Medicare--The 1000 Pound Gorilla

Medicare. There, I said it and used the term that sparks so much animosity, passion, and confusion no matter what your political bent. These days, it seems to be seeping into our everyday existence and, you might be very surprised, is very deeply entrenched in both personal injury and workers' compensation law.

This article could get really boring fast but fortunately I've included some visuals to draw your attention from the mind-numbing mention of government regulations and such.

Okay, so how does all this affect your personal injury or workers' comp case?

Well, start with the fact that if you are of a certain age ("Medicare eligible"), 62.5 or older, and you get hurt, the government has AN AUTOMATIC LIEN ON YOUR CASE. Let's back up for a moment. If you get hurt at work, in many cases your employer is REQUIRED to report this to Medicare and Medicare REQUIRES that a specific amount of money be held back or allocated to pay for your future medical needs in the form of a Medicare Set Aside or MSA.

If you are injured in, say, a car accident and are of that age, the regulations again REQUIRE the insurance company for the other driver to report this situation to Medicare. Ultimately, both you and your attorney MUST report your injury and this situation to Medicare and Medicare is entitled to be repaid what it paid out in medical costs for your injuries. Failure to report this or to repay Medicare CAN LEAD TO FINES, LAWSUITS, AND OTHER SANCTIONS.

The entire and rather byzantine process is described in numbing detail on the Medicare Secondary Payor Recovery Contractor (MSPRC) website. Let me know if you understand it--I think when they have sections explaining the letters they send explaining things you have to know you're in trouble!

So, for anyone who thinks handling his or her own workers' comp or personal injury case is relatively easy, think again. Not only is there the 1000 pound gorilla, Medicare, that must be maneuvered around and dealt with in many applicable instances, but there are many other liens, reimbursements, and other pay outs that must be handled. An experienced injury attorney will know how to handle these medical liens, insurance reimbursements, and subrogation contracts, all the while getting you the most money in your pocket. You may not even KNOW about these various requirements and get yourself in trouble with the goverment, or even your own insurer.

These days, liens, subrogation agreements, and especially Medicare make navigating injury cases best left to the professionals more than ever.

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