Boca Raton, FL – Using a sample of proposed workers compensation settlements, a new NCCI report looks at demographics and the review process related to MSAs. Some workers compensation claimants are eligible for Medicare benefits, or will become eligible in the near future. By law, Medicare is a secondary payer for work-related injuries—workers compensation should pay for medical services for such injuries. Workers compensation insurers (including self-insureds) are therefore required to protect Medicare’s interests when settling claims.
In 2013, the Centers for Medicare & Medicaid Services (CMS) approved $1.8 billion of workers compensation Medicare Set-Asides (MSAs). (An MSA is a fund established to pay future work-related-injury medical costs that might otherwise be paid by Medicare).
Using a sample of proposed workers compensation settlements who’s MSAs have been reviewed by CMS, this NCCI research report looks at:
Demographics related to MSAs, such as:
- The distributions of amounts of MSAs and total settlements that include MSAs
- The distributions of amounts of ages of claimants
Aspects of the CMS review process, such as:
- The length of time from submission to CMS approval
- The relation between submitted and CMS-approved MSA amounts
Key Findings
- After a period of dramatic lengthening, CMS’s processing time for MSAs has recently declined
- The ratio of CMS-approved MSA amounts to submitted MSA amounts has declined over time
- The differences between proposed and approved MSA settlements have been largely due to prescription drug costs
- Most MSAs are for claimants who are Medicare-eligible at the time of settlement – Most of these claimants are Medicare-eligible because they have been on Social Security Disability for at least two years
- MSAs make up about 40% of total proposed settlements – Of this 40%, prescription drugs make up half
Click here for a copy of the study: NCCI: Medicare Set-Asides (MSAs) and Workers Compensation (PDF)
Source: NCCI