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April 8, 2021

What is a Medicare Set-Aside?

For many years, personal injury cases have been resolved without consideration of Medicare’s secondary payer status even though since 1980 all forms of liability insurance have been primary to Medicare. At settlement, by judgment or through an award, an injury victim would receive damages for future medical expenses that were Medicare-covered. However, none of those settlement dollars would be used to pay for future Medicare-covered health needs. Instead, the burden would be shifted from the primary payer (liability insurer or workers’ compensation carrier) to Medicare. Injury victims would routinely provide their Medicare card to providers for injury-related care.

April 7, 2021

Why Qualified Settlement Funds are an Important Tool for Trial Lawyers to Understand

What do you do when you settle a case like this where your client is on public assistance, there are allocation issues, settlement planning issues must be addressed, and there are liens to negotiate? Where can you “park” the money while you set up any necessary public benefit preservation trusts, determine allocation of the proceeds, figure out a financial plan, and negotiate the liens?

April 6, 2021

What are Your ERISA Plan’s Recovery Rights?

Most, if not all, ERISA health insurance plans state that injuries caused by a liable third party are not a covered expense and require reimbursement when a plan pays for injury-related medical expenses (often referred to as subrogation clauses). ERISA provides that health plans which qualify under its provisions can bring a civil action under section 502(a)(3) to obtain equitable relief to enforce the terms of the plan. Appropriate equitable relief is really the only enforcement mechanism an ERISA plan can utilize to address its reimbursement rights contained in the plan.

April 5, 2021

Confused by Medicare? Here’s a Helpful Overview

The Medicare program—and the related Social Security Disability Income/Retirement benefit (SSDI)—is one of the primary benefit programs available to those who are injured and disabled. Understanding the basics of this program is imperative to protecting the client’s eligibility for their benefits.

Medicare and SSDI benefits are an entitlement and are not income or asset sensitive. Clients who meet Social Security’s definition of disability and have paid enough quarters into the system can receive disability benefits regardless of their financial situation.

April 2, 2021

How to Use a Special Needs Trust to Preserve Benefits Eligibility for Disabled Injury Victims

John Doe was a laborer since age eighteen, but when he was thirty, he was severely injured and became paralyzed. John didn’t have health insurance at the time of his accident, and the hospital applied for Medicaid on his behalf after getting injured. He qualified for Medicaid, since he had no real assets and no longer had an income. His family applied for Social Security Disability since he had worked enough quarters to be insured. John’s personal injury lawyer has settled the case for $1,000,000, which will help him pay for everything he now needs, but it is far less than what is needed to pay for all his future medical care. The question now is what to do with the settlement?

April 1, 2021

6 Real-World Considerations for Advanced Settlement Planning

Mrs. Smith was moved to the ICU and no neurologic monitoring was performed that evening after being moved from the surgical suite. The next morning, Mrs. Smith was found to be quadriparetic. A suit was brought against multiple defendants with a significant seven-figure recovery secured. Mrs. Smith and her family had Medicaid coverage and SSI. She had also applied for Social Security Disability Income (SSDI). At the time of settlement, there was no Medicare eligibility, since she had not been approved for SSDI and she wasn’t sixty-five.

In the confusing landscape of public benefits and planning issues that arise today for trial lawyers when settling catastrophic injury cases, finding your way can be a daunting task. In the paragraphs that follow, I’ll use Mrs. Smith’s real-world example to identify six key considerations to look out for when you’re settling a case for a catastrophically injured client.

March 2, 2021

Anti-Social Courts

Q. I’ve had my fill of ignorant and arrogant judges who disgrace the ill-fitting robes they wear. As lawyers, isn’t it time we speak out and post about judicial incompetence so we may improve justice for all? …

February 26, 2021

Vegetation Management Lapses Subjects PG&E to Heightened Oversight

The CPUC seeks greater oversight over PG&E’s safety practices after finding that PG&E is not properly prioritizing the electrical lines that need tree trimming.  KRONTV4 asks Mike Danko what it means. KRON4 asks Mike Danko About CPUC’s latest action against PG&E

February 18, 2021

Why Are Women Often Misdiagnosed When Having a Heart Attack?

The month of February is American Heart Month which aims to raise awareness of the number one killer of men and women in the US, heart disease. Heart health has proven to be even more important during the COVID-19 pandemic, as people diagnosed with heart disease have shown to have …

February 10, 2021

So you committed malpractice …

Q. I’m not inclined to make excuses. But things have been so hectic in my office that I let a nice accident case slip through the cracks and failed to file suit by the limitations deadline. My head is spinning. What should …

February 1, 2021

Suspending an “Extreme” Sanction

Finding Bar Counsel’s call for an indefinite suspension too “extreme,” the Court imposed a more modest moratorium on a lawyer with an unblemished record in close to 50 years of practice. Issue: What sanction should the Court impose upon an …

January 13, 2021

Nursing Home Provides Wealthy Donors COVID Vaccine Earmarked for Residents

As of today, over 374,000 Americans have died from COVID-19, a travesty in a nation with access to exponential wealth and one of the most advanced heath care systems. How we earned the “Most Killed by Corona” superlative can only be accredited to dismal leadership and the failure to roll …

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