In recent years, the Medicare Secondary Payer Act has wreaked havoc upon States Workers’ Compensation Systems. Worse still, injured workers have suffered from intolerable delays and onerous new regulations before they can resolve their claims often waiting a year, even more. CMS and their contractors refuse to admit they are overwhelmed and incompetent to handle the workload as has been cited by the General Accounting office. Clearly a change is needed. A Bill now before Congress can bring much needed relief for injured working people. It is HR 2549 (PDF) entitled: “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2007″.
This bipartisan proposal will exempt workers’ compensation settlements less than $250,000 or those settlements with a present value of less than $250,000. It includes a built-in escalator for future settlements which will raise the $250,000 floor over time. This legislation also provides an alternative to the set-aside process for settlements larger than $250,000 by creating a safe harbor set-aside amount of 10% of the settlement. It will also allow for direct payment to Medicare of the set-aside amount in lieu of administration of the trust. The Bill provides a clear process for appeals from any determination. It also requires Medicare to recognize and be bound by decisions on issues of compensability by the various States Workers’ Compensation Courts and Administrations. This law, if passed, will also require Medicare to respond to conditional payment requests within 60 days.
Those that would argue that this Bill provides a windfall to the insurance industry are missing the point. It is the worker who suffers the delays in receiving compensation for injuries wrought by Medicare’s ineffective administration. Passage of this legislation will clear the backlog in the State’s workers’ compensation systems and allow workers’ to make decisions concerning their pending cases in a more predictable and certain environment without fear of being subjected years later to disruptions in benefits.