In Benoit v. MMR Group et. al., 2014 La. App. LEXIS 716, the state court of appeals was asked to rule on an applicant’s attorney request for fees related to seed money secured from an insurer for a WCMSA. The court examined the approval documents for the WCMSA from CMS review contractor and noted the prohibitory language regarding the award of fees. The court also examined the release agreement which was also silent and was unambiguous as to the entire amount of the WCMSA being available to pay for medical items and services related to the resolved workers’ compensation claim. The result was to deny the request for award of fees. To read the opinion further, click here.
This result should not be a surprise to anyone in the Industry. Medicare is extremely protective of the WCMSA fund and will not allow fees for professional administration nor attorneys’ fees be taken that reduces the dollar amount available to pay for medical items and services. This fund is intended to replace what an Employer would have paid for such services over the life of the claim, and such fees would not have been charged in the first place had the claim continued. Nonetheless, the converse side of not allowing such fees is that funds are poorly managed without professionals and attorneys are not as incentivized to advocate for the value of the WCMSA. These may outweigh the present process and may be issues CMS will consider in the future.
When facing professional administration or other legal issues call us. We have a team of professionals that can guide you through the process so you don’t unnecessarily incur legal fees.