The United States Court of Appeals for the Ninth Circuit recently issued a significant decision for State Guarantee Associations. In California Insurance Guarantee Association v. Azar, 2019 U.S. App. LEXIS 30339 (9th Cir. 2019), the Court held that CIGA is not a primary payer under the Medicare Secondary Payer Act (MSPA) and thus, is not responsible to reimburse Medicare for its conditional payments.  CIGA is an insolvency insurer under California law and pays certain covered claims when its ins...

CMS recently released Version 1.3 of its Self-Administration Toolkit for WCMSAs. The Toolkit is a resource for claimants who intend to self-administer their Workers Compensation Medicare Set-aside (WCMSA). The newly released version remains primarily the same. However, there are a few notable changes, most of which are designed to address the WCMSA Portal and use of the same. Section 8 of the Toolkit, which addresses the annual attestation, now contains language indicating that a claimant may su...

Last month the Commercial Repayment Center (CRC) held a conference call regarding the substantial backlog of unworked conditional payment claim leads.  The CRC indicated that there are over 330,000 potential leads and that they have been mandated to “catch up” on collecting the monies owed to Medicare.  With such a large number of leads comes the potential for an inundation of correspondence from the CRC.  These leads will result in either conditional payment letters (CPLs) or conditional paymen...

Plaintiffs, MSP Recovery Claims, Series LLC (MSP Recovery), asserted a putative class action suit against Defendant, AIX Specialty Insurance Company (AIX) under the Medicare Secondary Payer Act.  MSP Recovery Claims v. AIX Specialty Ins. Co., 2019 U.S. Dist. LEXIS 86051 (M.D. Fla. May 22, 2019).  MSP Recovery was assigned recovery rights from various Medicare Advantage Organizations (MAO) and, in two exemplar cases, MSP Recovery asserts that AIX failed to reimburse the MAO for conditional paymen...

The plaintiff, Teodora Shaw, alleged two separate work-related injuries during her employment with defendant Whirlpool.  The parties reached a settlement agreement contingent upon Whirlpool’s satisfaction of any Medicare conditional payment claims that may exist as well as CMS approval of a Medicare Set-aside. 

Following what Shaw asserted to be undue delay in obtaining CMS approval of the Medicare Set-aside and resolution of conditional payment claims, Shaw filed suit against Whirlpool, its...

Plaintiffs, John Lenge and his wife, filed suit after John allegedly sustained an injury at work.  On the first day of trial, the parties entered into a settlement agreement.  The settlement agreement was memorialized on-the-record in open court.  As part of the terms of the settlement, Plaintiffs’ counsel and the Plaintiffs acknowledged the possibility of establishing a Medicare Set-aside as part of the settlement.  Plaintiffs also agreed to pay any Medicare liens that may have existed.  Later,...

In Marshall v. Workers’ Compensation Appeal Bd, (2019 Pa. Commw. Unpub. LEXIS 192, (Commonwealth Ct. of Penn. March 14, 2019)), the Commonwealth Court of Pennsylvania was faced with the issue of whether or not the Claimant’s partially funded Medicare Set-aside (MSA) was subject to subrogation by the Employer. The Claimant, a bus driver who was injured on the job, received a settlement of approximately $1.3 million from the Employer’s UIM carrier. The UIM settlement also provided the Claimant wit...