Retirement, workers’ comp and WCMSA

On Behalf of | Nov 16, 2017 | Blog

You may have made it through your entire career without suffering a significant on-the-job injury, but now, as you approach retirement, you suffered a serious injury at work. After months of recovery, you realize that reaching 100 percent just isn’t going to happen and you may not be able to return to work.

Since you are so close to retirement, you may consider negotiating a lump sum settlement of your workers’ compensation claim. That may be the best avenue for you, but you may want to understand what it would mean to settle your claim for a lump sum payment.

Workers’ compensation settlements in Pennsylvania

First, it may help to know that workers’ compensation claims are broken down into two main components: your lost wages and your medical needs. State law allows you to settle just one aspect or both depending on your situation. Since you could retire soon, settling both parts of your claim could provide you with a nice nest egg for retirement.

It would be a good idea to make sure that your settlement covers any future medical care you will need in connection with your injury or illness. When offering you a settlement, your employer and the insurance company will probably not just voluntarily add extra zeros to your settlement. Ensuring that your future medical needs are covered will be up to you. However, there could be a catch.

Medicare benefits could be an issue

When you enter into a settlement of your claim, you will probably end up setting aside a certain amount of money for your future medical care. In order to receive Medicare benefits for medical treatment connected to your work-related injury, you must use the funds put aside in your settlement first.

More than likely, you will need to enter into a Workers’ Compensation Medicare Set-Aside Arrangement to make sure that this happens. Any agreement you come to will require the approval of the Centers for Medicare and Medicaid Services. The CMS requires that you meet one of the following criteria in order to enter into a WCMSA:

  • You expect to be eligible for Medicare benefits within the next 30 months and your workers’ compensation claim settlement will be more than $250,000.
  • You already receive Medicare benefits and you expect your workers’ compensation claim to be worth over $25,000.

If you meet one of these criteria, you can apply for approval of a WCMSA.

Legal help

Fortunately, you don’t have to negotiate your lump sum settlement or gain approval for a WCMSA alone. Obtaining the appropriate legal help could help ensure that you receive the best settlement possible and know that any future medical needs you have associated with your injury will be covered one way or another.