PD rating (California)

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Re: PD rating (California)

Postby LawAdvocate on Tue May 19, 2015 10:54 am

First, you are most likely being asked to sign releases for CMS and Social Security to secure a Medicare Set-Aside (MSA) valuation.
Once the valuation is done, you really don't have to care what company it is with, as long as you insist that as part of any global settlement the MSA is approved by CMS. Once a MSA is approved by CMS, that is a compromise and should you pay all of the MSA out and still require medical care, any cost usually covered under Medicare will still be covered as long as whoever is administering the MSA has paid out all the funds properly.

I do not think they are asking this vendor to administer your Medicare moneys, those moneys are usually self-administered and you would get the funds to deposit in an interest bearing account to pay any Medicare covered medical care related to your industrial injury.
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Re: PD rating (California) (California)

Postby dolphines on Tue May 19, 2015 12:17 pm

Thank you very much. I plan on self administering the msa myself. How do I do that? Do I tell the ins. company I want to self administer the msa myself? Or do I notify someone else?
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Re: PD rating (California)

Postby LawAdvocate on Tue May 19, 2015 1:20 pm

Unless the MSA is huge, it is assumed you will self-administer. If you are not concise with record keeping, it is not recommended because it is a ton of work.
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Re: PD rating (California)

Postby dolphines on Tue May 19, 2015 2:13 pm

Thank you, again. I will let you know how much it is, when it is done.
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Re: PD rating (California) (California)

Postby dolphines on Thu May 21, 2015 3:40 pm

Got a letter from the defense att. with a list of the medical records he plans on sending to the PQME. I thought he was supposed to mail me a copy of the actual medical records for me to review. Right or wrong?

I just read this on the wcab web page.

Once you make the QME appointment, the physician has five days to send the QME appointment notification form to the claims administrator advising them of the appointment. The claims administrator is required to send you a copy of everything they plan to send to the QME physician 20 days prior to sending the records to the QME. You are also required to send any information (letters from friends, personal records) you are planning to send to the QME to the claims administrator 20 days before you send it to the QME. Both you and the claims administrator (or your respective attorneys) have 10 days to object to any non-medical records being sent to the QME. There is no form for this objection. Whoever is objecting simply writes a letter to the other party. If either you or the claims administrator does not follow the 20-day rule, the wronged party has the right to cancel the evaluation.
(Title 8, California Code of Regulations, section 35, Labor Code section 4062.3 (b))
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Re: PD rating (California)

Postby Barney5 on Sat May 23, 2015 4:34 pm

I already sent you a message but wanted to reply here in case another injured worker has this question. The claims adjuster is supposed to send you a copy of the records. You are correct.
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Re: PD rating (California)

Postby dolphines on Sun May 24, 2015 3:34 pm

Thank you.
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Re: PD rating (California)

Postby dolphines on Wed Jul 15, 2015 10:10 am

Hi everyone.

I was wondering about msa vendors. I noticed there are a lot of them.

Will one vendor come back with a different msa amount than another?
dolphines
 
Posts: 73
Joined: Sat Apr 28, 2012 8:16 am

Re: PD rating (California)

Postby dolphines on Wed Jul 15, 2015 10:10 am

Hi everyone.

I was wondering about msa vendors. I noticed there are a lot of them.

Will one vendor come back with a different msa amount than another?
dolphines
 
Posts: 73
Joined: Sat Apr 28, 2012 8:16 am

Re: PD rating (California)

Postby dolphines on Wed Jul 15, 2015 10:10 am

Hi everyone.

I was wondering about msa vendors. I noticed there are a lot of them.

Will one vendor come back with a different msa amount than another?
dolphines
 
Posts: 73
Joined: Sat Apr 28, 2012 8:16 am

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