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Claimant Files Breach of Contract Claim for Alleged Delay in Addressing Medicare Compliance Issues

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 TPA, and the employer/TPA’s MSA vendor for breach of contract and intentional infliction of emotional distress. The United States District Court for the Northern District of Iowa granted the defendants’ motion to dismiss Shaw’s claim of intentional infliction of emotional distress and determined that emotional distress damages were not appropriate in this matter. However, the court did allow Shaw’s breach of contract claim to proceed.

It is unclear what the specific allegations were regarding the cause of the delays. Delays in Medicare compliance work is often a result of Medicare’s practices, rather than the action of the parties, and the circumstances surrounding any alleged delays in this matter are unclear. Additionally, it remains to be seen whether Shaw’s breach of contract claim will be successful. We will provide an update if the court publishes additional information regarding this case.

Recently, we have been receiving CMS approval of Medicare Set-asides and information regarding Medicare conditional payment claims very quickly. Please let us know if we can assist you with the handling of your Medicare compliance needs.

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