Happy Thursday, Team!
This week’s tip is by special request and outlines when to apply Georgia’s 400-week cap vs. traditional life expectancy pricing in MSAs.
JOHN’S GA TIP OF THE WEEK- MSAs: When to Apply Georgia’s 400-Week Cap vs. Traditional Life Expectancy Pricing
RULE
- In Georgia, medical benefits are limited to a maximum of 400 weeks from the date of injury for all non-catastrophic claims. O.C.G.A. §34-9-200(a)(2).
- In claims that have been designated catastrophic, the Claimant is eligible for lifetime benefits rather than the standard “400‑week cap.” O.C.G.A. § 34‑9‑200.1(g).
Medicare Set-Aside (MSA)
- A Medicare Set-Aside (MSA) is a financial arrangement used in workers’ compensation settlements to allocate funds for future medical expenses related to the injury that would otherwise be covered by Medicare. The purpose is to protect Medicare’s interests by ensuring the settlement funds are used first for injury-related care before Medicare pays for those services.
- To calculate the amount of funds that need to be allocated for future medical expenses, the MSA will apply EITHER Georgia’s 400-week cap on benefits OR a traditional life expectancy pricing (AKA lifetime benefits).
When to Apply the 400-Week Cap vs. Traditional Life Expectancy Pricing
- If the claim has NOT been designated as catastrophic, the claim remains subject to the 400-week limitation on medical benefits and the MSA should be calculated using Georgia’s 400-week cap.
- If the claim HAS been designated catastrophic, the MSA should be calculated using Traditional Life Expectancy Pricing.
I hope everyone has a great Labor Day weekend! As always, feel free to reach out if you run into any Georgia questions/issues.
Sincerely,
John Fennelly | Junior Partner