ESS Settlement Services

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Open Enrollment: Time to Check Up on Your Clients’ Healthcare Coverage

November 10, 2015 by Brian Schachter Leave a Comment

open enrollmentNovember 1st is an important day on the calendar in contemporary American life. It’s nowhere near as festive occasion as Halloween, which comes the day before, nor is it a holiday for somber reflection as is Veteran’s Day, which follows only 10 days later. But is highly significant all the same as it marks the day on which the open enrollment period begins under the Affordable Healthcare Act, otherwise known as Obamacare. For those of us who represent and fight the good fight on behalf of personal injury victims, the open enrollment period provides an important opportunity to protect the interests of at least some of our clients.

Let’s face it. Many people are flummoxed when it comes to picking a policy on the healthcare exchanges. This is not at all surprising given the operational problems attendant on the rollout of Obamacare and the inherently confusing nature of most policy descriptions. This process can be even more of a challenge for people who formerly qualified for some form of government assistance and are unaccustomed to dealing with and analyzing the fine print on healthcare policies. All too often we have found situations where clients, left to their own devices, end up selecting policies with unreasonably high deductibles or other similar deficiencies, which effectively eviscerate the benefits of coverage.

[Read more…]

Filed Under: Affordable Care Act Tagged With: Affordable Care Act, Obamacare, open enrollment

How to preserve your clients’ medical coverage while settling a case

June 8, 2015 by Brian Schachter Leave a Comment

esq - affordable careWhen it comes to the settlement phase of personal injury litigation, plaintiffs and their counsel will typically be focused on the bottom line – how close to their settlement demand has the defendant’s offer come? But quite often a proposed personal injury settlement will introduce a host of additional complications, which make it important to evaluate more than just the bottom line number. The most important such complicating factor is determining how your client is going to get medical coverage once the settlement is done.

All in all, there are lots of ways a client may end up forfeiting the right to continue receiving subsidized medical coverage after receiving a large monetary damages award, so analyzing your client’s health care needs post-settlement is a vital part of any personal injury settlement process. Unfortunately, many lawyers fail to pay heed to this issue, as a result of which their clients end up needlessly squandering some of the significant benefits of the eventual settlement.

[Read more…]

Filed Under: Affordable Care Act, Mediations Tagged With: ABLE ACT 2014, Affordable Care Act, Health care, health insurance, healthcare, Medicaid, Medical Law, Medicare, Medicare Set Aside, settlements, Special Needs Trust, worker's compensation, workers comp

The Affordable Care Act and its Impact on Settlements

December 19, 2014 by Brian Schachter Leave a Comment

ACA and its effect on SettlementsIt’s a crazy world and people get hurt constantly. Car accidents, assaults and other catastrophes hurt people physically and emotionally but they don’t have to hurt financially on top of everything else.. The Affordable Care Act has removed lifetime limits on benefits and makes it illegal to deny people based on a pre-existing condition, like disabilities. As such, we are advising our colleagues and other lawyers to brush up on some of the specifics, especially now since the current enrollment period ends in February, and how the Act may impact their clients.

For example, our client Mr. Williams was a promising high school football player until his football career came to a devastating halt when he was shot nine times in his right leg. His 13-year-old sister called to tell him that a group of men were harassing her so he came to protect her. The men dispersed but one of the assailants shot Williams as he turned into a hallway in his building. He lost 40 lbs of blood, but he survived the encounter.

Williams woke up in the hospital 11 days later, happy to be alive but distraught by the realization that his leg was amputated and he would never walk again, much less play football. He was paralyzed from the waist down and spent several months in the hospital recuperating and receiving physical therapy.

In 2007, he was enrolled in New York State Medicaid, a “needs based” program that insures anyone below a certain income and asset threshold. However, his seven-figure settlement from his assault would have disqualified him from Medicaid, so we would have had to create a Special Needs Trust to oversee the funds. A Special Needs Trust allows a personal injury victim to receive a settlement without losing out on public benefits. The settlement money can also be used to pay for things that Medicaid does not cover, like extra therapy or rehabilitation.

Using the Affordable Care Act exchange, we were able to enroll Mr. Williams in a private plan health insurance plan from United Healthcare with no deductible, which provided for better health care and means that Williams no longer needs the Special Needs Trust which had a number of drawbacks in addition to adding an extra barrier to his money.

Federal law mandates that after the death of the beneficiary, any funds remaining in the trust must be used to repay Medicaid for all costs incurred while the trust was active. After Medicaid is reimbursed, the remaining funds can be passed on to the family of the beneficiary. Private insurance does not have this stipulation so the entirety of the settlement can go to the beneficiary’s family in the event of his or her death.

At ESS we help our clients assess their needs and figure out how to best deal with their situation. Many people are often caught between a rock and a hard place when it comes to dealing with settlements and insurance. We help our clients figure out how to receive the care they need to sustain them while at the same time be able to support their financial needs.

How else has the Affordable Care Act affected your clients? Are there other significant implications of the Act on settlements that you are aware of? Please share your thoughts with us.

Filed Under: Affordable Care Act, Brian, structured settlements Tagged With: Affordable Care Act, Medicaid, Special Needs Trust

Affordable Care Act-How the ACA Affects our Industry

September 19, 2014 by Randy Levine 1 Comment

affordable care actEssentially, the ACA protects insurance coverage for the uninsured. It eliminates lifetime limits on benefits for any participant or beneficiary. (ACA, Sec. 2711) and provides coverage for pre-existing conditions (ACA Sec. 2705). No longer can people be denied coverage for the following factors:
1. Health status/medical condition
2. Claims experience
3. Medical history
4. Genetic information
5. Disability
Insurance companies must now cover ‘essential health benefits’ (ACA, Sec. 1320) to at least include the following:
1. Ambulatory patient services (out care received without being admitted to a hospital)
2. Emergency Services
3. Hospitalizations, example surgeries.
4. Maternity and newborn care
5. Prescription drug coverage
6. Laboratory services
7. Pediatric services
8. Preventive and wellness services
9. Rehabilitative and habilitative services
10. Mental Health & Substance Abuse Disorders (Added February, 2013, by Sec. Sibelius of Dept. HHS. [Read more…]

Filed Under: Affordable Care Act, Randy Tagged With: Affordable Care Act, law, Obama Care

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