Category Archives: LMSA

Blog, LMSA, Medicare Set Aside

An article recently published in The Brief (Fall 2012), within the Tort Trial & Insurance Practice Section of the American Bar Association, may lead the reader to draw the wrong conclusion about how to protect Medicare’s interest when settling a general liability claim.  The implication in that article, “Medicare Set-Aside Arrangements Under the Medicare Secondary Payer Act”, is that if …
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Blog, LMSA, Medicare Set Aside

Finke v. Hunter’s View, 2009 U.S. dist. LEXIS 126830 (U.S. Dist. Court for Dist. of Minnesota, 5th Division) Facts:  Claimant was paralyzed when he fell from a ladder.  He sued the manufacturer (including the purported retailer) for defective design.  The case settled for $1.5M.   Prior to settlement, Claimant was dual eligible for benefits under Medicaid and Medicare.   Claimant lost his …
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Blog, LMSA, Medicare Set Aside

Cribb vs. Sulzer Metco (US) Inc. – 2012 – U.S. Dist. Court for Eastern Dist. of NC Facts:  Plaintiff, a Medicare beneficiary, settled his claim with Defendant.  Concerned over how to protect Medicare’s interest, Plaintiff filed a Motion in U.S. District court seeking Approval of Settlement and Determination of Need for and Amount of Medicare Set Aside.    Notice was provided …
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Blog, LMSA, Medicare Set Aside

Facts:  Plaintiff, a crane mechanic, was injured on the job.  In addition to his workers’ compensation claim, he presented a claim against the owner/operator of the liftboat he was working on.  He settled his liability claim for $785,000 and agreed to pay $82,500 of it to his employer’s workers’ compensation carrier in exchange of a waiver of their lien against …
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Blog, Franco Signor News, LMSA, Medicare Secondary Payer News

The Centers for Medicare & Medicaid Services (CMS) published its request for public comment on possible rules being  considered  for liability settlements involving future medicals this past June.   Franco Signor submitted its response to the Advanced Notice of Proposed Rulemaking (CMS-6047-ANPRM) last week.  To review our commentary, click here.    Our response was designed with two objectives in mind.  First, to …
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Blog, LMSA, Medicare Set Aside

Sipler v. Trans Am Trucking, Inc., et al., 2012 US Dist. LEXIS 109278 (U.S. Dist. Court for New Jersey, 7/24/2012). Facts: (Highlights): A settlement was reached for $225,000 on the eve of trial; No other terms were discussed at the time of settlement The injured plaintiff had recently become eligible for  Medicare benefits, but Medicare did not pay  because incident-related medical …
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LMSA, Medicare Set Aside

In a recent blog we highlighted a reference by CMS to an “Advanced Notice of Proposed Rulemaking” on the issue of “Liability Medicare Set Asides.” The final document has been sent to the Federal Register, where it will be published in a few days, and here is an advanced copy: CMS-6047-ANPRM. In the document, the Agency proposes seven different options …
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Allocation, LMSA, Medicare Conditional Payments, Medicare Set Aside

Bertrand v. Talen’s Marine & Fuel LLC, 2012 US Dist. LEXIS 78053 (U.S. Dist. Court for the Western District of Louisiana, 6/4/2012). Facts: (A condensed version of the Court’s Findings of Fact are set forth below): Plaintiff was injured in a workplace accident, and he was employed, at the time, by defendant Talen’s. As a result of the accident, plaintiff …
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LMSA, Medicare Set Aside

Frank vs. Gateway Insurance Company, 2012 U.S. Dist. LEXIS 33581 (U.S. Dist. Court for the Western Dist. of Louisiana, March 3, 2012) Facts:  Plaintiff was injured while in the course and scope of his employment.  He was a truck driver and at the time of the accident was unloading a trailer owned by a third party.  He suffered a lumbar …
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Legitimizing an MSA – A Need for More Guidance

13 Apr 2012 Roy Franco No Comments

Blog, LMSA, Medicare Set Aside

How does one determine exactly the amount that should be allocated for future medicals so that the risk of triggering Medicare recovery is minimized? And what kind of proof do you need?  Because CMS has stated that nothing will limit its recovery other than a court order on the merits of the case (CMS Pub. 100-05, Chapter 7, §50.4.4), claimants …
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