For those of you who submit WCMSA

Medicare Set-Aside Blog on March 6, 2009
Posted by

Error  Helpful Hints

1. No medical
for the last two years of



medical records from all treating physicians for the last two years of
treatment. The following are not treatment records (but may also be helpful):
Independent Medical Exams, Qualified Medical Exams, physical or vocational
therapy reports, case management notes, functional capacity evaluations, or
return to work statements. If the claimant has not treated in the last two
years, then get the records for the last two years of treatment and submit a carrier
claims payment history or carrier letter proving the last treatment date.


2. No rated
age statement
from submitter confirming all rated ages obtained on the

have been included


rated age confirmation with original proposal documents stating, “All
rated ages

on the claimant have been included.” Language limiting rated ages to those

for the set-aside case, or those obtained by the submitter, or those received
by the submitter, etc. will not be accepted.


No proof of stated rated ages             

Submit all
rated ages obtained on the claimant, regardless if expired, not independent, or
containing incorrect information.(Cover letter can address which rated ages were
used to calculate proposed life expectancy.) Rated ages must be on letterhead
from insurance company or structured settlement broker. A fax cover sheet or
email is not letterhead.            

4. No  claims payment history              

Submit complete current claims payment history
from carrier (one dated within six months from date of submission) showing
itemized medical and indemnity payments with providers, amounts, and dates of

Calculation method
not stated for either

set-aside or prescription set-aside or both


Submit method used for calculating proposed
medical services set-aside amount (workers’ compensation fee schedule or actual
charges) and for proposed prescription drug set-aside amount (retail, average
wholesale price, etc.). Calculation method refers to the method the claimant
will use to pay for medical services or drugs.