Do you need an MSA? Questions to Ask

Wondering if you need an MSA for your Auto or Liability case? Medicare Set-Asides are a vehicle to make certain that Medicare maintains its “secondary payer” status. If payment can reasonably be expected to be made under an automobile or liability insurance policy, they are defined in the statute as a “primary plan.” It then follows that Medicare should only pay if the primary payer’s funds for the underlying case have been exhausted. This statement is the basis for any MSA.

 

An MSA may be necessary wherever a settlement honestly anticipates the need for future medical care and provides for the funding of that care. Alternatively, the parties must avoid being found to have intentionally shifted future costs to Medicare and away from a primary responsible party (i.e., the defendant, notwithstanding settlement agreements’ denials of liability).

 

At MASSIVE, we analyze the need for an MSA by addressing four questions: 

1. Did the plaintiff plead for and did the defendant release future medical expenses?
2. Does the plaintiff honestly and more likely than not require future medical care?
3. What allocation methodology has been used to determine future medical needs?
4. What methodology protects Medicare from paying for future medical expenses?

 

So, do you need a Medicare Set-Aside? Contact us if you have any questions and want to discuss your case.