Category Archives: Medicare

Video: Medicare Secondary Payer Issues in New Jersey Section 20 Settlements

Here is the post-webinar video from our most recent presentation, “Medicare Secondary Payer Issues in New Jersey Workers’ Compensation Cases” from our New Jersey workers’ compensation webinar training series.

Subject: New Jersey, Workers’ Compensation Law, Medicare Secondary Payer, Section 20, Conditional Payments
Date Presented: January 23, 2017
Presenter(s): Greg Lois, Esq.
Run time: 29:27 Continue reading Video: Medicare Secondary Payer Issues in New Jersey Section 20 Settlements

Video: Medicare Secondary Payer Issues in New York Workers’ Compensation Claims

Here is the post-webinar video of our most recent presentation, “Medicare Secondary Payer Issues in New York Workers’ Compensation Claims” from our New York workers’ compensation webinar training series. Attorneys Declan Gourley and Greg Lois discusses Medicare Secondary Payer exposure and how it effects the settlement via Section 32 in New York workers compensation matters.

Subject: New York, Workers’ Compensation Law, Medicare Secondary Payer, Conditional Payments, Section 32
Date Presented: January 16, 2017
Presenter(s): Declan Gourley, Esq. and Greg Lois, Esq.
Run time: 21:46 Continue reading Video: Medicare Secondary Payer Issues in New York Workers’ Compensation Claims

The Impact of a Social Security Disability Award on New York Workers’ Compensation Benefits

Joseph Melchionne
Joseph Melchionne, Esq.

Social Security Disability Insurance (SSDI) provides protection for injured people who need to return to work without compromising

their rights to other federal and/or state benefits.  According to the Social Security Administration, someone is “disabled” if they are not able to work as the result of an illness or injury that will last for at least twelve (12) months.

SSDI Requirements.

In order to qualify for SSDI a person:

  • must be younger than 65 years of age,
  • must have worked in a job that is covered by Social Security, and
  • must have suffered from an illness or injury that meets the aforementioned Social Security definition of “disability.”

If all of the aforementioned criteria is met, Social Security will provide monthly cash benefits to individuals who are unable to return to work for at least one (1) year because of their impairment. Continue reading The Impact of a Social Security Disability Award on New York Workers’ Compensation Benefits

Post-webinar video: Medicare Secondary Payer Act and New Jersey Settlements

Here is the post-webinar video from our most recent presentation, “Medicare Secondary Payer in New Jersey.”  Three New Jersey attorneys introduce the topic and provide an overview of the interplay between the Medicare Secondary Payer Act and New Jersey Section 20 settlements.

Join us for our monthly webinars on New York and New Jersey workers’ compensation law. Click here to register. The complete archive of prior presentations is here.

Subject(s): Medicare Secondary Payer, Section 20, New Jersey
Date Presented: January 25, 2016
Presenter(s): Joe Jones, Esq., Michael Tomasino, Esq., and Greg Lois, Esq.
Run time: 24:14 Continue reading Post-webinar video: Medicare Secondary Payer Act and New Jersey Settlements

When Should a Medicare Set-Aside be Submitted to CMS for Approval Before Settlement?

Medicare is a federally sponsored health care plan that is available to individuals who are; a) 65 or over, b) to individuals who have received Social Security Disability Insurance (SSDI) benefits for more than two years, and c) to individuals with end stage renal disease. It is common for workers’ compensation claimants to be Medicare recipients.

The Medicare As Secondary Payer Act (Link) has made it clear that if medical expenses could be covered under either workers’ compensation or Medicare, workers’ compensation, and not Medicare, should pay. Workers’ compensation is primary and Medicare is secondary. Medicare is administered by the Centers for Medicare and Medicaid Services (CMS). Continue reading When Should a Medicare Set-Aside be Submitted to CMS for Approval Before Settlement?

Leading Edge Ideas for Settlements with Medicare/Social Security Entanglement

Common problems with settling cases where the claimant is Medicare- or Social Security Disability- entitled.

The hardest-to-settle cases are often those where the claimant is currently entitled to Social Security disability and/or Medicare benefits. There are two common obstacles posed by Medicare or Social Security disability entitlement are (1) sky-high future medical allocations necessary to satisfy the Secondary Payment obligation of the carrier/employer make the overall settlement unpalatable; and (2) settlements where the claimant/petitioner is afraid to take a lump-sum settlement because their monthly Social Security disability check may decrease.

Problem 1: Medicare’s Future Interest is driving up the settlement.

We must consider Medicare’s present- or future-interest in any settlement where the right to future medical benefits from the carrier/employer is being waived. This comes into play in the following ways in the jurisdictions I practice in when the claimant/petitioner is Medicare entitled:

  • New York: Section 32 settlements (WCL §32).
  • New Jersey: Section 20 settlements (N.J.S.A. 34:15-20).
  • Longshore: Section 8(i) Settlements (33. U.S.C. 908[i]).

Continue reading Leading Edge Ideas for Settlements with Medicare/Social Security Entanglement