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MSA for WC Cases

Under WC cases, two monetary thresholds exist in order to be eligible for an MSA. (1) if the WC claimant is a Medicare beneficiary and the total settlement is greater than $25,000; and (2) if the claimant is not a Medicare beneficiary but has a “reasonable expectation” to become eligible within 30 months of settlement date and total settlement is greater than $250,000.

Total settlement includes, but is not limited to, wages, attorney fees, future medical expenses, repayment of conditional payments, and payout totals for all annuities. CMS states the “threshold” is a set of guidelines, not a bright-line rule. In other words, even though a recipient does not fall into a category, this does not provide a safe harbor relief provision for a primary payer. Reasonable expectation may include persons applying for social security disability, if a person has End State Renal Disease or is 62 ½ years old (potentially eligible).