Category Archives: Allocation

Allocation, Blog, Medicare Set Aside, Trial Practice

On November 21, 2013, the Oklahoma Civil Court of Appeals decided a case about whether an Employer was forced to disburse a proposed Medicare Set Aside amount, when it was later determined Claimant was ineligible for Medicare benefits.  The ruling was for the Employer and against the Claimant.  In this case, the settlement included a clear record regarding the Medicare …
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Allocation, Medicare Conditional Payments, Uncategorized, WCMSA

On December 17, 2012 CMS announced they will be updating the life tables that allocators use when calculating life expectancy in WCMSAs. The impact will be an overall increase in life expectancy, although minimally, which will result in slightly higher costs in some situations. It is important to know that if a file has a pending WCMSA timely submission is …
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Allocation, Medicare Conditional Payments

Case Summary: Lee vs. Small and Toft, Small v. Lee, Small v. Brown, 829 F. Supp. 2d 728; 2011 U.S. Dist. LEXIS 135054; US Dist. Crt. Northern Division of Iowa, Western Division Background Facts of Case: On November 13, 2009 Seth T. Small, employed by Toft & Sons Farm, was driving a farm tractor while pulling a wide piece of …
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Allocation, LMSA, Medicare Conditional Payments, Medicare Set Aside

Bertrand v. Talen’s Marine & Fuel LLC, 2012 US Dist. LEXIS 78053 (U.S. Dist. Court for the Western District of Louisiana, 6/4/2012). Facts: (A condensed version of the Court’s Findings of Fact are set forth below): Plaintiff was injured in a workplace accident, and he was employed, at the time, by defendant Talen’s. As a result of the accident, plaintiff …
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Allocation, Medicare Conditional Payments

Sorrell vs. Lakeview Regional Medical Center 2012 U.S. Dist. LEXIS 70519 (U.S. Dist. Court for the Eastern Dist. of Louisiana) Facts:  Plaintiffs are the children of Joanne Sykes who died while a patient at Lakeview Regional Medical Center.  They filed a claim against the facility for negligent treatment and received a settlement of $15,000.  Joanne Sykes was a Medicare beneficiary …
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Allocation, Blog, Medicare Conditional Payments, Reimbursements

Most states follow the rule that a plaintiff can recover more than what an insurer pays when it comes to medical bills paid related to the incident. However, a growing number of states are beginning to consider the practical application of rules limiting such awards to those payments actually made by the insurer. In Haygood v. Escabedo, 2011 Tex. LEXIS …
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Allocation, Blog, Medicare Conditional Payments

In 1980, Congress passed the Medicare Secondary Payer Act (MSP) in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). In doing so, it constructed this law with several safeguards to protect the integrity of the Medicare Trust Fund. One of these is the …
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Allocation, Blog, Medicare Conditional Payments

If decedent is a Medicare beneficiary, be thoughtful about preparing for the related wrongful death action claim.  Medicare most likely will be entitled to reimbursement for the decedent’s related medical expense if there is a settlement, judgment or award.  The wrongful death claimants are not protected from Medicare’s reach, but practitioners may seek refuge through proper planning. Segregate the claims …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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Allocation, Blog, Medicare Conditional Payments

The Medicare Secondary Payer Act (MSP) was passed in response to a dramatic increase in Medicare expenditures. See Baptist Mem’l Hosp. v. Pan Am. Life Ins. Co., 45 F.3d 992, 997 (6th Cir. 1995). “In the MSP statute Congress made Medicare coverage secondary to any coverage provided by private insurance [and self insureds] programs. It did so in order to …
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