GA Tip of the Week – 10/28/15



Zal Linder


I recently attended the WC Institute annual seminar in St. Simons.  One of the issues that came up was the relationship between MSA’s and the 400 week cap on medical benefits in Georgia effective 7/1/13.  As you know, when preparing a MSA for CMS review, the Employer/Insurer must allocate for future medical care as long as same is reasonably anticipated to be related to the given accident.  However, with the 400 week maximum in place as of July 2013, there is an argument that this cap should allow Employer/Insurers to request that CMS only consider 400 weeks of future medical care rather than possible lifetime benefits.

From a review of the CMS guidelines, I believe that Section 10.4.2 covers this conflict and gives support for being able to request that medical care only be allocated for up to 400 weeks.  This Section indicates that “in order to protect Medicare’s interests, a WCMSA should be funded based on the life expectancy of the claimant unless state law specifically limits the length of time that WC covers work-related conditions.

I have attached a link below to the CMS reference guide if you want to review it.  If you have any questions regarding this, or anything else for that matter, please feel free to contact me.

Zal Linder | Partner