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Know the Medicare Requirements Regarding Personal Injury Claims

Written by Ankin Law Office

Personal injury claimants should be aware of the additional requirements that Medicare law places on any compensation received in a personal injury lawsuit.

As of January 1, 2011, personal injury claims made by Medicare-eligible claimants must be reported to Medicare. Moreover, Medicare is entitled to reimbursement of all of the benefits that it paid for the injuries sustained in the personal injury accident. Medicare will seek reimbursement for these amounts from any settlement or judgment that the claimant receives. If a Medicare recipient fails to comply with the reporting and reimbursement requirements, he or she may be fined $1,000 per day, plus interest and double damages.

Who Is Subject to Medicare Reporting and Reimbursement Requirements?

Not all personal injury claimants are subject to the additional Medicare requirements. Only those claims made by persons who are Medicare-eligible, or are reasonably expected to be Medicare-eligible within 30 months, must report their personal injury compensation to Medicare and reimburse the agency for the benefits it paid.

Age is not the only factor in determining if a person is subject to the Medicare reporting and reimbursement requirements, however. Those persons who are Medicare-eligible can include:

  • Individuals who are at least 65 years old;
  • In some cases, individuals who are 62½ years old; and
  • Individuals with certain disabilities who qualify for Social Security Disability Insurance benefits, who have permanent kidney failure and require kidney dialysis or transplant, or who have Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease).

A claimant must be also be a citizen of the United States or a legal permanent resident in order to be eligible for Medicare.

Only personal injury claims – such as motor vehicle accidents, medical malpractice, and toxic torts, for instance – must be reported to Medicare, with a few limited exceptions. There are minimum reporting thresholds that must be met before personal injury damages must be reported. In 2012, all payments totaling at least $2,000 were required to be reported, but in 2013 all claims over $600 must be reported. In 2014, all compensation paid in a personal injury claim must be reported.

How Do I Know If I Am Subject to the Medicare Requirements?

Any entity that makes a payment to a Medicare beneficiary on a settlement, judgment or award must report the personal injury compensation to Medicare reporting and reimbursement the agency. These entities include insurers, self-insured entities, certain categories of insured entities, and employers administrating workers’ compensation plans.

Reporting entities can submit a query to the Centers for Medicare and Medicaid Services (CMS) through its website (which must include the claimant’s name, social security number, date of birth, Medicare Health Insurance Claim Number, and gender) to determine whether the personal injury claimant is Medicare eligible. The CMS will respond to the query within 14 days.

How Can Ankin Law Offices Help?

At Ankin Law Offices, LLC, our Chicago personal injury attorneys are well-versed in the various personal injury, Social Security, and Medicare laws affecting personal injury damage awards. We will advise you of your rights and obligations in order to ensure that you comply with all applicable legal requirements. Contact our office at (312) 600-0000 to schedule a free consultation with one of our Chicago personal injury attorneys.

Categories: Personal Injury