Claims

Court Denies “Double Damages” under the MSP’s Private Cause of Action

Currently, there are two questions being litigated that involve who can sue under the Medicare Secondary Payer’s (MSP) private cause of action (PCA) provision and when “double damages” may apply. I...

Arizona Tweaks its "Full & Final" Workers' Comp Settlement Law - New Law Provides Opportunities to Settle Workers' Comp Claims

On October 31, 2017, Arizona Senate Bill (S.B.) 1332 became law allowing Arizona claims payers to reach “full and final” settlements of certain workers’ compensation (WC) claims. This new law...

Blockchain: Getting Smarter than Smart Contracts

Admittedly, my interest in blockchain has been fairly narrow. Given the role of PCS® in the global industry loss warranty ( ILW ) market, I’ve been particularly focused on how blockchain-enabled...

Will Catastrophe Bonds Experience a “Retail Revolution”?

During a track at the IFoA Asia Conference 2018 last week, a speaker laid out a “future state” vision that included access to insurance-linked securities (ILS)—or at least some version of ILS—for...

Five Steps to Reduce Your WCMSA Costs

It is no secret that high Workers’ Compensation Medicare Set Aside (WCMSA) allocation amounts can complicate claim settlement. The culprits can range from the Centers for Medicare and Medicaid...

New Kentucky Workers’ Compensation Law Limits Treatment to 780 Weeks for Certain Claims

On March 30, 2018, Kentucky House Bill (HB-2) was signed into law which makes major changes to the Kentucky workers’ compensation statute. The most significant addition is language that limits...

CMS’ Medicare Beneficiary Identifier initiative and its Medicare Secondary Payer impact

Starting in April, the Centers for Medicare and Medicaid Services (CMS) will begin replacing all Medicare cards with a new unique 11-byte Medicare Beneficiary Identifier (MBI) number. The change is...

CMS Releases WCMSA Reference Guide (Version 2.7)

The Centers for Medicare and Medicaid Services (CMS) has released its latest WCMSA Reference Guide (Version 2.7). This is CMS’ ninth release of the guide to date. A copy of CMS’ new reference guide...

Texas Court: Medicare Advantage Plans Can Sue for Private Cause of Action under the Medicare Secondary Payer Statute

In Humana v. Shrader , 2018 WL 1384529 (S.D. Tex. March 16, 2018), the federal district court ruled, in part, that the private cause of action (PCA) provision under the Medicare Secondary Payer (MS...

Medicare Advantage Update: Connecticut Court Rules MAPs Can Pursue “Double Damages” Under the Medicare Secondary Payer Statute

Connecticut is the latest jurisdiction to address whether Medicare Advantage Plans (MAPs) have private cause of action (PCA) rights to pursue “double damages” under the Medicare Secondary Payer (MS...