Picture a retired state trooper, Bob, with a cardiac condition rendered permanently and totally disabled after a multi-vessel bypass; he’s now facing a lifetime of medical visits, testing and treatments. As Bob hesitantly contemplated settling his workers’ compensation claim, his attorney contacted experts from professional administration and structured settlement companies to explain how he would have support and would not be left to fend for himself;
- He would have an advocate to answer any and all his questions.
- His medical bills would be processed and discounted for him.
- Requirements for government compliance would be appropriately handled.
Bob decided to finally settle his case in the hopes that with the help of a structure and professional administration, his future would be secure. In fact, since Bob settled his case, in the last few years he has had more than 100 medical bills reviewed and paid for by his administrator, and a variety of questions answered when he and/or his wife have called their professional administrator. For example, they’ve asked if they could change brand-name prescriptions to generics, and whether he could go see a new specialist for his heart condition. The administrator helped them get answers, ensuring they are finding the most affordable and effective care for Bob’s condition. Bob and his wife are now very happy with their post-settlement life.
This is a typical example of an injured party who settles their claim with the satisfaction of knowing their medical needs and concerns will be addressed because they have the benefits of professional administration, a structured settlement, or both. In fact, Paolo Longo, Jr., the former trooper’s attorney, won’t allow any of his clients to settle their claims unless there is a professional administrator involved.
Paolo Longo, Jr., from the Orlando office of Bichler, Oliver, Longo & Fox joined Ametros’ President, Porter Leslie, on an episode of Ringler Radio to discuss the challenges that injured parties are facing when it comes to settling their workers’ compensation or liability claims.
Host, Larry Cohen, head of Ringler’s Northeast Operations, pressed Leslie on why a professional administrator can be so important to a settlement. “Once a case settles the medical treatment isn’t over,” Leslie explained. “We focus on making sure that person has medical support and an advocate to help get the care they need. They become our client — we like to call them our members — for the rest of their lives.”
“The number one concern of injured parties is what happens after settlement,” Longo said. “They want assurance that their future medical needs will be taken care of; that they can continue with their doctors and their medical regimes."
While some injured parties try to self-administer their settlement funds, experts advise against it. In fact, last year Medicare updated their WCMSA Reference Guide to state that they ‘highly recommend’ using a professional administrator.
Leslie explained how Ametros, and its flagship product, CareGuard, provide peace of mind to injured parties who have settled their workers’ compensation or liability claims. “We are the custodians of the settlement funds; we pay all their medical bills and do everything automatically,” he said. “I liken it to taxes. Do you do it yourself with pencil and paper, or do you look for professional help?”
Often times, an injured party’s medical care is separated into a Medicare Set-Aside upon settlement and adhering to the numerous Medicare reporting requirements involved is extremely complex.
“We set up a bank account for the injured worker,” Leslie said. “We review and validate [the medical bills.] We make sure the person can use the MSA for treatment and we pay on their behalf, while reducing the bills and getting discounts to make sure their money lasts as long as possible.”
