Medicare and workers’ comp

If you are on Medicare but still in the workforce, it’s essential to know what to do if you are injured on the job. If you have a work-related accident, there may be confusion about how you will pay your medical bills. Does Medicare pay, or does your employer’s workers’ comp insurance pay? The answer is not an easy one.

If you get hurt at work, and the workers’ comp insurance carrier accepts the claim as a covered work injury, they should pay for all reasonable, necessary, and related medical care. However, what often happens is that Medicare receives the bill from the medical provider and the comp carrier ends up not providing payment for medical services.

Medicare, unless they are aware that it is a workers’ comp-covered accident, will continue to pay for treatment. This does not always end well for the injured worker.

Workers’ comp carriers often settle cases with injured workers without reimbursing Medicare. Medicare can then pursue repayment directly from the injured worker. This can result in thousands of dollars in medical debt to the injured worker.

If you get hurt on the job and are on Medicare, make sure you notify Medicare that the injury happened at work. You should file a workers’ compensation claim (assuming you are pursuing a compensation claim.) Medicare may make “conditional payments” while the case is pending. If you pursue the workers’ comp claim and do not prevail, Medicare would likely still be responsible for providing medical care. If you settle the claim, it is vital to resolve any medical payments made by Medicare before settling your claim.

These situations can be very complex. Injured workers should seek legal advice before proceeding too far into the world of Medicare reimbursement.

The statements contained herein are for general information purposes and not considered specific legal advice to your situation, as Mr. Shoen would need to meet with you individually to ensure client confidentiality. He would also require additional information not provided in this article. This article does not create an attorney-client relationship. Please consult directly with an attorney for legal advice.

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