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BENEFICIARY STATUS |
TSA = SETTLEMENT AMOUNT |
ALLOCATION? CMS SUBMISSION? |
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Claimant is a Medicare Eligible/Recipient: Age 65 or older; or On SSDI for 24 months or more; or End Stage Renal Failure (ESR Failure) |
“Total Settlement Amount” (TSA) is less than $25,000 | WCMSA Allocation should be prepared and referenced in settlement documents, but CMS will not review WCMSA. |
| Claimant is a Medicare Eligible/Recipient:Age 65 or older; or on SSDI for 24 months; or more; or ESR Failure | TSA is more than $25,000.00 | WCMSA Allocation can be submitted to CMS for a Determination letter. Voluntary process. |
| Claimant is not Medicare eligible, but has a “reasonable expectation” of eligibility in (30) months: Age 62.5 or older; or applied for SSDI; or SSDI was denied and is appealing denial. | TSA is more than $250,000.00 | WCMSA Allocation can be submitted to CMS for a Determination letter. |
| Claimant is not Medicare eligible, but has a “reasonable expectation” of eligibility in (30) months: Age 62.5 or older; or applied for SSDI; or was denied and is appealing denial | TSA is less than $250,000.00, but more than $25,000.00 | WCMSA Allocation should be prepared and referenced in settlement documents, but CMS will not review WCMSA. |
| Claimant is not Medicare eligible, and has no reasonable expectation of eligibility in (30) months: | Regardless of TSA |
If future medical care is anticipated due to nature of injury, WCMSA Allocation may be prepared and referenced in settlement documents, but CMS will not review. |