Workers Comp Medicare Set-Aside

Question from William from North Carolina:

I am on total disabilaty from an injury on the job. My company was required to set up an annuity to pay for future medical expences for my injury. I was told I had to keep records of all expenses the money was spent on and file a report every year. Where could I find this information and forms on the internet? IF you have the information I would real like it sent to me so I want have any problems with Social Secuity.

Answer:

When a WC claimant who is entitled to Medicare settles his WC case, the amount allocated to future medical bills must be set aside in a fund to pay such expenses so Medicare does not have to pay expenses that should be paid by the WC insurance company. When a fund is set aside at time of the WC settlement an administrator is appointed to use the funds for payment of medical bills related to the comp injury. The claimant or the treating doctor/medical provider normally will submit bills to the administrator who then pays them. Only when the fund is exhausted will Medicare cover any further expenses related to the job injury. The law requires an annual accounting to Medicare. Usually the administrator of the fund files the required reports. If your set-aside is self administered then you must pay the bills and file a statement when the fund is exhausted.

You should be able to get forms and more information from:
CMS
c/o Coordination of Benefits Contractor
P.O. Box 33849
Detroit, MI 48232-5849

Sorry- I can't find any on-line way to get the forms. You should also speak to your lawyer who handled your comp case for more help with this.

Stanley A. Tomkiel, III