Skip to main content

Is it possible to receive a lump sum and a medicare set aside in a workers comp case?

Anaheim, CA |

I have been offered 80k for a 92% rating in my workers comp claim. What I would like is a lump sum and a medicare set aside. This is a California claim. Is it possible to have both? I am a 68 yr-old-male who is suffering financially. I have Kaiser Medicare. If I do this 80k cashout of future medical, can I still use my Kaiser for these work related injuries? Please advise asap. Thanks

My other option is to receive approximately $250.00 every two weeks beginning on March 12, 2015 for the rest of my life. I believe I will also be entitled to all future medical expenses through Workers Comp and/or the company involved. Thanks again for any help you can give me.

+ Read More

Attorney answers 5


It is possible to receive a lump sum settlement, but a lot of factors go into a case like yours to make that possible. First the carrier must agree to want to do a lump sum settlement. Secondly an msa must be obtained since it appears you would be on Medicare and that msa would need to be approved by cms(Medicare). The amount of your settlement would need to be inclusive of the cms approved msa. You would also be required to set the msa dollars aside and pay for the care that would have been covered by the wc carrier, as Medicare will not want to be responsible for that care. There are multiple additional issues here that are too numerous and complicated with respect to msa s and Medicare and without additional facts about your case can not be answered sufficiently.


Your question does not provide enough information to provide you with a complete response. In view of the significant amounts involved, you should have a competent workers' compensation attorney (preferably a certified specialist) review your case completely. At 92%, your case includes a life pension. Depending on your earnings at the time of your injury, the value of a 92% case, including the life pension, including a Medicare Set-Aside (MSA) would very likely far exceed $80,000. About the only time a case would be concerned with an MSA is when the claims adjuster is looking to close out the case by settling with a Compromise and Release. When your permanent disability rating is 92%, it is not a far cry to get your case to 100% with at least some work on your future diminished earning capacity. A 100% case is worth much, much more than a 92% case.
I cannot over-emphasize your need to retain a competent workers' compensation attorney if you do not already have one. Good luck.

Any person who makes or causes to be made any knowingly false or fraudeulent material statement or material represetation for the purpose of objtaining or denying wokres' compensation benefits or payments is guilty of a felony.


It is possible, but I fear that you need an Certified Specialist in WC to assist you in your case if you are even considering a cash-out of your Future Medical. If you have one, you should listen to him. If you do not, I would be happy to look at your Medical record and help you estimate the proper value. It is also extremely important to structure the language of your settlement so that your Social Security benefits are not devastated.

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.


You definitely need to retain an attorney. Your situation can get very complicated and throwing in part D medicare even more so. Moreover, you want to make every effort to get your matter to 100%.


You need help. Ofen carriers in an unrepresentative a&e will try and hoodwink you into accepting the Medicare set aside as your settlement. THEY ARE SEPARATE! You should e paid an amount to settle your disability AND the set aside.

Also, at 92% and 68 years of age 80k seems low to me.

Hire counsel at once. Looking at reviews and rating on this site is a good place to start. Good luck.

This site is informational only and creates no attorney client relationship or a reasonable expecation of accuracy as any comments here are based on less than all of the facts. No comments here form any client relationship or create a reasonable expectation that you can rely on the comments. Only a formal retainer agreement can form an attorney client relatiopnship.