Ringler Associates Announces New Chief Strategy and Business Development Officer: Melissa Evola Price

melissa RinglerAliso Viejo, California, July 5, 2016 – Ringler Associates Incorporated, the largest company of structured settlement advisors in the United States, is proud to announce that Melissa Evola Price, President of Structured Financial Associates (SFA), will be joining Ringler as Chief Strategy and Business Development Officer effective immediately.

 

Melissa Price, from the Greater Detroit area, has a longstanding reputation as a leader in the profession. She joined SFA in 1999 as a Structured Settlement Consultant/Corporate Marketing Consultant, expanding her role to National Account management, marketing/communications, IT infrastructure, corporate business development planning. Prior to that, she worked for eleven years in the Electronic Commerce (EC) industry, where she specialized in strategic planning, product management and sales management  focusing on emerging product markets. She    has

Life, Health and Accident Insurance licenses in multiple states and is a member of the National Structured Settlement Trade Association (NSSTA). She also holds the Certified Structured Settlement Consultant (CSSC) certification.

 

Ringler President and CEO Geoffrey E. Hunt commented, “We are absolutely delighted to have Melissa join our executive team.  Melissa has long been known as one of the distinguished thought leaders in our industry now dedicated to assuring Ringler reaches new levels of innovation and growth. I could not be more excited to have Melissa as my partner as we write the next chapters of Ringler as the continued leader in settlement advisory. Melissa has the intelligence, energy and creativity to make outstanding contributions to our future.”

 

Upon accepting the position Price says “I have admired Ringler as a company and I am very pleased to be able to become part of the leading firm in our industry. Joining Ringler provides an opportunity to work with Geoff, the leadership team and Ringler board to execute on our strategic plan that delivers the advances so necessary for us to continue advising our clients as well as injured parties and their families for the best possible outcomes.”

 

Hunt also notes that James M. Early, Executive Vice President and National Sales Director at Ringler has decided to retire at the end of the year, notifying the Ringler leadership several months ago.  Early will

 

continue working on the executive team to assist in the transition through 2016 and he will continue in an advisory role as he takes the reins as President of NSSTA in 2017.

 

And Ringler Chairman of the Board, W. Ross Duncan adds that, “Melissa is well respected across our profession and all of us at Ringler look forward to working with her in this important position as we look toward the future. We welcome Melissa, her husband Chris and his son, Harry, to the Ringler family.”

 

 

About Ringler

Ringler is the largest structured settlement company in the United States with over 120 Consultant in 61 offices since it was established in 1975. The Ringler team consists of over 250 experienced professionals who have earned the trust of all parties involved in the settlement process. Every Ringler Consultant takes an individualized, customer-focused approach to each case, backed by the strength and resources of a national brand to collaborate with injured people, attorneys and insurance professionals providing the best settlement solutions for claimants and their families. Ringler continues to expand its expertise in financial markets with a steadfast mantra of innovation and leadership in the profession.

Selecting the Right MSP Compliance Service Provider

Selecting the right Medicare Secondary Payer (MSP) compliance service provider is an important part of any claims operation.  These service providers are essential when it comes to making sure a claim complies with all aspects of the Medicare Secondary Payer Act by providing suggestions to help resolve troublesome cases.  This must include a focus on selecting someone who provides innovative solutions to complex problems.

 

 

Understanding the Medicare Secondary Payer Act

 

The Medicare Secondary Payer Act was passed into law in 1980, but was largely ignored until the late 1990s.  Since that time, claim management teams have paid considerable attention to compliance with the Act by considering Medicare’s interests in all workers’ compensation claims.

 

One part of MSP compliance is the projection of future medicals related to injury-related claims.  This includes the careful review of medical records related to the injury and projecting costs associated with future medical care reimbursable by Medicare.  The result should be a medical cost projection that is reasonable.  Another factor is an acceptable approval rate for those allocations submitted for review and approval under the voluntary workers’ compensation Medicare Set-aside submission process.

 

 

Threshold Factors for Consideration

 

There are several threshold factors for consideration when selecting a MSP compliance service provider.  When making this decision, it is important to answer the following:

 

  • How would you describe your current MSP compliance program for workers’ compensation?

 

  • What is the MSP compliance provider’s experience and expertise including legal/compliance, and pharmaceutical/medical?

 

  • How are clinical interventions handled? Is the process seamless?

 

  • What is your criteria for success? (or how do you measure success?)

 

  • What is the level of communication your current MSP partner provides during the Medicare-related processes?

 

By answering these questions, the leadership within a claims management team will understand the importance of a provider that offers innovative services.

 

 

Moving Beyond the Basics of MSP Compliance

 

Countless MSP service providers do an excellent job providing precise medical allocations.  While this is an important component of effective compliance efforts, it is important to seek a provider who is able to offer innovative services that take the extra steep.

 

  • A sophisticated service provider utilizes technology that drives all compliance related processes.  This includes the ability to manage in an effective manner the three main components related to the MSP Act: conditional payment resolution; Medicare Set-asides; and Section 111 Mandatory Insurer Reporting.

 

  • Pre-MSA Triage. Stopping problems before they occur is an important component missing in most MSP compliance programs.  When selecting the right service provider, it is essential to work with a provider that can identify barriers to settlement and provide specific intervention recommendations.  This should include physician peer review, drug utilization review and clinical oversight.

 

  • Compliance automation and tracking services. Automation allows interested members of the claim management team to track Medicare related activity on a claim from the time a beneficiary is identified through final settlement via end-to-end visibility.  It also allows team members to view in real-time what actions the MSP service provider is taking and what additional steps will occur in the future.  This includes communication with physicians, pharmacists, conditional payment searches, and medical/pharmaceutical interventions.  This not only give claim handlers peace of mind, but also frees them to address issues that require attention.

 

Conclusions

 

Effective MSP compliance includes a service provider that goes beyond the basics.  These providers will offer services that allow members of the claim management team to focus on their job and provide information and resources to comply with Medicare regulations in workers’ compensation claims.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Structured Settlements Protect Injured Workers & Save Work Comp Costs


Michael Stack:   Hello, Michael Stack here. Principal of Amaxx, founder of COMPClub, and co-author of “Your Ultimate Guide to Mastering Worker’s Comp Costs”. One of the core philosophies that I believe is that a better outcome for your injured worker will lead to lower worker’s compensation costs for your organization. Again, a better outcome for your injured worker will lead to lower worker’s compensation costs for your organization. And structured settlements certainly fall under that criteria and that philosophy. I have a special guest joining me today, the Senior Vice President of National Marketing at Ringler Associates, Duke Wolpert. Duke, thanks for joining me. I’d love for you to share with me what is a structured settlement, a little bit of context there.

 

 

What is a Structured Settlement?

 

Duke Wolpert:   Sure Mike, my pleasure. Thanks for having me today on the program. A structure settlement, essentially, is a cost-effective alternative to a lump sum settlement, a cash settlement. The series of tax-free future periodic payments, established between an insurer or self-insurer, and an injured party, a claimant or plaintiff, as part of either a worker’s compensation settlement, or a personal injury settlement.

 

They’re designed to protect and offer security to injured parties, so that they can meet their financial obligations in the future. Essentially, they bridge the gap to settlement, and any way parties can move closer to settlement by simply a change in the way the settlement is funded certainly is a step in the right direction.

 

Michael Stack: Absolutely. I agree with that, and I think these points you made are very good ones. Alternative to cash, really that lump sum settlement as an alternative to that, this point I think the tax free periodic payments in really a strong benefit to this, and then not to really be understated is that protection and security issue that really those structures offer throughout that settlement process, so thanks for sharing those point, Duke. Now, tell me, really how are these used then in the worker’s compensation space, really to leverage these benefits that you mentioned?

 

 

How Are Structured Settlements Used in Workers’ Compensation?

 

Duke Wolpert:   Yeah, what we’re seeing in the worker’s compensation space is a growing use of structured settlements, when it comes to the funding of Medicare set aside allocations. In addition to the MSA, the Medicare set aside allocation, oftentimes there are non-Medicare allowable expenses that aren’t part of the Medicare set aside allocation cost projection, that need to be quantified, and many times, we actually structure those non-Medicare allowable expenses as well as the MSA’s that we see.

 

On the indemnity side of the cases, we oftentimes are pulled into permanent and total claim scenarios, widow benefits, minors, in catastrophic claims, burns, amputations, traumatic brain injuries, for instance, are certainly cases that we’re asked to get involved in, to customize proposals that assist in meeting the financial needs of the injured parties in the future.

 

On occasion, we see situations involving injured parties with drug dependency, or competency issues, folks that for one reason or another cannot manage their own money, and there is certainly a value, the funding of those settlements with periodic payments and structured settlements.

 

Finally, the use of the structured settlement is growing in conjunction with the growth of Medicaid entitlement and the Medicaid programs in the states. In order to protect entitlements for Medicaid recipients, oftentimes the funding of the settlement has a direct correlation with their eligibility status, so the funding of a settlement would be using periodic payments, a structured settlement, certainly provides some protection to injured parties when it comes to ongoing incontinuity of Medicaid entitlement.

 

Michael Stack:   I think a couple of things that you said there … this competency issue, and we talked about it in regards to drug dependency, but I think we hear these stories so often of the lottery winners who get this huge sum of money, and a couple of years later, the people go bankrupt, and it’s just a very common story, and I think the value here is really in that protection, which we talked about in those benefits initially, and these catastrophic cases that Duke mentioned  … I think very valuable when you really put that in a context of leveraging this for those better outcomes for those injured workers, so let’s talk about that now, Duke. How do we now leverage these tools? How do we leverage this tool then in the context of really creating those better outcomes, both for the injured worker, and then creating those lower worker’s compensation costs?

 

 

How Do Structured Settlements Reduce Workers’ Compensation Costs?

 

Duke Wolpert: Absolutely. When we look at outcomes on the insurance, self-insured side, the primary payer side, oftentimes the use of structured settlements offers a reduction in the pay loss dollars in the claim, the lost dollars associated with a claim file. That oftentimes leads to improved cycle times or closing ratios for claims professionals, and what we find is that it at times avoids unnecessary expenses, especially in cases in litigation, either litigation costs or ancillary expenses related to the litigation, so clearly there’s value from a cost containment and cycle time claim inventory perspective, when it comes to the use of structured settlements.

 

Michael Stack:   I agree. Now, let’s talk about those injured workers, so we’re saving money through the use of these tools in loss dollars and the comparison of using an annuity versus a lump sum payment, and really leveraging the interest that leads to those savings. Now, let’s talk about those injured workers on that perspective and some of those benefits in creating a better outcome for them as well.

 

 

How Do Structured Settlements Lead to a Better Outcome For Injured Workers?

 

Duke Wolpert: Yeah, understanding that the plans that we develop are individually customized, they’re done that way to meet the needs of the injured parties, and every plan is a little different. In conjunction with the structuring and work up for the pricing of the Medicare set aside, there are oftentimes non-Medicare allowable expenses and other needs on the [inaudible 00:06:18] side that we need to address with the injured parties, as well as their own financial needs that will lead to the establishment of the creative design, the structured settlement proposal, and by doing that, it bridges the gap of the settlement. It gets the parties closer to resolving the claim in hand.

 

Michael Stack:   I think that really summarizes it nicely in the sense of really customizing those needs. I think when we talk about objections that injured workers might have, that would be a fear of mine certainly if I was offered a settlement, that I want to make sure that my needs are protected. As you said … I think one of the things you said there was I think was key, was it’s really individual to that individual person. Do they need some money up front to pay for certain things? How much money do they need over time? … And really customizing it to meet those needs, and as we said, at the same time saving those worker’s compensation costs for the payer organizations.

 

Duke, thanks for joining me. I’d love to just ask to share some final thoughts as we wrap up here.

 

 

A Structured Settlement Could Be the Last Check an Injured Party Ever Receives

 

Duke Wolpert: My final thought would be that we need to remember that an injured party who’s been disabled for a period of time, that receives a settlement, may not be going back to work. This could be the last check, the last payment that they receive for the rest of their lifetime, so protecting their financial future certainly is something that we want to be part of, and structured settlements absolutely do just that.

 

Michael Stack:   Yeah, I couldn’t agree more, and I think that point of really thinking that this is a last check that individual can receive is a very powerful point, and really leveraging this tool to create those better outcomes for that individual person, and as we mentioned, at the same time, lowering those worker’s compensation costs for the payer organizations. Thanks again, Duke for joining me today, and remember, your success in worker’s compensation is defined by your integrity, so be great!

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Reducing Future Medicals through Medicare Secondary Payer Automation

RitaWilson

Rita Wilson, CEO, Tower MSA

…on reducing future medicals through Medicare Secondary Payer Automation

 

Handling Section 111 reporting, conditional payments, physician peer reviews, and Medicare Set-Asides in separate technology silos leaves room for errors and delays.  Organizations can resolve these problems with a Medicare Secondary Payer solution that automatically and seamlessly connects all compliance, intervention, and MSA processes from the initial identification of a Medicare beneficiary all the way through closure and settlement.

 

An all-encompassing MSP Automation Suite should:

 

  • Capture, store, and manage all data points in a paperless environment
  • Easily integrate with any claims system
  • Enable clients’ business rules to be overlaid onto the vendor’s business processing rules
  • Prompt for missing data
  • Escalate medical and pharmacy issues when triggers occur
  • Initiate and seamlessly track pre-MSA interventions
  • Drive oversight until evidence of treatment changes has been confirmed
  • Provide end-to-end visibility into claims
  • Create an audit trail for each claim
  • Benchmark CMS trends to ensure compliance

 

Tower MSA’s sophisticated technology encompasses all of the above to ensure timely, complete and accurate reporting.  It enables Tower’s legal and clinical specialists to quickly and thoroughly analyze conditional payments and negotiate appropriate reimbursements.  The system even drives and tracks pre-MSA medical and pharmaceutical interventions, which can save hundreds of thousands dollars on a single claim.  Integrating all these processes into a single system ensures 100% MSP compliance, reduces MSA costs and expedites settlements.

————————————————————————————————-

Reducing Future Medicals through Medicare Secondary Payer Automation

 

Workers’ compensation claims continue to be driven by the “cost” of medical benefits.  This is especially the case when dealing with issues of Medicare Set-asides and future medicals in workers’ compensation claims.  This has resulted in many claim management teams to seek service providers who understand this concern and have innovative solutions to satisfy Medicare’s interests.  One such solution is a complete suite of services that cover the entire life of a claim.

 

 

Barriers to Effective Medicare Secondary Payer Compliance

 

Members of the claim management team need to track the movements of files submitted for Medicare Secondary Payer compliance matters.  This is based on the nature of the work being performed by a service provider and its time-sensitive nature.  Common complaints by claim handlers include:

 

  • Lack of creative solutions on the front-end of compliance to reduce the cost of a Medicare Set-aside allocation;

 

  • Inability to track files and determine the status of work being performed; and

 

  • Ineffective communication between the parties to implement cost-saving mechanisms.

 

 

Cost Savings Starts with MSA Triage

 

The concept of “triage” was developed in World War I as a means to better assess a wounded soldiers condition and direct appropriate medical care.  This concept was such a success that it has been applied successfully to other areas, including Medicare Secondary Payer compliance.  By using an effective case triage model, a Medicare Secondary Payer service provider is able to review a case and identify barriers that may delay settlement.  The net result is real savings to the claim management team through a better reserve system and efficiency in settlements.

 

 

Effective Medicare Secondary Payer Case Management

 

An effective Medicare Secondary Payer service provider will also implement strategies for cost savings beyond the initial in-take and triage phases.  These additional steps strive for efficiency via computer-based technologies that include assistance with the following matters:

 

  • Physician peer review;

 

  • Drug utilization review; and

 

  • Clinical oversight.

 

A fully automated process should make case specific recommendations for further intervention when reasonable and necessary.  These suggestions will result in the lowest defensible Medicare Set-aside allocation.  The use of these system processes will also keep the claim handler involved in the process and allow for greater transparency.  This includes the identification of missing data elements, conditional payment searches/resolution and medical/pharmaceutical interventions.

 

 

Other Benefits to Complete Medicare Secondary Payer Automation

 

Automation of Medicare Secondary Payer compliance services offer members of the claim management team a number of benefits.  From the onset of the claim, it provides the opportunity for the client to receive front-end services that reduce costs over the life of a workers’ compensation claim.  Other attributes include:

 

  • A holistic approach that ensures consistency in Medicare Secondary Payer compliance services;

 

  • Moves the claim forward through the final step of compliance, which is Section 111 Mandatory Insurer Reporting; and

 

  • Allows for 24/7, end-to-end visibility that keeps the workers’ compensation claims team engaged and updated during the entire compliance process.

 

 

 

Conclusions

 

Medicare Secondary Payer compliance services are moving beyond providing clients with an a la carte list of services.  More advanced service providers are able to offer solutions throughout the entire life of a claim.  This also allows members of the claim management team to be active in the claim and aware of what is taking place.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Understanding Medicaid Recovery in Workers’ Compensation Settlements

The expansion of Medicaid under the Affordable Care Act (ACA) is starting to impact workers’ compensation settlements nationwide.  This is based primarily on the new pressures placed on state health programs who administer these programs.

 

 

What is Medicaid?

 

Medicaid came into existence at the same time as the Medicare program.  While there are some similarities between the two government programs, they should never be confused.  Medicaid is a state-based health program, which receives part of its funding and coordination from the federal government.  The Medicaid program has some unique differences that provide healthcare for millions of Americans.

 

Prior to implementation of the ACA, Medicaid served only low-income individuals with a disability.  Since 2014, persons with an income up to 133% of the poverty line to qualify for coverage.  This also includes adults without dependent children.  Individuals receiving Medicaid can also be eligible for Medicare.

 

 

Medicaid Recovery in Workers’ Compensation Cases

 

Due to the fact that Medicaid is mainly a state-government program, federal regulations had little impact on the ability of these programs to recover for medical funds related to medical care and treatment in workers’ compensation cases.  This is an area where significant changes in law have been made on the federal level, which will impact your cases.

 

Arkansas Department of Human Services v. Ahlborn, 547 U.S. 268 (2006), represents an important case related to the rights of recovery for state Medicaid programs.  In this case, the Arkansas Department of Human Services sought 100% recovery of funds paid on behalf of a personal injury victim.  Based on the settlement amounts and costs for associated medical care, this practice would have nearly taken away all of the available settlement monies and left the injured party without compensation.  In a unanimous decision, the Court held this program could not recovery against a plaintiff related to portions of their settled attributable to pain and suffering or wage loss.

 

 

Post-Alborn and Congressional Action

 

Notwithstanding this settlement, state programs have continued to seek reimbursements in these cases.  This has included congressional action that threatens workers’ compensation settlements and insurance carriers who make payments to injured parties.

 

In early 2014, Congress passed a series of amendments to the Social Security Act that covers Medicaid.  This law is sometimes referred to as “Section 202 of the Bipartisan Budget Act of 2013,” or the “Medicaid Secondary Payer Act.”  Under this law, state programs were given additional recovery opportunities that overrode the unanimous Alborn decision preventing recovery against the non-medical aspects of a personal injury or workers’ compensation claim.  The effective date of these provisions was initially October 1, 2014.  The law was later amended to move that date out two years.

 

 

Ramping Up Enforcement in the States

 

Several states have taken their new recovery powers seriously and are ramping up their enforcement and recovery efforts in anticipation of full-fledged Medicaid Secondary Payer becoming effective on October 1, 2016.  These states include Rhode Island, Kentucky and Mississippi.  The initial steps in this process includes sending warning letters to attorneys and members of the claim management team.

 

 

Practice Pointers

 

Claim management teams need to be proactive when dealing with issues related to Medicaid recovery.  This can include the following:

 

  • Proactively identify claims who potentially will become Medicaid beneficiary, or who are beneficiaries at the time of the claim.
  • Identify and place appropriate state agencies on notice of their potential intervention rights.
  • Keep all parties updated regarding Medicaid recovery efforts and include the appropriate government officials in your settlements.
  • Continue to stay updated regarding changes in Medicaid Secondary Payer recovery.

 

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices.  Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

Maximize Settlement Value And Solve Complex Problems With Structured Settlements

Structured settlements offer all parties in workers’ compensation cases an opportunity to maximize the settlement value of the case and have creative solutions to solve complex problems.  Before using a structured settlement in your case, it is important to understand key terms and how they work.

 

 

Key Structured Settlement Terminology

 

The use of structured settlements include a complicated vernacular.  Using terms incorrectly can result in delay or having a settlement fall apart.  Consultation with a structured settlement representative is key.

 

  • Annuitant: A person who receives the benefits of an annuity.
  • Annuity: A specified income payable at stated intervals for a fixed or a contingent period, often for the injured employee’s life.
  • Beneficiary: The injured employee who receives the payments from the structured settlement.
  • Deferred Lump-sum Payments: These are payments to the injured employee, which are larger than the regular periodic payments, and are given at pre-determined dates in the future to cover the cost of a college education, car replacement, home remodeling, etc.
  • Flexible Settlement Plan: A structured settlement that takes into consideration the needs of the injured employee, both financially and medically, while also addressing the cost of the structured settlement.   A flexible settlement plan includes the planning necessary to achieve the goals of the injured employee while maintaining control of the cost of the structured settlement for the employer/insurer.
  • Period Certain Annuity: When the injured employee knows that in the future there will be additional income from Social Security, a pension, IRAs, 401Ks, etc., the injured employee may elect to get larger payments from the structured settlement annuity by shortening the time period the annuity will be paid to age 65 or some other cut-off point.
  • Periodic Payments: Settlement payments that the injured employee receives based on an agreed payment schedule, whether it bi-weekly payments, or monthly payments, or quarterly payments or annual payments.
  • Qualified Assignment: A qualified assignment is the transfer from the workers’ compensation insurer to the life insurance company, the obligation to pay the future periodic payments of a structured settlement.  The obligation to pay qualifies for favorable income tax treatment as the obligation arises out of an injury.

 

 

Correctly Using a Structured Settlement

 

The use of structured settlements is made possible by special provisions within the Internal Review Code.  When done properly, they can provide a claimant with a consistent flow of money that is not taxable under the Code.

 

When using a structured settlement, it is important to be aware of the special tax rules that apply.  A structured settlement must be established by:

 

  • An agreement for a party to accept periodic payments for personal damages that are excludable from gross income as set forth in 26 U.S.C. §104 (a) (2); or
  • An agreement for a party to accept periodic payments for applicable workers’ compensation benefits that are not considered income per 26 U.S.C. § 104 (a) (1); and
  • The payments are also those as described in subparagraphs (A) and (B) of Internal Revenue Code Section 130(c) (2), or 26 U.S.C. § 130(c) (2).

 

These periodic payments must also be paid as follows:

 

  • A party to personal injury type lawsuit or workers’ compensation claim; or
  • A party who has assumed liability for the periodic payments under a qualified assignment per 26 U.S.C. § 130.

 

Conclusions

 

Structured settlements remain an important tool in settling workers’ compensation cases.  It is important to understand key terminology and how they work before using one in your settlement.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Settling the Difficult Cases with Structured Settlements

Complex workers’ compensation cases require creative thinking.  One tool that can help resolve these cases in an innovative manner is a structured settlement.

 

 

What is a Structured Settlement?

 

A structured settlement is a financial tool purchased through a structured settlement broker.  When the structured settlement is purchased as part of a workers’ compensation settlement, the injured employee will receive periodic payments under an agreed schedule rather than a lump sum payment.

 

These periodic payments can come in various forms.

 

  • Deferred Lump-sum Payments: Payments are made to the employee, which are larger than the regular periodic payments.  This agreement is structured under a schedule consisting of pre-determined dates.
  • Flexible Settlement Plan: Payments under this arrangement take into consideration the needs of the injured employee by addressing the cost of the structured settlement.   A flexible settlement plan includes the planning necessary to achieve the goals of the injured employee while maintaining control of the cost of the structured settlement for the employer/insurer.
  • Period Certain Annuity: In this type of structured settlement, the injured employee may elect to get larger payments by shortening the time period the annuity will be paid to age 65 or some other cut-off point.

 

 

Using a Structured in Your Settlement

 

Imagine you have a troublesome case with high exposure and the settlement negotiations between the plaintiff attorney and insurance company reach an impasse.  The solution is a structured settlement.

 

The parties agree to a settlement amount of $500,000, which will be settled via a structured settlement.  By working with a broker, the insurance carrier was able to purchase an annuity through a life insurance company.  The broker was also able to secure a rated age for the injured party that further drove down the actual cost of the annuity due to co-morbid conditions of heart disease and diabetes.  The final terms are as follows:

 

  • Agreed upon settlement amount: $500,000
  • Savings via rated age: $98,000
  • Savings via annuity payments versus the lump sum: $126,000

 

  • Total savings: $224,000
  • Total payments to the Employee: $500,000

 

Everyone Wins with a Structured Settlement

 

How does the employee win?  In this case, the employee receives the full value of the settlement.  By receiving periodic payments, they will have better management of their settlement funds via guaranteed cash flow over their life expectancy.  The settlement money also remains tax-free.

 

How does the employee’s attorney win?  They were able to be a zealous advocate for their client while at the same time being creative.  Not only do they have a satisfied client, but they also helped their client have financial stability.

 

How does the insurance carrier win?  The carrier wins because they are able to free up funds that would otherwise be used for a settlement paying a lump sum.  The claims management team can now concentrate on other troublesome files.  They will also receive recognition for being efficient and creative by settling an annoying claim.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

 

Medicare Advantage Plans: How It Impacts Your Workers’ Compensation Cases

The changing needs in healthcare are shifting millions of Americans onto Medicare Advantage (MA) Plans.  Issues arise when these people suffer workers’ compensation injuries and the Plans make payment for their medical treatment and care.  Claim management team members need to understand how this affects their case.

 

 

What is a MA Plan?

 

In 1965, Congress created the Medicare program (Parts A and B; referred to as “Original Medicare”) to allow retired and older disabled people an opportunity to receive affordable health care insurance.  Throughout the years, the demands of this segment of American society changed and so did their needs.  This resulted in the creation of Medicare Part C with the passage of the Balanced Budget Act of 1997.  Medicare expanded several years later with Part D and a prescription drug benefit.

 

Under its current scheme, Medicare eligible persons have an option for coverage.  They can receive coverage under Original Medicare, or through a MA Plan.  An MA Plan offers the same coverages found under Parts A and B, but has the added benefit of a prescription drug plan and additional coverage options provided through a private insurance company.

 

 

MA Plan Compliance in Work Comp

 

The popularity of MA Plans has a significant impact on workers’ compensation cases, as federal courts are open to allowing these plans to have similar rights of recovery as Original Medicare.  Claim management teams should take note of the following issues when settling cases involving these Plans.

 

  • Expansive Rights of Recovery. Recent case law interpretations has given MA Plans in most states expansive rights of recovery using the private cause of action provisions under the Medicare Secondary Payer Act. In Collins v. Wellcare Healthcare Plans, 2014 U.S. Dist. LEXIS 17442 (E. Dist. La. 2014), a federal district court judge not only gave MA Plans another victory, but determined that regardless of what the Plan’s contract stated, their rights of recovery could also be defined and expanded by federal law.

 

  • Resolving MA Plan Conditional Payments. Recovery of conditional payments by Original Medicare is coordinated through the Benefits Coordination & Recovery Center (BCRC).  This allows for a smooth process when resolving Original Medicare’s claims by dealing with a single entity.  The BCRC does not facilitate recovery efforts for MA Plans.  This can result in a complicated process as some workers’ compensation cases can involve multiple Plans.

 

  • Medicare Set-asides for MA Plans. While a Medicare Set-aside is never required, CMS does assert a right to “future medicals” under agency interpretations of the Medicare Secondary Payer Act.  If courts continue to define the rights of MA Plans as being similar or the same as Original Medicare, it goes without saying a demand for future medicals could be made by MA Plans.  This could be something the industry sees in the foreseeable future given increasing demands from consumers and investors who reply on private health insurance plans to remain profitable.

 

 

Dealing with MA Plans in Your Case

 

Claim management teams should remember to consider the recovery rights of MA Plans when settling workers’ compensation cases.  This should include adding the following best practices to their compliance efforts:

 

  • Make early inquiry if a Medicare beneficiary also has coverage through a Medicare Advantage Plan.

 

  • Treat Medicare Advantage Plans as you treat Medicare. Be aware of current case law interpretations regarding their rights in the jurisdiction of the settlement.

 

  • Obtain a copy of the Plan’s policy language to determine their contractual rights of recovery if case law suggests they do not have a right of recovery under federal law.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Medical – Legal Conference Strengthens Defense In Complex Cases

 

Medical care for an injured employee can be complicated.  When the injured employee is represented by an attorney, the plaintiff’s attorney often tries to make the seriousness of the injury to appear to be greater than it actually is.  Defense attorneys who have handled many similar claims often have a fairly good understanding of the medical terminology and what is meant by various medical reports and are not fooled by the plaintiff attorney overstating the nature and extent of the injury.

 

 

Defense Attorney & Doctor Need Conference in Complex Cases

 

However, there are situations where the injury to the employee is unique, and the seriousness and/or complexity of the injury is not fully understood by either the work comp claims adjuster or by the defense attorney.  It is in situations of this nature that the need for a conference between the defense attorney and the doctor is needed.  These medical-legal conferences are normally held during the discovery phase of a work comp claim in litigation, but can be held at any time.

 

Med-legal conferences can occur by telephone, but more often the defense attorney will reserve an appointment with the medical provider to review and discuss the medical treatment an injured employee is incurring.  The med-legal conference allows the defense attorney to better understand the injured employee’s medical care.  The defense attorney will have the opportunity to ask questions about the medical reports and will hence be able to decipher and understand the medical reports better.

 

 

Understand Issues, Make Negotiation Easier

 

The med-legal conference puts the nature of the injury, the extent of the injury and the future medical treatment needed into plain English that the defense attorney will be able to understand and to convey, if necessary, at a Board hearing or in a full-blown trial.  This makes the negotiation of any settlement on the work comp claim more accurate and feasible.

 

The med-legal conference also will assist the defense attorney to understand the chronological sequence of the injury, the medical treatment and the recovery.  The defense attorney will also better understand the reasonableness of the previously provided care and the reasonableness of the proposed future medical care.

 

 

Real Claim Example

 

To better understand the use of a med-legal conference, consider the following real claim.

 

The employee was removing a motor from a dump truck.  The employee fastened a chain around it and lifted it with a fork of the forklift (no safety program at this employer!).  When the forklift moved, the motor dangling on a chain, swung around and struck the employee in the top of the back, breaking the right clavicle with a compound fracture.

 

After four months of treatment, the medical provider placed the employee at MMI.  The work comp adjuster paid the PPD rating and thought the claim was done.  Two months later the claimant calls the doctor and is in severe pain. The doctor does an x-ray and the clavicle, which had been healed in the prior x-ray before the employee was placed at MMI had developed a non-union along the fracture lines. The plaintiff attorney filed for a “worsening of condition” with a request for additional medical treatment, additional temporary total disability and was pursuing a higher PPD rating.

 

The defense attorney met with the doctor following the resumption of medical care to discuss the cause of the non-union and how it could have developed after the employee was released from care.  The doctor explained that within a reasonable degree of medical certainty the failure of the previous union of the bones had to be caused by the employee suffering an aggravation at his new employer.  The doctor explained there was diagnostic evidence of an aggravation.  The aggravation broke the chain of causation resulting in the employer at the time of the initial injury no longer being responsible for the claimant’s medical condition.

 

 

Cost of Savings Can Far Outweigh Cost of Conference

 

The cost of a med-legal conference is the cost of the doctor’s time and the cost of the defense attorney’s time.  The med-legal conference will often answer the questions the defense attorney has in regards to the medical treatment and the status of the injured employee, eliminating the need for a formal deposition and the associated cost.

 

It is often worthwhile to pay for the time the doctor and the defense lawyer spend reviewing the medical care, the causes of medical issues and the proper resolution of the medical issues.  Med-legal conferences should be considered any time the medical issues are complex and the understanding of the employee’s medical condition is not clear.

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

CMS Alert: Changes for Conditional Payment Recovery

CMS recently announced changes regarding the conditional payment recovery process that will impact workers’ compensation attorneys and claim management teams.  These changes will be effective October 5, 2015, which will include a new role for the Benefits Coordination & Recovery Center (BCRC).  It will also include the use of a new contractor to assist in the process.

 

 

What is Changing?

 

The change will affect the recovery of conditional payments in Non-Group Health Plan (NGHP) matters.  These are considered “applicable plans,” which include the following:

 

  • Liability insurance (including self-insurance);
  • No-fault insurance; and
  • Workers’ compensation laws or plans.

 

 

Ongoing Role of the BCRC

 

The BCRC will continue to monitor and work with interested parties in the conditional payment recovery process for the following workers’ compensation cases on and after October 5, 2015:

 

  • Cases where the beneficiary is listed as the debtor;
  • Cases with reported Ongoing Responsibility for Medicals (ORM); and
  • Cases reported under Section 111 Reporting with conditional payments.

 

 

New CMS Contractor: Commercial Repayment Center

 

The Commercial Repayment Center (CRC) is the new CMS contractor that will assist with a defined category of matters involving the recovery of conditional payments in workers’ compensation cases.  It will handle all conditional payments matters not serviced by the Non-Group Health Plan (NGHP).  Cases where the NGHP is the listed debtor will coordinate with this contractor.

 

The new contact information for the Commercial Repayment Center (CRC) is P.O. Box 93965, Cleveland, OH 44101.  Their fax number is (216) 583-0228.

 

 

Understanding the New Process

 

Claims management teams and attorneys representing workers’ compensation insurers and self-insured employers need to understand these changes.  Failure to follow these new processes can result in unnecessary delay, interest charges on conditional payment matters and referrals to the US Department of Treasury for conditional payment collection actions.

 

Along with changes in conditional payment recovery contractors, interested stakeholders must also understand the new conditional payment appeals processes that went into effect on April 28, 2015.  Under this new system, a ridged appeals process will impact your cases.  These revised procedures include the following steps applicable plans must follow in order to challenge conditional payments amounts if informal discussions with CMS prove unsuccessful.

 

  1. Initial determination (Demand Letter)
  2. Redetermination by the contractor issuing Demand Letter
  3. Reconsideration by a Qualified Independent Contractor
  4. Hearing before an Administrative Law Judge (ALJ)
  5. Review by the Departmental Appeals Board’s Medicare Appeals Council
  6. Judicial review in the United States District Court.

 

 

Implementing Best Practices

 

The advent of the new contractor will also require attorneys and claim management teams to adopt new best practices.  This should include from your organization, or your Medicare Secondary Payer service provider:

 

  • Basic education of Medicare Secondary Payer compliance matters and a review of current procedures;
  • Understand what cases involving conditional payment recovery will be processed through the Benefits Coordination & Recovery Center (BCRC) and Commercial Repayment Center (CRC). Determine what adjustments need to be made to internal processes.
  • Monitor CMS websites for updates related to conditional payment matters. It is expected that additional changes will be announced shortly regarding the multi-factor authentication process and the Medicare Secondary Payer Recovery Portal.
  • Take a proactive approach to address Conditional Payments early and allow more time prior to settlement to possibly negotiate any unrelated/disputed charges, as well as to promptly respond to any demand letters.
  • Conditional payment requests should be submitted automatically upon receipt of a positive beneficiary query response from CMS. If gaps in treatment exist, the Conditional Payment Letter (CPL) information should be reviewed for lien purposes and negotiated prior to CMS submission.

 

Coordinate your efforts with a Medicare Secondary Payer service provider that knows and understands these processes.

 

 

 

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a monthly basis working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

 

 

©2015 Amaxx LLC. All rights reserved under International Copyright Law.

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress - www.greencp.de