12.
Which party in a WC claim is responsible for obtaining CMS approval of an MSA?
Either party can obtain
approval of a Medicare Set-aside (MSA) from the Centers for Medicare and
Medicare Services (CMS). Approximately eighty percent, however, are processed
by the employer/defendants.
Some states have different
“customs” for the handling of MSAs. In Michigan, for example, the claimant
usually handles the MSA. The opposite is true in Georgia.
There is one particular
problem with the MSA process that needs to be addressed. When one party (or its
representative) submits an MSA proposal to CMS, that party is designated as the
“submitter” by CMS. No one but the submitter is allowed to communicate with CMS
about the MSA proposal or the status of the MSA. This is true even if the
employer has submitted the MSA and the employee contacts CMS about the status of
the MSA. In such a case, CMS will not speak to the employee even though he/she
is the Medicare beneficiary that is affected by the MSA.
Please keep this in mind
before any agreement is made about which party is going to submit an MSA to CMS.
BACK
All of the content was
prepared by Michael R. Merlino II, an attorney in Georgia who focuses on his
practice primarily on MSAs. He prepares MSAs for many large self-insureds and
insurance companies. If you have questions, he can be contacted at 770-374-3697
or
mmerlino@gmail.com. He also has a website devoted to MSAs, which is updated
frequently: www.wcmsainfo.com
© 2007
Wisconsin Association of Worker’s Compensation Attorneys, Inc, and Michael R.
Merlino II. All rights reserved.
