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Sunday, December 15, 2013

Settling a Workers’ Compensation Claim – Future Medicals and Medicare

Guest post by Kristina Brown Thompson of the North Carolina Bar and a member of the The Jernigan Law Firm.

Will Medicare cover my future medical expenses for my workers’ compensation injury if I settle my case? Yes, no, maybe…the answer to this question is always a tricky one. In fact, this is one of the most complex questions that will confront an injured worker at the time of settlement.
Kristina Brown Thompson

Most settlements are final. Once you agree, you may have created a binding contract that will have serious financial repercussions for you and your family. It’s best to be prepared ahead of time so you fully understand the potential impact of a settlement. Settlement agreements cannot be set aside except in very rare circumstances. Before settling your case, you should take a full accounting of your future medical expenses and your insurance coverage. In reviewing your medical needs, do not forget to account for over-the-counter medications. These costs add up quickly over time.

If you are already a Medicare beneficiary, it’s quite likely you will need to set aside a portion of your settlement for future medical expenses. Medicare may refuse to pay for medical coverage relating to your injuries unless you’ve allocated some of the settlement funds for future medicals. Determining how much to set-aside is another complicated question and usually an outside company is hired to help assist with this determination.

Furthermore, injured workers must also take into consideration the fact that there are certain medical expenses that Medicare may not cover. For example, when an injured worker needs someone to take care of them. Medicare will not pay for these services so the injured worker would be forced to pay if she failed to negotiate this amount prior to settlement. Also, even when Medicare does help foot the bill, the injured worker will still likely pay the coinsurance amount (typically 20%). In short, be careful and think about future medical expenses.

Kristina Brown Thompson, born Columbia, South Carolina, January 20, 1980; admitted to bar, 2008, North Carolina. Education and Certifications: University of North Carolina at Chapel Hill (B.A., 2002); North Carolina Central University School of Law (J.D., 2008). Bars and Courts: Admitted to North Carolina State Bar in 2008. Affiliations: North Carolina Advocates for Justice (Member, Workers’ Compensation Section; Member, Auto-Torts Section); North Carolina Bar Association (Member, Workers’ Compensation Section ; Member, Young Lawyer’s Division ); and the North Carolina Association of Women Attorneys (Member, Wake County) .Primary Areas of Practice: Workers’ Compensation, Personal Injury.E-mail: