Set-Asides Without Safe Harbor

In May 2013, this blog reported that a New Jersey court had done what the Centers for Medicare & Medicaid Services (CMS) declined to do. In Duhamell v. Renal Care Group East, Inc., 431 N.J. Super. 93 (Law Div. 2012), the Superior Court in Atlantic County approved two self-administered Medicare set-asides after CMS refused to review them, citing limited resources. Thirteen years later, CMS still will not grant a safe harbor outside its own review process, but it now sees nearly every set-aside that gets created. For injured workers in New Jersey, that shift changes the calculus of every lump-sum settlement.

Coverage Gaps Become Compensation Claims

Medicaid cuts, lapsed subsidies and Medicare Advantage exits will push more medical costs into workers' compensation.

Asbestos Claims Clock Runs Out

Quebec’s Court of Appeal has refused to disturb the Asbestos Corporation Limited claims regime. For American workers’ compensation practitioners, carriers, and self-insured employers, the September 10, 2026 bar date is now the only date that matters.

Libby Care Dies Quietly

The federal model for occupational disease care collapsed in Montana. Workers’ compensation inherits the wreckage.

Chevron Gone, Benefits Threatened

Two Years After Loper Bright: Workers' Compensation, the Administrative State, and a Coming Reckoning Over Social Security

Medicaid Cuts: Workers' Compensation Pays?

Trump Administration's Medicaid Work Requirements May Shift Enormous Costs to Employers and Workers' Compensation Insurers

Hemp, Medicare, and Workers' Compensation

A federal district court in the District of Columbia has dismissed a challenge to a novel Medicare hemp-access program, ruling that the plaintiffs lacked standing to sue. The decision in Smart Approaches to Marijuana v. Kennedy (D.D.C. May 22, 2026) has significant implications for healthcare providers, insurers, and workers' compensation practitioners navigating the rapidly evolving landscape of cannabis-related medical treatment.

CMS Tightens WCMSA Compliance Rules

The Centers for Medicare & Medicaid Services (CMS) has released Version 4.5 of the Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, dated April 13, 2026 (COBR-Q2-2026-v4.5). While the technical updates in this version are modest, they come amid sweeping enforcement changes that every workers' compensation practitioner must understand.

CMS Penalties Hit Workers' Compensation

Workers' Compensation - Medicare Secondary Payer Compliance

Healthcare Costs Crush Workers' Compensation

The cost of medical treatment is not just rising — it is accelerating. And nowhere is this felt more sharply than in the workers' compensation system, where medical payments now constitute a dominant and growing share of every claim. What was a slow-burning crisis a decade ago has become an urgent structural challenge for employers, insurers, policymakers, and injured workers alike.

Health Reimbursement Rules Impact Claims

How IRS Coverage Mandates Affect Workers' Compensation Costs in 2026.

Medicare's Post-Acute Care Crisis

Post-acute care has emerged as a critical pressure point in workers' compensation claims, driven by Medicare policy changes and skyrocketing costs that directly impact claim settlements and future medical allocations.

WCMSA Gap Widens Dramatically

The Centers for Medicare & Medicaid Services (CMS) has released its fiscal year 2025 statistics for Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs), revealing a striking trend that should concern workers' compensation professionals: the gap between what parties propose and what CMS recommends is at an all-time high.

Podcast: Chevron Falls: Workers' Compensation Survives

This podcast reviews the workers' compensation landscape one year after the US Supreme Court's Loper Bright decision, which struck down the Chevron defense.

Chevron Falls: Workers' Compensation Survives

A year ago, we examined how the Supreme Court's landmark decision in Loper Bright Enterprises v. Raimondo might reshape the workers' compensation landscape, particularly regarding Medicare Set-Aside (MSA) agreements and the Centers for Medicare & Medicaid Services' (CMS) administration of the Medicare Secondary Payer (MSP) Act. Now, with twelve months of hindsight, we can assess what has actually transpired—and what remains uncertain.

Shutdown Threatens Workers' Compensation Settlements

As the September 30 deadline looms, workers' compensation professionals nationwide face an unprecedented crisis that could freeze thousands of settlements, leaving injured workers in a state of financial limbo.

Navigating Physician Payment Changes

The Centers for Medicare & Medicaid Services (CMS) has recently unveiled its proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS). This proposal outlines significant changes that will shape how physicians are reimbursed for their services going forward, and stakeholders will need to understand the potential implications.

WCMSAs: What You Need to Know

The Centers for Medicare & Medicaid Services (CMS) recently hosted an informative webinar on Workers' Compensation Medicare Set-Asides (WCMSAs), shedding light on these crucial financial agreements and their impact on workers' compensation claims. 

Medicare Set-Aside Shake Up Ahead?

Awaiting a decision from the U.S. Supreme Court, Federal Communications Commission v. Consumers' Research is poised to potentially redefine federal administrative agencies' authority scope. This shift could flow into various regulatory processes, including the Workers' Compensation Medicare Set Aside Agreements (WCMSAs) adjudication. 

DOGE and Medicare Set Aside Agreements

This is the first in a series of posts concerning the potential impact of the US Department of Government Efficiency (DOGE) on the nation's patchwork of workers' compensation systems.