MSA in Liability Cases | Best Practices Series

November 1st, 2021

Precision Resolution is the Plaintiff’s Medicare Set-Aside Authority

By: Paul K. Isaac, Esq., ChSNC  | Managing Partner, Precision Resolution, LLC

Precision Resolution takes the guesswork out of Medicare Set-Aside solutions. When considering if an MSA is appropriate in your client’s case don’t rely on flow charts, questionnaires, or the guidance of defense counsel. 

The stakes are high, with the potential for Medicare to deny plaintiffs coverage for future accident-related treatment. What is needed is the advice of experts. 

Defense Has No Exposure
At the outset, it is important to note that Medicare Set-Asides are not required in any case – not workers’ compensation or liability. For this reason, Precision Resolution offers a host of MSA solutions including:

  • Opinion Letters;
  • MSA Allocation Projections & Reports;
  • CMS Submissions (where appropriate); and
  • Audit and Review of Defense-Prepared MSA Allocation Projections 

An MSA is the Obligation of the Plaintiff. However, many insurance carriers are convinced that they can be exposed to “double damages” if an MSA was not prepared and funded from the settlement proceeds.  This notion is entirely false as the defense has no exposure if the plaintiff elects not to set-aside funds for future Medicare-covered, accident related treatment in a liability case. 

You may think that by now, Medicare or CMS must have published regulations, or a formula to guide plaintiffs’ attorneys and illustrate how to best protect the Medicare Trust Fund. However, no such regulation has been published or passed to date. 

The most relevant guidance is in the form of a 2011 CMS memorandum. The memo states that, “each attorney is going to have to decide, based on the specific facts of each of their cases, whether or not there is funding for future medicals, and if so, a need to protect the [Medicare] Trust Funds.” 

Our Medicare Set-Aside Certified Consultant attorneys and nurse allocators develop case-specific strategies to ensure that no future Medicare benefits are denied, the settlement proceeds are maximized, and that your practice is protected.

Let us review the specific facts of your case and we will recommend a defensible, plaintiff-focused and cost effective MSA solution that will protect your plaintiffs and practice in the long run.

Click here to read Precision Resolution’s comprehensive assessment regarding Medicare Set-Asides in Liability Cases

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