Deciding between open lifetime medical treatment or closing medical benefits in exchange for a monetary payment is not a decision parties take lightly in a workers’ compensation claim. Closing medical benefits requires careful consideration of many factors for all parties involved but especially for the injured worker.
For the first time, an original best practice and educational guide called, ‘30 Minute Guide to Medical Treatment after Settlement’ created by the Tennessee Bureau of Workers’ Compensation, has been released as a post-settlement resource for injured workers. The guide helps injured workers in Tennessee make an informed decision on settling their state workers’ compensation claim. Ametros commends this effort and believes the transparency and resource will help all parties to a settlement.
Major contributors involved in the development of this booklet include, Ametros’ very own, Dorothy Holland, National Account Executive East, Brian Bargender, CSRP, Business Consultant/Senior Subrogation Professional for Humana and Daniel M. Anders, Esq., MSCC, Chief Compliance Officer at Tower MSA Partners, LLC.
The guide informs its readers, it “was created to provide injured workers a resource to better understand open lifetime medical benefits and what it means when injured workers choose to close their workers’ compensation claims. The guide is for educational purposes to help injured workers more carefully consider their options and make a more informed decision.”
“I realized how little I knew about the complications injured workers faced when they closed their medical benefits in 2018. Shortly afterward, I was able to learn from and collaborate with many fantastic subject matter experts. I believe that together, we have created a resource that helps injured workers better understand their lifetime medical benefits and if they choose to close their medical benefits, they have sufficient information to do so in a fair and appropriate manner.”
-Brian Holmes, M.O.S.T. Director, Bureau of Workers' Compensation
The guide serves as an educational resource simplifying the following topics:
- Open lifetime medical benefits vs closed medical benefits;
- Medical benefit considerations;
- Understanding how future medical costs are calculated;
- Workers’ compensation Medicare Set-Aside Arrangements; and
- Self-Administration vs Professional Administration
When an injured worker settles a claim, typically they are on their own to manage the settlement proceeds. Oftentimes, closing out future medical care can be a daunting and complex decision to make for an injured worker. Once a claim settles, resources such as their attorney or adjuster, access to medical discounts, and help with coordination of care are no longer available. Many injured workers can become anxious when they realize the reality they are on their own post-settlement. Further, many injured workers may not truly understand the implications and responsibilities of settling, which may cause them to be reluctant to ultimately settle their claim or will leave them confused if they choose to settle the case. Educating injured workers on after settlement options, like professional administration or self-administration, is critical in helping injured parties make informed settlement decisions. Understanding their Medicare Secondary Payer (MSP) responsibilities post-settlement and helping injured workers is the focus of this guide.
“The development of this document is one step forward in creating greater awareness for helpful post-settlement services like professional administration and sets the industry standard for helping injured individuals access the resources they need to make informed decisions. It was a great experience working with the TN Bureau of Workers’ Compensation to establish the first simple best practice guide that addresses what’s involved for injured individuals when closing their workers’ compensation claim.”
-Dorothy Holland, National Account Executive East, Ametros
Ametros welcomes the opportunity to work with other jurisdictions on similar guides. An injured worker educated on the consequences of settlement is better able to make an informed decision on which settlement options are best for him resulting in a better workers’ compensation for all stakeholders.