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If I am settling my workers comp. case does Medicare have any say in this?

Greensboro, NC |

I was injured at work and had surgery on my low back. im and disabled and am unable to return to work. I was advised at my mediation that if I settle for more then a certain amount that social security disability Medicare can get involved and take some of that money, also I was told that I could not take this to court.

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Attorney answers 5


Somebody is smoking Crack. If you settle for $5,000 and are collecting SSDI benefits, Medicare may force you to pay for up to 5K in your treatment before they pick up the tab. They are not "taking" your money as much as they are preventing you from spending the Tax Payer's money. If you take $50,000 from the insurance for your Future Medical, you have $50,000 to spend on your FM. Medicare just wants you to use that for your medical before they have to pay. That sounds fair....

The other, wiser option is to leave your FM open and just take money for your disability. Then the Medicare Storm Troopers will never rappel onto your house at night.

We offer general concepts, but you should give ALL your facts to a licensed Attorney in your state before you RELY upon any legal advice.


A lot to consider in a very short question...first if you are represented, we really cannot offer any legal advice to you specifically, I would first advise that you sit down and have a good talk with the attorney representing you.

Generally speaking, if an individual is a current Medicare recipient or if the workers' comp case settles for more than $250,000.00 AND there is a reasonable anticipation that the individual will be on Medicare within 30 months, that person is required to have a Medicare Set Aside agreement. The set aside is to be used for medical care that is related to the workers' compensation case that Medicare would otherwise have covered. These funds need to be put in a separate interest baring account.

It is complicated stuff ( there are other ways a set-aside can be needed) and you should definitely have a long talk with the attorney you have or find someone to represent you ASAP.

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Ask your lawyer. Complicated question.

This answer is intended as general information and not as specific legal advice. If you want to have a free consultation with me, please contact me through AVVO.


Depending on the amount of your settlement and whether you intend to file for SSD benefits you could be required to submit a proposal for set-aside of medical expenses that will protect Medicare's interests. Since you went to mediation it is assumed you have an attorney. Get him or her to explain this process.


If you are currently on Medicare or have applied for Social Security/Medicare, Medicare absolutely has a say in your settlement. If you do not take Medicare's interests into account, you risk the US Government withholding future SSDI benefits or payment for medical treatment under Medicare. Your case is complicated and could have very serious negative consequences if you settle without satisfying Medicare's concerns. A lawyer knowledgeable in workers' compensation is essential for you.

This communication is not intended to establish a lawyer-client relationship. Any advice is intended for the general public and may not be appropriate for a particular case. Talk to an attorney about all the details of your case before taking any action.