Author: Argyropoulos & Associates

by Argyropoulos & Associates

The Basics Behind Medical Malpractice

At Argyropoulos & Associates, we know that those who have been subject to medical malpractice are often in a difficult position physically and emotionally. Being ill or requiring medical attention for bodily issues can already be a stressful time for anyone. Seeking treatment and then having that treatment backfire as a result of improper medical procedures or unreasonable mistakes can leave patients feeling hopeless and without recourse. The statute of limitations for medical malpractice is two and a half years in New York

How Is Medical Malpractice Defined?

Medical malpractice can be defined as when a healthcare professional causes undue harm or injury to a patient through not adhering to standard practices or not properly informing patients of all risks associated with any given procedure to be undertaken. When most people think of medical malpractice, they think of the most obvious cases such as errors or mistakes during surgery that lead to direct damage or loss of functions. While these cases are very grave, the realm of malpractice spans outside of surgery and into how care is given.

For example, if a physician gives unreasonable delay to the treatment of a condition that is easily identified and harm comes of it, that would be grounds for malpractice. It’s not enough for a medical professional to fail to meet standards of care, the patient must be able to prove that any harm they received was partly or fully in result of that negligence.

The Three Different Types of Medical Malpractice Damages

Malpractice damages can be categorized in a few different ways. Generally speaking, most categorizations will be something along the lines of this:

Compensatory Damages. These damages are awarded in response to any medical costs incurred as well as any wages that were lost as a result of missing work.

Non-economic Damages

These can be summed up as damages awarded for non-financial aspects of loss. A malpractice injury can result in very real, quantifiable damages such as loss of function or inability to perform work which leads to calculable loss of wages due to off time or the relinquishment of the victim’s career. These examples would fall under economic/compensatory damages.

In other words, non-economic damages account for things such as Pain and Suffering—which is a specific type of damage that must be specified and negotiated since it is highly dependent on the nature of the injury and how that would impact quality of life for the aggrieved.

Punitive Damages. This category of damages is reserved for only the worst offenders. If the malpractice is so overwhelmingly clear and was caused by an indisputable and reckless level of negligence, action could be sought to not only receive the prior category of damages, but also take legal action against the accused. The intent behind punitive damages is to punish the accused.

How Do I Know If I Have a Case For Malpractice?

Many malpractice cases have merit when you consider events in a timeline. The parameters of medical care are fairly well known if you feel as if you have received insufficient care and were neglected by a healthcare professional, there is a very real possibility you were. All too often, many doctors and healthcare professionals try to cut corners and save time by moving patients along too quickly or failing to listen to the patient with a compassionate ear. Everyone has had an experience where they tried to explain their condition to a doctor and felt as if they were not listened to. Not only is this unethical, but it is also dangerous to the patient and exceedingly costly to the provider.

Medical Malpractice Lawyers in New York

There’s no better way to determine if your medical malpractice claim has merit than to consult professionals. At Argyropoulos & Associates, we’ve successfully won numerous cases across the realms of medical malpractice, personal injury, workers’ compensation, and social security disability.

Call us today for a free consultation so we can hear your story and determine the eligibility of your case.

by Argyropoulos & Associates

What Should I Ask When Visiting a Personal Injury Lawyer?

Meeting a Personal Injury Lawyer After an Accident

Being involved in an auto accident can be a harrowing ordeal. In many cases, injuries are sustained for both parties whether minor or major, some injuries are not at all obvious until medical examinations are done. For example, if you hit your head during the accident, it is in your best interest to do scans to ensure there was no damage done. Head injuries are notoriously deceptive—that is, an injury that does not hurt much at all can prove to be far more serious than initially expected. You may be under a great deal of stress when considering the prospect of having to pay for your injuries, the damage to the vehicle, and possibly the injuries and damages of the other person involved in the accident if the ruling does not go your way. It is for these reasons we’ve put together this small guide of things to consider when visiting a personal injury lawyer.

Document Everything ASAP

If you’ve been involved in an auto accident, one of the most important and time-saving things you can do is to document everything when it’s still fresh in your mind. Assuming you aren’t immobilized or gravely injured, upon being involved in an accident, it is wise to take stock of the scene before the police arrive. Take pictures of the damage to both vehicles from every angle as well as any skid marks on the ground. If there are any people who have witnessed the accident you can ask them to stick around for when the police arrive to give their version of the events.

A big detail that can make a difference in the verdict of your case was whether the other driver was guilty of distracted driving—using their cellphone while driving. New York is particularly known for its aggressive and strict laws regarding distracted driving. While it is not always the case, sometimes call or text records may be used against a person if the court orders it. The driver’s mobile service provider need not offer permission to access this information unless directly ordered by the court—these laws vary from region to region and court to court.

Questioning the Validity of the Case

One of the most important aspects of providing a quality service as a lawyer is offering a free consultation. A free consultation is in the best interest of all involved parties. At the very least, it can set your mind at ease to visit a lawyer to find out if your case has merit. While most attorneys are cautious in giving absolute opinions on cases, they are most certainly going to tell you if you have a good case or not based on the basic details of the incident.

This is precisely why documenting the details of your case prior to visiting is so important, the more information you have on hand that you can present to your attorney, the more efficiently they can set about a plan of action for your defense. Court cases are all about deadlines and being well prepared in advance, providing your attorney with concise information can save a lot of time.

When it comes down to personal injury/automobile accidents, the most important facet of the case is being able to determine and prove fault. Proving that the person who caused the accident was indeed at fault and is guilty of negligence is the number one goal of the case.

Personal Injury Law in Astoria, New York

At Argyropoulos and Associates LLC, we are well versed in the complex laws surrounding personal injury liability and New York’s accident laws. If you feel that you have been harmed due to someone else’s’ negligence, give us a call at 718-777-1777 or send us a message on our contact page!

by Argyropoulos & Associates

Avoiding Slip and Fall Accidents at Work

According to the National Safety Council, a worker is injured approximately every seven seconds. The infographic states that the top 3 injuries which result in lost days are overexertion, contact with objects and equipment, and then slip and fall accidents. Much like OSHA would caution you, many if not most of these work-related injuries are avoidable with proper precaution and care.

Slips, trips, and falls are particularly avoidable with some common sense solutions. Here are some ways in which you can avoid becoming a victim of negligence.

Slips are a Common Occurrence in Astoria, NYC

Pay attention to the ground you’re walking on and watch out for any spills and/or oily surfaces. A small portion of the ground getting slicked with liquid and a bit of dirt can spell out unexpected disaster for you. We often laugh at cartoon characters that trip on banana peels, but the reality is that is how the scenario unfolds in many cases. A person unexpectedly meets the ground with significantly less traction than they anticipated and one foot slides counter to the other. Even in circumstances when a person does not fall due to the sudden loss of traction, there is a large possibility to cause strains and overstretched ligaments

Trips in the Workplace Happen Often

Trips happen for reasons different than slips. Most trips occur due to poor housekeeping. Many trips occur due to uneven steps or areas in the facility. Housekeeping is an apt name for this type of workplace negligence. If your workplace is unorganized and has objects laying around or objects which block your view or items such as power cables lying about on the ground, the likelihood that someone will experience a trip and fall is much higher than it needs to be. Tr

What are the Best Ways to Avoid Slip and Fall Accidents?

The first and foremost way to avoid slips is to wear slip resistant shoes. In many industries—especially the food service industry, many people slip and fall because they fail to wear shoes that adhere to the standards set by OSHA for Minimum Floor Coefficient of Friction (COF). It is the deeper treading on these shoes which give them their slip-resistant abilities. Treading greatly impacts how effective the shoes are at preventing any loss of traction.

However, that does not account for all slips that occur—if it did, there would be no need for legal action in regards to work-related slips. The truth of the matter is that many employers fail to adequately handle a manner of issues including but not limited to: wet ground, spills, environmental hazards due to weather, ground that has suddenly changing levels of traction.

There is something to be said about exercising personal caution in regards to how an employee maneuvers and conducts themselves in the workplace. However, much of what needs to be done in terms of workplace safety rests on the shoulders of the employer. Cleaning up spills, organizing the floor so that there are no obstructions and making sure all cords and cables are snug and routed properly as well as ensuring that there is adequate lighting in the workplace are all logistical issues that need to be handled by your employer.

Slip and Fall Accidents in New York City

In a perfect world, all workplaces would be streamlined, efficient and safe for traversal by employees. Sadly, this is not the case, and so in the meantime having a proper law firm representing you is in your best interests. At Argyropoulos and Associates LLC, we have extensive knowledge and experience regarding slip and fall accidents. If you feel as though you have suffered an injury due to employer/workplace negligence, do not hesitate to contact us so that you may be represented fully and fairly.

by Argyropoulos & Associates

What is Social Security Disability?

To begin, let’s start off with the definition of disability from Social Security itself:

“You are entitled to receive Social Security disability (SSDI) or Supplemental Security Income (SSI) benefits when you are no longer able to perform a “substantial” amount of work as the result of a physical or mental impairment that is expected to last at least 12 months, or possibly result in death. To Social Security, a substantial amount of work, called “substantial gainful activity,” is making $1,220 or more per month, before taxes (or $2,040 per month for people who are blind, in 2019).”

Many conditions can meet the definition of disability if the condition is severe enough. This can include depression, anxiety, arthritis, asthma, heart failure, heart conditions, and other severe medical disorders. An applicant must have a very severe medical condition to win a disability approval based on the Social Security medical listings book (also called the Listing of Impairments). Generally, applicants will qualify if they can prove that their condition prevents them from performing work that will constitute substantial gainful activity (SGA).

The Definition of Social Security Disability

Social Security will look at an applicant’s job history over the past 15 years to assess whether or not you are capable of doing your job based on your medical and job history. Social Security will then assess whether you can perform other work that would qualify for substantial gainful activity. Individuals with severe mental impairments such as low IQ, anxiety, or depression will not be expected to perform work that require a large amount of concentration or focus, whereas a person with a severe physical condition would not be expected to regularly lift 50+ pounds.

How to Apply for Social Security Disability

Social Security’s evaluation process is naturally stringent, as thousands of people apply each day. When you apply for Social Security disability benefits, make sure to include a full list of your conditions, medications, symptoms, and impairments, as well as the names and numbers of your doctors, clinics, and hospitals that have been involved in your treatment. The more information that you can give to prove your condition, the better. Make sure that your doctor and other medical professionals know that your condition is limiting your ability to work as well.

Requirements for Social Security Disability Benefits

To qualify for Social Security Disability benefits, you must have paid taxes related to Social Security for a specific length of time. The number of years required for Social Security payroll taxes varies by age, and if you stop working and paying taxes, you must be able to show that the disability or condition began before the insured status ran out.

Social Security Disability Attorney New York

At Argyopoulos and Associate LLC, we provide assistance to individuals who are disabled and in need to Social Security Disability benefits. We also help appeal disability denials, as well as assist clients during every step of the application process. Since we have helped hundreds of people with this process, we are confident that we can help you win your case. Our law firm serves SSD clients in many areas of New York, including Manhattan, Brooklyn, Queens, the Bronx, Staten Island, New York County, Kings County, Queens County, Bronx County, Richmond County, Nassau, Westchester, and other New York counties. If you need help securing your Social Security Disability benefits, call us at (800) ARGYLAW or visit our online contact page today.

IMPORTANT: If you have just been involved in an accident and/or injured – do not wait, protect your rights and contact us immediately by phone or email for immediate assistance.

If you are seeking legal counsel, representation or any additional information, then please enter your information in the contact menu and submit. Shortly thereafter, an attorney or associate of our firm will contact you, thank you.

by Argyropoulos & Associates

Driving in the New York Winter

According to a recent article by CNN, “[this is] the fifth consecutive season that at least 30 inches of snow have fallen in New York City. The only other recorded time it snowed this much, for this long a period, was back in the 1880s (Enten)”.  With increased rates of snowfall and ice on the roads, drivers living in New York City have to be very careful while they brave their morning commute.

If you’ve been living in New York City for the past few years, you may have experienced the largest snowstorm in the history of the city; in January 2016, New York City experienced a 27.5-inch snowstorm and the only subzero temperature since 1994. The National Weather Service is warning people to exercise extreme caution due to record levels of snowfall and inclement weather. Naturally, citizens need to take extra precautions during the winter months due to dangerous conditions on the road.

More Snow More Problems

Remember this: when the road is icy and/or wet, it takes a much longer time to come to a complete stop in a motor vehicle. By not leaving enough space in front of their car, a driver will not have enough time to break in the event of a sudden stop. This can lead to the driver losing control of the vehicle, which can result in a rear-end collision. These types of accidents can be mitigated if drivers leave enough extra space between their automobile and the automobile in front of them. It’s a simple equation that far too many people do not seem to follow: more space equates to more reaction time.

Winter Driving Tips 

There are quite a few strategies you can use to lower your risk of a car accident in New York City during the winter months.

• Accelerate and decelerate slowly. If you accelerate or slam on the breaks too quickly on an icy patch, it can send your car spinning. Remember, inclement weather will increase brake time.
• Your margin of safety between cars should increase. If you are driving on the highway, allow yourself a breaking distance of 7-10 seconds from the car in front of you. When it is not icy out and visibility is ideal, the recommended time is 3-4 seconds.
• Keep your gas tank at least half full at all times. This will help avoid a gas line freeze.
• Regardless of the weather, always wear a seatbelt and encourage your passengers to do the same.
• That text or phone call can wait. According to the Department of Motor Vehicles, 9 people in the U.S. are killed each day as a result of crashes involving a distracted driver.

Automobile Accident Attorneys in New York City

Even if you follow every safety precaution recommended, there is always a chance that another driver could rear-end your vehicle. With record levels of snowfall and a record number of miles driven in the U.S. last year, the occurrence of automobile accidents is not on the decline. If you’ve been involved in an automobile accident in New York City, Argyopoulos & Associates is here to represent you. With over 27 years of legal practice, we have the experience needed to settle any legal conundrum. If you need representation, contact us today to speak with an attorney.

by Argyropoulos & Associates

What is No-Fault Auto Insurance?

12 states are known as something called “no-fault” states due to mandatory requirements for Personal Injury Protection (PIP) insurance. New York is a state that participates in this law. In the large majority of other states, this is not the case. Generally speaking, the at-fault driver is responsible for the damages caused in a car crash, with their bodily injury liability and property damage liability covering the other driver’s medical expenses and car repairs. This is not the case in New York, where the law is a ‘no-fault”. The extent of liability with no-fault auto insurance and pay-outs can widely vary depending on the state and having a lawyer that knows the law is an absolute must.

Do I need a Lawyer if I Live in a No-Fault State?

If you were inured in a car accident in New York, we still recommend hiring an experienced attorney to represent you. Your Personal Injury Protection (PIP) claim is what you must file after the incident occurs, as the PIP claim is what your no-fault auto insurance uses to help with the payment of lost wages, medical bills and other damages after a car accident. This can be an incredibly trying time, regardless of who was at fault. Knowing the law is key, as things can become complicated very quickly.

Often times, submitting a claim can feel like a shot in the dark. Did you complete the form right? Should you have given a statement? What if you were at fault? Knowing what to say, or having someone to represent you can be the difference between an unpaid claim and thousands of dollars. We’d like to think that your insurance company will pay for all the damages incurred, but as we often see, insurance companies put their bottom line ahead of the needs of their customers. This is why you need to hire an experienced automobile accident lawyer in New York if you’ve been injured.

The types of damages can vary and always depend on the extent of the crash and the injuries that were suffered. These are the common types of damages that we look for when investigating your case:

1. Wrongful death
2. Emotional Distress
3. Pain and suffering
4. Lost wages as a result of the injury
5. Compensation for medical bills accrued due to the injury

No-fault Auto Law

In New York, you must go after the ‘pain and suffering’ category by pursuing that at-fault driver’s insurance. This law was meant to help streamline the process for smaller accidents, as you cannot make a claim for ‘pain and suffering’ with your own car insurance. There are a few requirements that you have to meet when filing for this type of injury, such as substantial disability, disfigurement, bone fracture/breakage, and/or a certain amount reached in medical expenses. For example, if you break your leg in a car accident and it’s not your fault, filing a third-party claim or personal injury lawsuit is a must if you want to obtain all the money you are entitled to. Pain and suffering is not covered in a no-fault claim in New York. Your only option is to bring a claim directly against the at-fault driver.

Auto accident attorney in Astoria, New York

If you’ve been injured in a car accident in New York, contact Argyropoulos and Associates today. Having celebrated over 27 years of legal practice, we have the experience and knowledge needed to help you get every single penny you deserve. Often times, automobile insurers will try to get out of paying for everything that they are accountable for. We can help you detail the full extent of your injuries to help you obtain the maximum payout. We highly recommend that you call a lawyer before you make a statement and start the claim process.

by Argyropoulos & Associates

Are You Liable for Slip and Fall Injuries?

Slip and fall injuries are not just something to just laugh at. A fall that goes wrong may cause broken bones, internal bleeding, spinal injury or even brain damage! If someone slips and falls, just because they can get up afterwards isn’t a sign that they’re fine – for all we know the pain is hiding in cracked bones or a concussion. If someone slips and falls inside your home or place of business, does this make you automatically liable?

Maybe yes, maybe no. There is a Reasonable Expectation Not to Be Injured whenever a person enters someone else’s property with the owner’s permission. Incidents like slip and fall injuries or being hit by falling objects, being attacked by dogs or other pets, accidents involving amusement park rides, being injured inside a restaurant, etc., may fall under Premises Liability.

The Implied Promise of Premises Liability

Employers are held liable for the actions of their employees, parents for their children, pet owners for their pets, and property owners for the conditions of their property.

When someone is invited to a home or workplace, or appears there for a legal reason (like a courier delivering a package) there is an implied promise that the owner of the property has exerted a reasonable amount of care to assure the safety of their property for themselves and others. Property owners have the responsibility to minimize unsafe conditions. Inadequate lighting around stairs, unmarked slippery surfaces, ice and snow in the sidewalk, aggressive pets, and many other hazards could cause someone to slip and fall in surprise.

For example, if someone slips and falls on an unmarked wet floor, and your employees were negligent to inform about dangerous conditions (such as leaving a sign or cordoning off the area), you will likely be ordered to compensate them for their pain and medical bills. Unsecured equipment on rollers are another likely culprit. Malfunctioning air conditioning equipment and vents that drip water are classic examples of open-and-shut personal injury claims.

However, there are exceptions to slip and fall cases.

Limits on Premises Liability

• Restricted Areas

  Clearly marked restricted areas such as kitchens, industrial workplaces, or private workshops, generally will not make you liable for accidents suffered by visitors that should not be there. There is, instead, an expectation of danger for people who are not authorized personnel. Such areas should be clearly marked or you would still be held liable for the mistake.

• Trespassing

  People who enter your property without permission do not generally have the protection of the implied expectation not to get injured. However, if you have a serious property hazard and fail to leave a warning, you may still be held liable because the hazard would also be a danger to allowed visitors.

• Unforeseeability and Prevention
  
  If you have already exercised all reasonable steps to secure your property and mark unsafe areas, you are not liable for freak accidents that could not have been anticipated. For example, at a party a guest spills a drink and someone slips, the fault falls on the person that caused said accident. But if they tripped and fell from a loose rug, you are the one at fault. If someone from outside throws something that lands inside your property and causes someone to lose their footing, you could not have predicted that.

• Self-Inflicted Injuries

  While people have an expectation not to get injured, they also should have a general awareness to protect themselves. They should not engage in activities that would prevent them from noticing the hazard – like texting or talking on their cellphone while walking, or ignoring adequate warning signs and safety measures. As noted in 1) and 2), they should also have lawful access or a legitimate reason to be in a dangerous or restricted area.

Proving Negligence and Liability with Slip and Fall Injuries

Only when it can be proven that the property owner or their representatives failed to act prudently to reduce potential hazards will a slip and fall claim will be granted in states that follow Contributory Negligence rules. Other states allow Comparative Negligence, in which the claimant’s damages are reduced by how much they contributed to causing their injuries.

Consult with your attorney as soon as possible to know if your actions could mark a form of slip and fall negligence that would impact the claim.

by Argyropoulos & Associates

Your Worker’s Compensation was Denied – Now What?

If you are living and working in New York, chances are high that you are covered by your employer’s workers’ compensation insurance. If you’ve been injured on the job or have been diagnosed with an occupational disease, your claim should be approved. The issue arises when worker’s compensation is denied, as coverage is not automatically guaranteed in all cases. We often have clients come to us with a denied claim; there can be a variety of reasons for why the claim was denied:

• The insurance company deemed the injury was non work-related
• The insurance company or employer argued that the worker was under the influence of alcohol and/or other drugs at the time of the incident
• The employee is not covered by their insurance
• The employee intentionally injured him/herself or intended to injure another
• The illness afflicted was deemed not an occupational disease
• The insurance company simply does not want to pay out and has an expert lawyer on the other end of the claim

There are a few things that you can do if your Workers’ Compensation Claim was denied.

Workers Compensation Claim Denied in New York

If you receive a decision by the New York State Workers’ Compensation Board that is not in your favor and is not justified, there are actions that you can take. What are your options? You can file an appeal with the Worker’s Compensation Board to the commissioners of the board, outlining the reasons why you think the judge made a mistake when dealing with your case. You must file the appeal within 30 days of the decision. Look for the filing of the notice, also known as the “control date” on the bottom of the decision.

If the appeal is denied again, you may ask for a full board review of the matter and even contact the 3^rd department, which is a court system that oversees the entire Workers’ Compensation Board. The commissioners of the board that deal with Workers’ Compensation claim may decide to hold a hearing or series of hearings that will be heard by an experienced attorney that deals with workers’ compensation. The judge will re-review the case and decide whether or not the claimant should receive the benefits. Either side has the right to appeal the decision within 30 days and you always have the right to an attorney during any point in this process.

Attorneys in New York

There are options that you have if your workers’ compensation claim has been denied in New York. If the judge does not rule in your favor, there are many avenues of defense that you can take to help the next hearing run smoothly. Having an experienced attorney that has dealt with hundreds of workers’ comp claims is highly recommended if your claim was denied at any point in the process. At Argyropoulos and Associates, we have a proven track record of getting our clients the money they deserve, even after their claim has been denied. Work related injuries can be frightening. Having your claim denied can be even more frustrating. We have the compassion and diligence needed to help guide any worker through the process. Contact us today if you would like us to represent you or if you have any questions regarding your workers’ compensation claim.

by Argyropoulos & Associates

Settling your Workers’ Compensation Case

Many industry professionals involved in the workers’ compensation industry will focus their time and effort on litigation, settlement procedures, and regulatory initiatives. Claims management is important, but many people don’t think about what happens after the case is settled. When a worker who has been injured on the job settles their case, it can have profound effects on their own life, as well as those involved in the workers’ compensation system.

Settling a Case

If an individual chooses to settle his/her workers’ compensation case, this usually means that they are agreeing to a lump sum or annuity payment. This releases the insurance company from being financially responsible for future medical payments. Some states may require the insurer to continue weekly or monthly paid medical benefits, while others allow insurers to terminate medical benefits upon settlement of a workers’ case. Always be sure to read the terms of a settlement very carefully. If you agree to a lump sum, these funds usually represent the future value of ongoing benefits and usually the cost of future medical treatment related to the injury. It is incredibly important that you and your lawyer calculate and understand the cost of future medical treatments related to your injury. Keep in mind how the settlement could interact with government benefits such as social security, short-term/long-term disability and Medicare/Medicaid. This can be a trying life experience for anyone and can be very confusing and challenging for an injured worker if they are unrepresented.

The Pros and Cons of Settling your Workers’ Compensation Case

If an injured worker chooses to settle a workers’ comp case, knowing the possible pros and cons of the decision is necessary. Settlement can be an appealing option for a number of reasons:

· Less restrictive treatment: The freedom to see any doctor or specialist with the money acquired through the settlement may make a workers’ life easier. Often times, doctors that are assigned to a case through the workers’ compensation system can be very far away from your house. This can be exhausting, especially if you have a major, debilitating injury.
· Living life outside the workers’ compensation program: Ending a case can represent a life changing moment. The worker will have a much larger future responsibility, but will also be free from future court dates, required doctor’s visits and state mandated supervision.
· Turning a new leaf: Putting the case behind them, settling the case and focusing on their health can help workers move on with their life. It can represent a fresh start.

Settlements can also be a trying time for an afflicted worker:

· Freedom is a double-edge sword: Once a worker settles a case, they have the freedom to choose their own doctor and health care professionals. However, once the case is settled, changes occur: their adjuster, attorney, support from the system, nurse case manager and other health care professionals must step away. This can leave an injured worker feeling lost, as they may have been relying on the system for an extended period of time.
· Cost of treatment may increase: Employers utilize the workers’ compensation program to receive generous discounts on medical treatment and pharmaceuticals to assist injured workers. This may mean that the cost of medication could increase. Make sure that you take this into account when settling a case. This can leave many workers feeling uncertain about their financial future.
· Added responsibilities with a Medicare Set Aside (MSA): About 45% of total submitted settlements will settle with MSA. This includes added responsibilities required by the Centers for Medicare and Medicaid Services (CMS) in order to remain compliant.

Medicare Set Aside

There are many requirements for an MSA if an injured worker decides to settle a case. These requirements consist of:
1. A new bank account
The CMS requires that all funds received for an MSA must be deposited into a separate FDIC-insured interest-bearing bank account. In the past, many workers would put their funds from the settlement into a regular checking or savings account. It can become difficult to tell the difference between MSA funds and personal funds if a worker does this. A worker may accidentally pay their cable bill with MSA funds, which can complicate end of year reporting and taxes.
2. Funds for Medicare-covered expenses only
Since MSA is money set aside specifically for future medical treatment on Medicare-covered items, it must be spent in a way that protects Medicare’s interest. Sometimes drug codes and treatment codes can be confusing and this confusion can result in someone falling out of compliance. Know the drug codes and take measures to be compliant.
3. A new schedule
Injured workers that have an MSA typically pay full price. CMS requires that treatments be paid at a state fee schedule, meaning an incredibly difficult and and unknown process usually awaits them. Injured workers with an MSA are also required to keep track of every single expense made with their MSA funds. Every detail must be recorded and sent to the CMS for inspection. This can be as complicated as filing taxes, as there are funding report guidelines and additional depletion reports to file if a worker exhausts their funds each year.

Settling your Workers’ Compensation Case: Resources after the Fact

If an injured worker feels lost after settling their case, there are some resources that are available to help assist in the process. Accessing the CMS website can grant a worker a plethora of information, including a 31-page CMS Self-Administration Toolkit. This provides the guidelines and examples that are needed to successfully report MSA funds. CMS highly recommends a personal administrator to assist in managing and reporting MSA funds if a worker decides to settle.

Weighing the pros and cons of a settlement can be incredibly confusing and conflicting for an injured worker. It is necessary to fully and completely understand what it means to settle a case before a worker decided to settle theirs.