Medicare Set-Aside Programs & Life Care Planning

Worker’s Compensation carriers are under increasing pressure to consider and protect the interests of Medicare when settling claims. In fact, under Federal law, any entity found to be not protecting Medicare interests in future medical costs can be held liable for double damages.

In order to protect Medicare interests, an appropriate amount of settlement money must be “set-aside” for the payment of future medical costs that would otherwise be Medicare compensable. And under certain circumstances, the amount to be set aside must be approved by Medicare.

To assist Worker’s Compensation carriers in meeting these obligations, the GENEX Medicare Set-Aside Program determines the appropriate set-aside amount based on an expert analysis of the condition, current treatment, projected future treatment, and life expectancy. Our staff, highly trained in Medicare Set-Aside, is then able to secure Medicare approval through a Medicare Set-Aside Proposal submitted to the Centers for Medicare and Medicaid Services (CMS).

Life Care Planning

Life Care Planning allows adjusters and attorneys working with disabled individuals to plan for the future with the knowledge of when and how the expenditures for care will be allocated, allowing for financial planning and the setting of reserves from provider sources. Life Care Plans also provide an excellent tool for claim settlement negotiations.

Highly qualified GENEX professionals with more than 25 years of experience in Life Care Planning are able to accurately establish and quantify medical damages resulting from an injury. We provide a detailed outline of the current and future medical, vocational, educational and psychosocial needs of a catastrophically ill or injured individual, while projecting the related costs annually or over the individual’s life expectancy.