Medicare Secondary Payer Statute and Workers Compensation Settlements

Is the total settlement amount less than $25,000?

Yes

The total amount of the settlement includes, but is not limited to, wages, attorney fees, all future medical expenses, and repayment of any Medicare conditional payments. If an annuity is included as part of the settlement, the payout totals for all annuities to fund the above expenses should be used rather than cost or present values of any annuities. Further, any previously settled portion of the WC claim must be included in computing the total settlement amount. See the April 25, 2006 CMS memo.

Facts Established:

1) The settlement is closing the claimant's rights to future medical benefits that would otherwise be payable under the workers' compensation claim.
2) The claimant is currently eligible for Medicare.