If you are an injured worker who:

  1. Was injured in Virginia and has an open Virginia Workers Compensation Claim
  2. Is on Medicare, AND
  3. you have filed for Social Security (or are otherwise eligible for Medicare benefits)

When you settle your Virginia workers compensation claim, you and the insurance company have to get approval from Medicare.

This often a very lengthy process and many times the entity overseeing the settlement for Medicare will require a self-administered Medicare Set-Aside fund.

What Is a Self-Administered Medicare Set-Aside Fund?

This means that a portion of your settlement money must be used for future medical care related to the work related injured body part(s).  Once those funds have been exhausted, then Medicare will start cover your bills. You will get the funds and need to place the money in an interest bearing account to use for your future workers compensation related medical care that Medicare would have to pay for.

Injured workers who have a Self-Administered Medicare Set-Aside fund need to keep excellent records in order to ensure that they are in compliance with the Self-Administered Medicare Set-Aside fund. The Centers for Medicare and Medicaid has now come up with a tool kit for injured workers which explains this process and breaks down what records and expenses the injured worker needs to keep track of. This is a great tool for anyone who has a Self-Administered Medicare Set-Aside fund stemming from a workers compensation injury settlement. If you would like a free copy of the tool kit, please feel free to contact my office and my staff will be happy to provide you with one.