MAJ Lunch and Learn Q&A
MASSIVE COO and attorney, Ryan Weiner, Esq., recently presented to the Michigan Association for Justice on how Michigan’s No-Fault Reform impacts Medicare liens. Michigan’s no-fault has changed from always unlimited to various limits (including, for some drivers, unlimited). The following are questions Ryan received during that presentation and Ryan’s answers.
Question: “CMS will still send a letter stating it knows we settled a liability case even when there is unlimited no-fault. We send them a letter giving them the no-fault information. Is there something else we should send to CMS?”
Answer: Yes. CMS’s agent, in this case the BCRC, does not care that no-fault is unlimited. It believes it has a right to the Michigan Liability settlement. Your best course of action is to prove otherwise. Notify BCRC, via an appeal, that No-Fault is unlimited and therefore the liability case (whether BI, UM, or UIM) cannot and did not legally include medicals. BCRC should then close the liability file.
Question: “With No Fault Reform, is Medicare now able to claim a lien or collect conditional payments on third party claims where the plaintiff does have unlimited PIP still?”
Answer: No. If PIP/No-Fault is unlimited, then it legally follows that all medicals are to be paid from that insurer and settlement. Nothing in the law allows the corresponding liability case to include damages for medicals. Always ask: Can my case include medicals? If the answer is no, then Medicare should not have a right to collect a Medicare lien.
Question: “I have a $250,000 PIP Policy and settlement is made for $150,000. How do you calculate what Medicare may be owed in the future on the third-party payment, seeing there is still $100,000 on PIP medical?”
Answer: In this scenario, the liability case can also include medicals. So the $100,000 PIP remainder is not completely relevant. A future medical allocation – or Medicare Set-Aside – will start by considering all case-related future needs. This calculation remains the same regardless of how much PIP or liability coverage remains. Additional tools can be used to determine what portion of a remaining settlement should be allocated to cover that MSA. As of February 1, 2022, Medicare will not review NFMSAs or LMSAs.
Question: “How does Defense report end of Ongoing Responsibility for Medical (‘ORM’) if the case with unlimited PIP is settled but there’s ongoing treatment?”
Answer: Defense or the insurance carrier will only report ORM if it has no legal responsibility for that future treatment. If unlimited PIP still exists and future benefits are not waived in a PIP settlement, then, defense should not report ORM. If future benefits no longer exist, this scenario may call for a Medicare Set-Aside.
MASSIVE is here to help! If you are interested in increasing your client’s net recovery and eliminating the unnecessary time spent resolving liens yourself, contact us today!