Most of us have either said or heard the following: “I am not going to settle this claim if we need
an MSA. The case becomes too expensive to settle and it’s just too complicated! The claimant will never agree to it.”
MSP Compliance can be cumbersome— especially if companywide protocols do not exist. The last thing a busy adjuster wants to do is spend time weeding through multiple CMS memos to decipher what needs to be done to comply with Medicare!
Other obstacles to settlement include obtaining the required two years of current medical treatment and Rx records; or going back to the primary physician to confirm treatment options
and the Rx regimen. Then there is the aggravation of receiving an “over-inflated” MSA allocation
that includes everything under the sun— surgeries the claimant will not have— or does not
want— and an Rx allocation calculated over the life expectancy of the claimant.
In addition, we are often confronted with a claimant who is unwilling to sign the releases needed to confirm benefits or simply does not want to settle the case with an MSA— either because he does not want to spend the funds for medical care or does not want to administer the account himself.
Even if insurers are able to resolve all of these hurdles, they still have to deal with Medicare’s
timetable for CMS approval and resolution of conditional payments.