On October 5, 2020, CMS released version 3.2 of its Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide.

Medicare coverage is not limited to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage Plans (Part C) are also an available option for Medicare beneficiaries.

In the words of Ralph Waldo Emerson, every sunset brings the promise of a new dawn. For first responders and front-line workers affected by COVID-19, the sunset provision of House Bill 4276 extends the promises and benefits of the COVID presumptive laws from December 31, 2020 to June 30, 2021.

The phrase “no risk, no reward” is especially relevant in workers’ compensation, where risk is central to a compensable injury.

The concept of risk is a heavily debated, highly contentious, and extremely nuanced area of Illinois Workers’ Compensation law. 

I recently wrote about Section 111 Total Payment Obligation to Claimant (TPOC) reporting in bifurcated settlements.

Although our nation is currently focused on the COVID-19 pandemic, the opioid abuse epidemic continues to claim many lives.

Prescription drugs can make up a large part of a Medicare Set-Aside.  Since Medicare prices future prescription drugs using average wholesale price, the ultimate cost of the drugs through a pharmacy benefits manager (PBM) is often less than the average wholesale price.

Almost every Workers’ Compensation Medicare Set-Aside (WCMSA) includes future diagnostic imaging studies, usually x-rays and MRIs.

Most workers’ compensation claims adjusters would agree that the best claim is a closed one.