This process can take anywhere from 2-9 months, depending on what agencies are involved.
Estimated timelines are dependent upon LitPRO’ s receipt of complete, accurate information, settlement allocations, and appropriate authorizations. LitPRO will update timelines and manage expectations as we proceed with our work.
In cases involving exposure, ingestion, or implantation, it is required to report the date of loss or injury as the initial date of claimant exposure. Medicare possesses the entitlement to recover from the date of exposure (or the first date of entitlement if it occurred after the date of exposure) up to the settlement date. If exposure ended before December 5, 1980, Medicare would not have the right to recover. In such instances, a No Interest letter will be issued promptly upon receipt of the complaint or other documentation validating the final date of exposure.
LitPRO is well-prepared to leverage the three levels of appeal at our disposal. The first level of appeal is managed internally by the team responsible for issuing the Final Demand, and it frequently confirms the initial decision. The subsequent two levels of appeal involve external contractors, with the third level entailing an Administrative Law Judge (ALJ) hearing. Both levels of appeal beyond the initial stage have demonstrated higher rates of success.
Before initiating each level of appeal, LitPRO will engage in consultations with the firm to deliberate on a strategic approach and determine any additional information that may be required.
Three distinct avenues exist for securing additional lien reductions in this scenario: Pre-Settlement Compromise, Post-Settlement Compromise, and Waiver.
1. Pre-Settlement Compromise: LitPRO will provide the proposed settlement amount, enabling Medicare to contemplate a compromise of their lien to facilitate claimants' acceptance of the settlement. In the event that the final settlement deviates from the proposed amount, the compromise requires reassessment with Medicare. Timely payment within 60 days of funding is mandated by Medicare.
2. Post-Settlement Compromise: Following the reception of Medicare's final demand, an equitable division of the settlement funds may be considered. Payment must be made within 60 days of the final demand, and a refund is disbursed upon the successful conclusion of the compromise decision.
3. Waiver: Differing from compromises, Medicare resolves waiver requests based on the financial hardship endured by the claimant or their dependents. The submission of a form outlining the claimant's assets and expenses is necessary post-receipt of the final demand. Despite a successful waiver decision, the final demand must be paid within 60 days, and a refund is issued accordingly.
Additional Settlement: It is crucial to note that compromises and waivers are not deemed full and final in the event of an additional settlement.
We highly recommend that claimants refrain from direct outreach to lienholders, as LitPRO's dedicated contacts are typically situated in a distinct department, separate from general call center operations. Engaging directly with the call center may result in the receipt of inaccurate information. It is essential to inform your clients that they may indeed receive correspondence from these agencies. However, it is imperative to emphasize that LitPRO is concurrently receiving and diligently addressing all relevant correspondence. For seamless coordination and resolution, we encourage the forwarding of any received correspondence to LitPRO for management.
Medicare and Medicaid serve as mandatory notice agencies, and as a best practice, LitPRO strongly advises verifying this information. Submitting the necessary documentation to Medicare/Medicaid ensures compliance with the notification obligation, and these agencies will issue clearance if the claimant is not entitled to their services.
When a person covered by Medicare receives a settlement or judgment related to a wrongful death claim, Medicare may have a right to recover any conditional payments it made for medical expenses related to the injury that led to the wrongful death. Medicare will typically follow the state statutes to determine if medical payments are recoverable in Wrongful Death actions. It's important to review the state statutes regarding WD and understand that Medicare will require documentation showing what was pleaded, claimed, and released in the settlement in addition to the state recovery rules. If allocations to Wrongful Death are not made based on the merits of the case, and approved by a Judge, Medicare may not reduce their recovery even in states where medical payments aren't recoverable for Wrongful Death actions.
