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Medicare Set Asides 101: Who’s on Your Settlement Negotiation Team?

With playoffs in full swing for basketball and hockey, and baseball season heating up, we are all witness to the power of teams working in coordination. Choosing the right personnel for your team and putting them in the right place at the right time can be the most important decision you make.

Your Settlement Team

When it comes to personal injury and workers’ compensation settlement negotiations and mediations, there is a familiar standard lineup. The defense side often shows up with the adjuster and defense counsel, while the plaintiff side brings the plaintiff attorney and the injured party. Sometimes the adjuster will be flanked by a risk manager or supervisor. Sometimes the plaintiff attorney will be supported by additional counsel, or in larger cases, a life care planner.  For larger cases, often a structured settlement broker will be involved as well.

What's intriguing about the standard cast of characters for negotiations is that they all assemble to try to reach a final resolution of a claim and that marks the end their work with the injured party. For the attorneys and adjusters and brokers, the settlement proceeding is typically the culmination of a lot of hard work and compromises. The settlement negotiation is their fourth quarter, or sometimes, it even feels like overtime.

By contrast, a professional administrator views the settlement negotiation as only the beginning of a new relationship. Only the professional administrator walks away from settlement with a new client and the beginnings of responsibility. This is a very powerful fact that allows the professional administration group to bring a unique perspective and be extremely helpful in settling cases.

Why Involve a Professional Administrator?

One of the frequent questions injured parties have is: Who is going to take care of me after I settle my case? If a professional administration group is at the settlement negotiation, that question is easily solved. More and more groups are seeing the benefit of bringing a professional administrator to a mediation for several reasons. A professional administrator:

  1. Will assist the injured party with coordinating their future medical care after settlement
  2. Can share the true price of items after settlement - helping to resolve disputes over what future medical treatments will cost
  3. Will answer and eliminate of any ongoing Medicare Set Aside concerns with the case
  4. Is an independent party and often will be able to assess issues from both sides with future medical concerns

Our Settlement Negotiation Experience

Recently, our team attended a mediation in Tallahassee, Florida. Sally*, the injured party, was very hesitant to settle her future medical. She attended the mediation because her attorney advised her that settlement may be a good idea.  Leading up to the mediation, Sally had a few prescriptions denied through utilization review and she was very frustrated with the carrier. She was 47 years old and had been dealing with adjusters for nine years already. 

The settlement offer from the carrier showed a total medical cost projection of $189,000. The cost projection prepared included many seemingly expensive medications that added up to $130,000 over Sally’s life expectancy. Sally and her attorney were nervous if it would be enough money to cover her over the next 40-50 years. 

Ametros’ representative, Johnny, put together a CareQuote projection analyzing the cost on the CareGuard platform. It showed that CareGuard could provide potentially up to $60,000 in cost savings through our discounted pharmaceutical networks and Johnny reassured Sally that there was no form of utilization review with our CareGuard service. She loved the idea of having a card where she could see the doctors she wanted without having to worry about any paying bills.  Sally has now been a happy CareGuard member with us for 8 months.

How to Involve Our Team

Last year at Ametros, our team attended over 200 mediations and settlement negotiations. Our representatives, like Johnny, bring a unique perspective, helping our clients on both sides of the "v" get cases closed and make sure the injured party is in good hands.

At Ametros, we do not charge anything to attend a mediation or settlement negotiation. Our sales force is nationwide and always available by phone or in person.

Contact us today for a free consultation on how we can help you! Call us at 877.275.7415 or email us at [email protected]

*To protect the privacy of our members, names and identifying details have been changed.

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