One way to resolve a workers' compensation case in New Mexico is negotiate a settlement that "closes" a workers' right to life time medical benefits. In exchange for the worker giving up this right, the workers' compensation insurer will agree to pay money to create what's called a Medicare Set Aside Trust otherwise known as a MSA Trust.
Closing workers' compensation medical benefits is an extremely important decision. Any injured worker considering closing his or her workers' compensation medical benefits should retain a lawyer in my opinion.
The Medicare Set Aside Trust is an issue when an injured worker is Medicare eligible or expects to become Medicare eligible within three years of the closing of workers' compensation medical benefits.
Usually, an injured worker is Medicare eligible based on the following:
- The injured worker was 65 years or older when they were injured. Most people 65 years or older have Medicare.
- The injured worker turns 65 years old after the work injury.
- The injured worker is receiving Social Security Disability benefits before the work injury. Social Security Disability usually includes Medicare coverage.
- The injured worker applies for or intends to apply for Social Security Disability after the work injury.
- Medicare has paid for treatment of the work injury.
The money deposited into the Medicare Set Aside Trust is supposed to pay for the injured worker's future medical treatment after the workers' compensation medical benefits are closed. Medicare, therefore, will not be used to pay for any treatment of the work injuries.
The creation of a Medicare Set Aside Trust is complicated. The effect of the Trust on the injured workers' future medical treatment of the work injuries is also complicated. The effect of the Medicare Set Aside Trust on the injured worker's Medicare is also complicated.
Additionally, a Medicare Set Aside Trust is often not as good as the medical benefits required by the New Mexico Workers' Compensation Act.
Therefore, if you are considering closing your workers' compensation medical benefits and/or using a Medicare Set Aside Trust, you must get the advice of a workers' compensation attorney.