Hamberger & Weiss LLP



Previously unable to settle a Workers’ Compensation claim because the Medicare Set-Aside (“MSA”) was too high? It may be time for a second look. Changes in the claimant's prescription costs, prescribed medications or medical treatment plan sometimes allow for a lower MSA calculation. Reach out to us on an annual basis or sooner to refresh the MSA and determine whether the time is right for CMS submission and settlement.

Prescription medications on the cost driver on most MSAs. Prescription medication pricing is volatile; many medications have been reduced in price from several dollars per pill to only a few cents. This type of pricing change can significantly reduce your MSA. Even if your MSA was previously approved at an amount that made it impossible to settle your case, we can request an AMENDED REVIEW from CMS based on the new pricing. CMS permits AMENDED REVIEW one year from the date of original submission to CMS, but no later than six years from the date of the original submission. Also, the change in the MSA calculation must be at least 10% or $10,000 (whichever is greater). We have successfully obtained Amended Reviews on many cases for our clients.

We have a dedicated Settlement Team, and all attorneys in the firm are trained to prepare WCMSAs and settlement agreements. Our settlement team is led by Partners Dan Bowers (Buffalo), Joe DeCoursey (Rochester), and Nicole Graci (Buffalo). Since beginning our WCMSA practice in 2001, our firm has submitted thousands of WCMSAs to CMS for pre-settlement approval. Hamberger & Weiss LLP stands out in the field of Medicare Secondary Payer Compliance because in addition to being experienced WCMSA submitters, we are lawyers. In addition to expert preparation of the WCMSA, we offer legal strategies and recommendations for cost-saving, mitigation and the best chance that the WCMSA will be approved by CMS. Except for the Re-Review and Amended Review processes, CMS will only review a WCMSA once. Our attorneys recommend strategies to position the case properly for approval of a WCMSA that fits within your settlement parameters. Before making a CMS submission, we prepare a preliminary Medicare Set-Aside with legal analysis and recommendations on how to reduce the amount of the MSA and whether or not to submit to CMS.

Please contact Dan Bowers dbowers@hwcomp.com, Joe Decoursey jdecoursey@hwcomp.com or Nicole Graci ngraci@hwcomp.com for MSA calculations, CMS submissions, to refresh your MSA or to explore the possibility of an Amended Review

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