CUTTING EDGE INDUSTRY THOUGHT LEADERSHIP INSIGHTS

Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.

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How the Advent of the Mandatory Insurer Requirement Causes Problems for Lawyers

How the Advent of the Mandatory Insurer Requirement Causes Problems for Lawyers

As of April 1, 2011, a Responsible Reporting Entities/insurers (RRE), (liability insurer, self-insurer, no-fault insurer, and workers’ compensation carriers) must determine whether a claimant is a Medicare beneficiary (“entitled”) and if so, provide certain information to the secretary of Health and Human Services (hereinafter “secretary”) when the claim is resolved. This is the so-called Mandatory Insurer Requirement, MIR for short.

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Nathan Carter on TLV Podcast

In Episodes 3 & 4 of Trial Lawyer View, TLV host and Synergy CEO Jason D. Lazarus has a wide-ranging heartfelt discussion with Nathan Carter of Colling Gilbert Wright & Carter about representing him after he was struck by a car while cycling, cases Nathan has handled that have made a difference, his philosophies on […]

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The Unregulated New Frontier of Medicare Set-Asides

The Unregulated New Frontier of Medicare Set-Asides

Consider this scenario: you represent a current Medicare beneficiary in a third-party liability case. As part of the workup of the case, you determine the client will need future medical care related to the injuries suffered, and you settle the case. Since the client is a Medicare beneficiary, the defendant will report the settlement under the Mandatory Insurer Reporting law as it is greater than $750 in gross settlement proceeds.

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What is a Medicare Set-Aside?

What is a Medicare Set-Aside?

For many years, personal injury cases have been resolved without consideration of Medicare’s secondary payer status even though since 1980 all forms of liability insurance have been primary to Medicare. At settlement, by judgment or through an award, an injury victim would receive damages for future medical expenses that were Medicare-covered. However, none of those settlement dollars would be used to pay for future Medicare-covered health needs. Instead, the burden would be shifted from the primary payer (liability insurer or workers’ compensation carrier) to Medicare. Injury victims would routinely provide their Medicare card to providers for injury-related care.

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Workers Compensation , MSA

Workers’ Compensation Medicare Set-Aside (WCMSA) Arrangement

April 8, 2021 Rasa Fumagalli JD, MSCC, CMSP-F The nature of the Workers’ Compensation Medicare Set-Aside (WCMSA) has evolved over the years since the 2001 Patel Memo. That evolution has seen us move from every WCMSA that met the Center for Medicare and Medicaid Services (CMS) internal workload review threshold being submitted to CMS for […]

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Why Qualified Settlement Funds are an Important Tool for Trial Lawyers to Understand

Why Qualified Settlement Funds are an Important Tool for Trial Lawyers to Understand

What do you do when you settle a case like this where your client is on public assistance, there are allocation issues, settlement planning issues must be addressed, and there are liens to negotiate? Where can you “park” the money while you set up any necessary public benefit preservation trusts, determine allocation of the proceeds, figure out a financial plan, and negotiate the liens?

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What are Your ERISA Plan’s Recovery Rights?

What are Your ERISA Plan’s Recovery Rights?

Most, if not all, ERISA health insurance plans state that injuries caused by a liable third party are not a covered expense and require reimbursement when a plan pays for injury-related medical expenses (often referred to as subrogation clauses). ERISA provides that health plans which qualify under its provisions can bring a civil action under section 502(a)(3) to obtain equitable relief to enforce the terms of the plan. Appropriate equitable relief is really the only enforcement mechanism an ERISA plan can utilize to address its reimbursement rights contained in the plan.

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Sean Domnick on TLV Podcast

In Episodes 1 & 2 of Trial Lawyer View, TLV host and Synergy CEO Jason D. Lazarus has an engaging conversation with American Association for Justice Secretary, Sean Domnick of Domnick Cunningham & Whalen. They discuss the importance of work-life balance, learning to choose your battles, finding your niche to really make an impact, and […]

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Confused by Medicare? Here’s a Helpful Overview

Confused by Medicare? Here’s a Helpful Overview

The Medicare program—and the related Social Security Disability Income/Retirement benefit (SSDI)—is one of the primary benefit programs available to those who are injured and disabled. Understanding the basics of this program is imperative to protecting the client’s eligibility for their benefits.

Medicare and SSDI benefits are an entitlement and are not income or asset sensitive. Clients who meet Social Security’s definition of disability and have paid enough quarters into the system can receive disability benefits regardless of their financial situation.

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