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CMS's first statement regarding the thresholds for workers' compensation
cases settled by injured workers who are not yet Medicare beneficiaries
was expressed in its memo of July
23, 2001. If a claimant has a reasonable
expectation of Medicare enrollment within 30 months of the settlement
date and the anticipated total settlement amount for future medical expenses
and disability/lost wages over the life or duration of the settlement
agreement is expected to be greater than $250,000, then approval by CMS
of the workers' compensation settlement is required.
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 July
11, 2005 CMS memo, Q&A
2.
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