Big R. Towing, Inc. v. David Wayne Benoit, et al.
Civil Action No. 10-538, 2011 WL 43219
(D. W.D. LA, January 5, 2011)
The Big R case involved a Jones Act case which is treated as a liability claim by CMS for “future interests” purposes. In Big R, the principal dispute was whether the claimant needed low back surgery and a hip replacement in relation to the alleged accident. The carrier disputed the recommendations for these surgeries on grounds of medical necessity and causation. There were divergent medical opinions regarding these issues.
The parties eventually reached a settlement for $150,000. At the time of the settlement, the claimant was not a Medicare beneficiary; but was receiving social security disability benefits (SSD). Given that the claimant was on SSD and would become entitled to Medicare at some point after the settlement in connection with the SSD award, the parties decided to take steps to protect Medicare’s interests, which included setting aside monies to protect Medicare’s future interests post-settlement. Continue reading “Big R. Towing, Inc. v. David Wayne Benoit, el al.”