Medicare Set Aside (MSA)

Do not let the workers comp insurers control the Medicare Set Aside submission process for your workers compensation settlement.

At the Law Office of James M. Hoffmann, we are dedicated to helping our clients understand the MSA process. Our legal team has a strong history of helping injured workers get the medical attention and financial compensation that they need.

What is a Medicare Set Aside?

An MSA is a financial agreement that designates a portion of a workers compensation settlement to pay for the future medical bills that are related to the work related injury or disease. These funds must be used entirely before Medicare will pay for any of the treatment related to the injury or illness.

The law states that an MSA (Medicare Set Aside) is required if:

1. A person is on medicare and the settlement exceeds $25,000; or
2. Reasonable expectation that the injured employee will become a medicare beneficiary with 30 months of the settlement date and the settlement exceeds $250,000.

The MSA program was created because the government does not want to pay for future medical treatments for an injury. It is an additional lump sum paid by the work comp carrier to the employee for future medical care. However, in a workers compensation case, if the work comp carrier agrees to provide future medical care for life, or if future medical care is awarded at trial, no Medical Set Aside is required.

Basically, when the the employee is no longer able to work following a work related injury and applies for SSD (Social Security Disability), the MSA process is triggered.

The MSA Pitfall

Many lawyers just have their clients sign authorizations that are provided by the defense counsel. The defense counsel agrees to pay the costs of the “determining MSA” amount. However, what commonly happens is that that recommended amount is low. This happens because the insurance company’s attorney is the one controlling the process. They often control what records are sent and sometimes hire a firm that specializes in getting low MSA amounts approved by the federal government.

Frequently Asked Questions About Medicare Set Aside in Workers’ Compensation

Workers Compensation Benefits Missouri