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Jonathan Ginsberg


Thank you for an excellent summary of how the Medicare Set Aside works. We are finding that the Set Aside does not come into play in Class I cases if the claimant has not yet filed for Social Security disability. At the same time, a claimant's insurability for SSDI runs out within a few years after stopping work so it is not always possible for the claimants to hold off on filing. As is the case in most workers comp matters, timing is everything.

Jonathan Ginsberg--

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Craig Hughes

How does one settle with liability insurance when Medicare has not filed a lien? Maximum recovery has occurred and the liability limits have been met.

Chris Nichols

Response to Craig's question above:

Craig, well, first of all, Medicare does not have to "file" a lien. There is no notice provision in Medicare Third Party recovery. If you know that your client has Medicare (or should know) then you are considered "on notice" of the lien.

Lawyers all over the U.S. have the same problem you have: the claim exceeds the liability policy limits, the liability policy tenders, and you can't get Medicare to tell you the exact amount of the lien. For liens on past medicals paid, the best you can do is to "pre-figure" the Medicare lien reduction, and hold that money in trust. I've set that formula out in this post:

Then you just have to pester Medicare until they send you the "final pay" letter. In NC at least, we've seen waits of one to two years in some cases.

Now, if you were talking about MSA's in liability cases (for future medicals) my position is that they do not exist right now (except in workers comp cases).

I hope this answers the question. If it doesn't maybe you can add a little more to the question.

Chris Nichols

Stephen Larocque

I noticed that the information regarding the MSA's for Liability cases is a couple of years old. Has there been any progress? Is there any links to information regarding this aspect?

Stephen Larocque


Assuming there has been total compliance with Medicare's lien, short of consistenly pestering Medicare, is there some action attorneys can take to somehow expedite their clients receiving their settlement after Medicare has taken control over it?


i am trying to settle my w.c. and we are waiting on medicare to tally up what i will be getting. how long does this process take? i am in georgia.

Chris Nichols

It ia always difficult to judge how quickly Medicare will respond to any request. In years past it sometimes took a year or more for them to get back, but in recent years the times have shortened considerably. If you have a lawyer, they should be able to give you some estimate based on prior cases. Also, it depends on what stage of the request process you are in.

avery lewis

how do i find a lawyer to help me get a reduction of my MSA

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