Frequently Asked Questions
Workers Comp and Medicare Set-asides

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Q4. Avoiding the Continuation of Indemnity Payments While Waiting for CMS to Review a WCMSA

Is there a way to avoid the continuation of indemnity payments while awaiting a CMS determination on a proposed WCMSA?
A4. Yes. To avoid this situation, CMS recommends that the claimant (or the claimant's representative) close out the indemnity portion of the settlement and leave the settlement of medical expenses open pending a determination by CMS on the proposed WCMSA. In determining the review thresholds, the total settlement amount, including indemnity and medicals, shall be used.

Note that the computation of the total settlement amount includes, but is not limited to, wages, attorney fees, all future medical expenses, and repayment of any Medicare conditional payments, and that payout totals for all annuities to fund the above expenses should be used rather than cost or present values of any annuities. Also note that any previously settled portion of the WC claim must be included in computing the total settlement amount.