Medicaid, Medicare, & Your Workers’ Compensation Claim



There are times when an employee is receiving Medicaid or Medicare benefits or is eligible to do so, has an on-the-job accident with injuries, and for whatever reason, his or her claim is denied by the workers’ compensation insurance carrier. Thus, the employee seeks medical care at his or her own expense for the work related injury and files these expenses with Medicaid or Medicare.

Like private health insurance, Medicaid or Medicare will likely expect to be reimbursed. To be sure their interests are protected, Medicare or Medicaid may file a lien against the injured worker’s case. Sometimes, Medicaid or Medicare will be willing to reduce their lien amount. Nonetheless, if you have received these benefits in relation to your work accident, be sure to discuss this with your attorney.

Likewise, if you were not receiving these benefits at the time of the work accident nor at any time throughout the claim, but you anticipate you might enroll after settling your workers’ compensation case given the severity of your medical condition, it would still be advisable to discuss this with your attorney.

Should you choose to represent yourself, make sure these governmental benefit providers have been contacted and considered before you sign any settlement papers. Otherwise, they may be able to take some of your settlement money as reimbursement money after you have already settled your claim.

Although this is a necessary step in the workers’ compensation process, working out the details with the Medicaid or Medicare offices can take some time, so you should anticipate a period of waiting before a proposed settlement is signed-off on by all parties and you receive your portion of the settlement.

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