Lien Resolution.

    Good luck.

    This information is provided for general purposes only and should not be construed as legal advice. No attorney-... more
  5. Christian K. Lassen II

    Pro

    Contributor Level 20

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    Answered . Typically

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