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Will workers' comp affect my ability to obtain Medicare?

When applying for workers’ compensation benefits, it is important to understand the ways in which receiving these benefits may affect other benefits that you may depend on. While you may or may not think of them this way, workers’ compensation benefits are essentially a form of insurance. Medicare is another form of insurance. As a result, obtaining workers’ compensation benefits may affect the ways in which you use Medicare.

Because both workers’ compensation and Medicare both function as insurance, they are subject to specific coordination of benefit guidelines and rules. These rules essentially structure which benefit will serve a primary function and which will serve a secondary function. Generally, workers’ compensation will function as the primary source of benefits for the treatment of any injury or illness sustained while the recipient was on the job.

Because Medicare is the secondary “player” in this scenario, it will generally not pay for medical expenses directly related to treatment for illnesses and injuries sustained while on the job. However, it may cover a portion of a medical expense claim if workers’ compensation does not cover the entire expense. It may also make some payments if workers’ compensation denies a given claim.

It is additionally important to note that if you receive a large workers’ compensation settlement, you may be required to repay Medicare for treatment and/or require you to set aside funds to pay for treatment in the future that might otherwise be covered by Medicare. If you have questions about how Medicare and workers’ compensation may affect each other in your unique situation, please do not hesitate to speak with an experienced attorney.

Source: Findlaw Injured, “Workers' Comp and Medicare: Can You Get Both?” Daniel Taylor, Dec. 2, 2014

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