Workers’ Compensation and Medicare – The Interplay

Are you a Medicare beneficiary who has been injured on the job? If you have been injured on the job, you are entitled to certain benefits under the law. Seeking the advice of an attorney is paramount to ensure that you are receiving your appropriate benefits. It should be noted that these matters are handled on a contingency, meaning that there is no fee for representation unless a recovery.

Although the insurance carrier for your employer is entitled to direct your medical treatment, you remain entitled to reasonable and necessary medical care as long as it remains curative in nature. Furthermore, as long as the authorized physicians indicate that you are medically unable to work, you are entitled to temporary disability payments, according to the statute. If these benefits are not being afforded to you, it is important to seek counsel, as there are steps an attorney can take to secure your benefits.

This is especially a concern if an injured employee is Medicare eligible. In the event that you are Medicare-eligible, Medicare is actually the secondary insurance in a Workers’ Compensation matter. Therefore, Medicare may pay for medical benefits on a conditional basis but will seek reimbursement for those payments in the future. This is primarily sought from the insurance carrier, but exposure remains for you if the insurance carrier denies payment.

The question arises as to when an employee is Medicare eligible. You are Medicare-eligible upon reaching sixty-five (65) years of age, have been receiving Social Security Disability for twenty-four (24) months or longer, or if you are suffering from end-stage renal disorder.

Should permanent partial disability remain after your treatment is completed, you may be entitled to a settlement pursuant to the Workers’ Compensation Statute in New Jersey. This is paid according to the Statute and is determined based on your continuing disability and permanent limitations you may suffer.

An employee should be concerned in the event that he or she has a reasonable expectation of becoming a Medicare beneficiary within thirty (30) months of the time of this settlement. This may affect your rights and the settlement to which you are entitled.

You should consider yourself to be Medicare eligible within thirty (30) months if you have applied for Social Security Disability by the time of settlement. In addition, if you have been denied Social Security Disability benefits at the time of settlement, but anticipate appealing this decision, are in the process of appealing the decision, or have been denied, but are in the process of re-applying, you also should seek counsel to determine the ramifications that this may have on your rights. Lastly, if you are sixty-two (62) and will be turning sixty-three (63) within six (6) months, you are also considered to be Medicare eligible within thirty (30) months and should seek the advice of an attorney to protect your interests.

The law firm of R.C. Shea & Associates is a full-service law firm representing and advising clients in the areas of Estate Planning, Estate Litigation, Personal Injury, General Litigation, Real Estate Law, Medicaid Law, Medical Malpractice, Workers’ Compensation and Wills, Trusts, and Powers of Attorney. Call or visit our firm in our Toms River office at 732-505-1212, 244 Main Street, Toms River, or email us.

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