Liability Allocation Services
Liability / No-Fault Auto
Prior to the implementation of MMSEA Mandatory Insurance Reporting MIR requirements, Medicare could not track Medicare Secondary Payer compliance in liability and no-fault auto cases. Now, vast amounts of data will be reported to Medicare on a regular basis if the case involves a Medicare eligible individual. It is recommended that an allocation be included in certain liability and no-fault auto cases to protect the Carrier, Self-insured, Plaintiff and Medicare. Gould & Lamb has developed the Claim Settlement Allocation CSA, Liability Settlement Allocation LSA and Liability Medicare Set-Aside LMSA to serve these needs.
The products are produced by a multidisciplinary team of in-house attorneys, pharmacists and nurses. They are accepted by Medicare as a means of demonstrating adequate consideration of Medicare’s future interest and represent the lowest medically indicated and defensible allocation. They will shield the Claimant/Plaintiff’s settlement proceeds from Medicare recovery and is the recommended method of MSP compliance in liability and no-fault auto cases.
Claim Settlement Allocation - CSA
A Claim Settlement Allocation is recommended in liability cases if the Plaintiff’s injuries include one of the following general orthopedic injuries: cervical neck sprain/strain or cervical disc problems, mid and/or low back strain/sprain, lumbar disc problems, sciatica, shoulder sprain/strain, rotator cuff injuries, elbow sprain/strain, epicondylitis, carpal tunnel syndrome, wrist sprain/strain, knee or hip sprain/strain, fracture, or joint replacement, and/or ankle sprain/strain or fracture.
A Claim Settlement Allocation is recommended in Workers’ Compensation Claims that involve a Medicare beneficiary and the total claim settlement value is less than $25,000 or reasonable expectation of Medicare eligibility and the total settlement value is less than $250,000.
Liability Settlement Allocation - LSA
A Liability Settlement Allocation is recommended in liability cases if the Plaintiff’s injuries include one of the following: complex regional pain syndrome, chronic pain or failed back syndrome that requires a spinal cord stimulator/dorsal column stimulator or intrathecal pain pump, major psychiatric condition requiring long term monitoring, including major depression with suicidal ideation and post traumatic stress disorder, immunodeficiency and/or vision or hearing loss which requires a prosthesis or implant.
Liability Medicare Set-Aside - LMSA
A Liability Medicare Set Aside is recommended in liability and no-fault auto cases if the total claim settlement value is greater than $250,000 or the Plaintiff’s injuries include one of the following catastrophic claims: spinal cord injury, traumatic brain injury, toxic exposure, multiple trauma with multiple organ/orthopedic involvement, amputation with prosthesis, burns and/or organ transplants. The Liability Medicare Set Aside may be submitted to Medicare for review and approval.
For more information on Gould & Lamb’s Claim Settlement Allocation services, contact us at 1-866-MSA-File and ask to speak with your Regional Claims Consultant or Client Service Representative.