STEVEPSCA@YAHOO.COM
Senior Member
Posts: 990
Joined: Jun 2002
|
Monday February 16, 2009 12:02 PM
|
|
You said....
<< the amount place in this account and hasn't touch for 3 years or more....THEN....Still waiting for MSA approval from the CMS. >>
Which is it..? If you are 'still waiting' on CMS... HOW can there be money in a WCMSA now.. ?
Regardless... it is not in your best interest to settle a claim BEFORE you have the approval letter from CMS/Medicare with the determination, IF you need a setaside, and HOW MUCH money is required to fund the account.
Additionally, as you can only use those funds for services Medicare would 'normally be responsible for', you also need a WCMCA/WC Medical Custodial Account. That is money, you don't have to account to CMS for annually, that is used to pay for those services you can't use the setaside fund for...eg. co-pays, deductibles, and any other items, such as the ramp and/or scooter. Medicare will require you to pay out of pocket 20% 'co insurance' for those items...that money can't come from the setaside account.
<< It is my money anyway from my structured settlement. >>
Yes, when you die, if there are funds remaining in the account, those monies would go to your estate. But only after the final accounting to CMS/Medicare has been approved.
You should understand though, the money you receive for future medical treatment, and/or a setaside account is not actually part of your 'award' for your injury. If there were no need for the WCMSA, you would not have received that money in the first place.
Your 'award' in a WC settlement is the indemnity associated with the PD/WPI rating...the amount of impairment due to your injury.
<< Can I use my medical set aside to buy a ramp van and scooter? since it was approved by my workkers comp doctor before we settled >>
The payment for treatment/services/durable medical equipment you may need due to your injury isn't provided based on the 'approval' of your PTP, but that of the ER/IC/CA after the UR process has been used to determine medical necessity.
If your ramp/scooter have been approved through the process... then Why would you be paying for these out of your setaside account ?
If it's authorized prior to the settlement, then the ER/IC should be providing the items.
Still waiting for MSA approval from the CMS
For WHAT ?
If you are waiting for approval to reduce the amount in the setaside account... it's not going to happen.
If you are waiting for the approval letter on the account... then the ER/IC is still holding liability for any FMT you need.
If you haven't actually 'settled' this claim... you should be discussing with your AA ALL of the associated issues regarding the actual WCMSA, and WCMCA accounts. At this point, from what you are providing here, this isn't in your best interests.
|
|
