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Office of Administrative Law Judges

IMPORTANT NOTICE

Longshore practitioners are urged to familiarize themselves with the provisions of the Medicare Secondary Payer Act (MSP) found at 42 U.S.C. §1395y(b)(2) and its implementing regulations at 42 C.F.R. §411.

Basically, Medicare is not the primary payer for medical expenses covered by workers' compensation plans including the Longshore Act (the Act). See 42 C.F.R. §411.40(a). Parties submitting settlement agreements under Section 8(i) of the Act should be aware of the potential impact of the MSP on lump sum settlements as they relate to (1) future medical expenses and (2) reimbursement for conditional payments made by Medicare prior to settlement.

Settlements submitted to OALJ should reflect that the parties have considered Medicare requirements as they may pertain to the settlement. For additional information on Medicare's role in workers' compensation settlements, practitioners should refer to www.cms.hhs.gov/WorkersCompAgencyServices/04_wcsetaside.asp and the HHS CMS FAQ Page [Select Medicare Secondary Payer topic].