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workers’ compensation Medicare set aside arrangement (WCMSA)

What is a Workers’ Compensation Set Aside Arrangement?

In years past (pre-1980’s), Medicare beneficiaries would settle their claims with workers’ compensation and then the very next day, would put medical services through Medicare. CMS/Medicare did not appreciate paying for expenses that should otherwise be covered by workers’ compensation (or other payers), and thus the Medicare Secondary Payer Act was enacted. The MSP comes

May 22, 2023 Comments (0)

Medical Non-Compliance in Florida Workers’ Compensation Claims

Mark Lee

Non-Compliance in Florida Workers’ Compensation Claims

Non-Compliance in Florida Workers’ Compensation Claims I have heard this phrased several ways from clients: ‘the adjuster said if I didn’t make the doctor appointment, my benefits would be cut off” “I had to reschedule an appointment, and the adjuster suspended my benefits” “I missed an appointment, and my case was denied” What this describes

May 14, 2023 Comments (0)

Mark Lee

If your Work Comp Claim is Denied

If a workers’ compensation claim is denied, in part, or in whole, a notice of denial is filed with the State of Florida. The appropriate form is a DWC-12, which looks like this in format. Once a denial is filed, there are generally two ways the denial is rescinded. 1) the employer/carrier rescinds the denial

March 25, 2023 Comments (0)

Injury at Social or Recreational Event | Florida Workers’ Compensation

Mark Lee

Injury at Social or Recreational Event

Injury at Social or Recreational Event | Florida Workers’ Compensation Employers, or groups of employees, sometimes organize events for coworkers to get exercise, increase camaraderie, i.e. sometimes called “team building”. But what happens when someone gets hurt at one of these events, is the injury covered under workers’ compensation? A worker sustaining Injury at Social

February 4, 2023 Comments (0)

Mark Lee

2023 Maximum Compensation Rate

2023 Maximum Compensation Rate Florida Statute 440.12 sets forth that there shall be a maximum compensation rate in Florida workers’ compensation claims. It also dictates a minimum compensation rate. The Division of Workers’ Compensation issued a memo that for all injuries in 2023, the maximum compensation rate will be $1,197. This is quite a significant

February 4, 2023 Comments (0)

Volunteers and Florida Workers' Compensation Coverage

Mark Lee

Volunteers and Florida Workers’ Compensation Coverage

Volunteers and Florida Workers’ Compensation Coverage There are many volunteer opportunities that are very physical in nature. From building houses to delivering meals, people often give their time and physical efforts towards noble causes. As with any activity, volunteering can subject a person to injury. Florida workers’ compensation coverage is generally available to employees. The

January 18, 2023 Comments (0)

Mark Lee

Importance of Accurately Calculating the Average Weekly Wage

Importance of Accurately Calculating the Average Weekly Wage All indemnity (money) benefits paid to an injured worker throughout the life of his/her workers’ compensation claim are paid based upon the Average Weekly Wage. If the Average Weekly Wage is under calculated from the beginning, it will result in months or potentially years of under paid

November 12, 2022 Comments (0)

Mark Lee

Forced use of PTO in Workers’ Compensation Claims

Forced use of PTO in Workers’ Compensation Claims An issue presents in Florida workers’ compensation claims with forced use of PTO, or when in lieu of workers’ compensation benefits – pay is continued by the employer (and not the insurance company), but it docked from the claimant’s personal, accrued/earned time. In the course of my

August 28, 2022 Comments (0)

Notice of a Workers’ Compensation Injury

Mark Lee

Notice of a Workers’ Compensation Injury

Notice of a Workers’ Compensation Injury A whole host of issues can come up when a person suffers an injury/has an accident at work involving notice of a workers’ compensation injury. Who do you report it to? When do you report it? When is too late to report it? The individual may not realize the

July 24, 2022 Comments (0)

Mark Lee

The Petition for Benefits has been filed; What to Expect

A Petition for Benefits is the primary method to invoke the jurisdiction of the court to resolve disputes in a Florida Workers’ Compensation claim. When there is any dispute regarding benefits owed to an injured worker—either medical and/or lost wage/indemnity, a “good faith attempt” to resolve the issue is sent to the employer/carrier. If the

July 19, 2022 Comments (0)

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What is a Workers’ Compensation Set Aside Arrangement?