The First District recently declined to re-write a settlement agreement involving terms of a Medicare Set-Aside Account (MSA) in Mary A. Ferreira v. Home Depot / Sedgwick CMS (Per Curiam) [1st DCA June 9, 09]
In this workers compensation case, the claimant, not the employer-carrier, was responsible for administering the MSA. The E/C was supposed to provide the “seed money” for the account and purchase an annuity. The contract held the specific amounts were not subject to change, even if the Center for Medicare and Medicaid Services (CMS) later determined a different figure. The agreement specifically held that if CMS “determines more money is necessary for future medical expenses,” the Claimant was responsible. Of course, the facts developed where the CMS determined a different amount and the E/C argued that it had overpaid.
The full panel of the appellate court held that the contract was unambiguous and there were no grounds to interpret or re-write the agreement to allow it to be amended. To wit, the contact held, “neither [payment rights] can be acclerated, deferred, increased or decreased…” and “… no action by CMS concerning claimant’s eligibility or the sum of money required to be set aside for claimant’s future Medicare-covered costs will render this release void or otherwise ineffective…”
Instead, the court appeared to admonish the E/C for depositing the seed money but holding off on buying the annuity. Of note, the date of the accident was January 1993 and the opinion was issued in June 2009, if that ultimately makes a difference under MMSEA.
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First DCA Decides MSA “Seed Money” Case
The First District recently declined to re-write a settlement agreement involving terms of a Medicare Set-Aside Account (MSA) in Mary A. Ferreira v. Home Depot / Sedgwick CMS (Per Curiam) [1st DCA June 9, 09]
In this workers compensation case, the claimant, not the employer-carrier, was responsible for administering the MSA. The E/C was supposed to provide the “seed money” for the account and purchase an annuity. The contract held the specific amounts were not subject to change, even if the Center for Medicare and Medicaid Services (CMS) later determined a different figure. The agreement specifically held that if CMS “determines more money is necessary for future medical expenses,” the Claimant was responsible. Of course, the facts developed where the CMS determined a different amount and the E/C argued that it had overpaid.
The full panel of the appellate court held that the contract was unambiguous and there were no grounds to interpret or re-write the agreement to allow it to be amended. To wit, the contact held, “neither [payment rights] can be acclerated, deferred, increased or decreased…” and “… no action by CMS concerning claimant’s eligibility or the sum of money required to be set aside for claimant’s future Medicare-covered costs will render this release void or otherwise ineffective…”
Instead, the court appeared to admonish the E/C for depositing the seed money but holding off on buying the annuity. Of note, the date of the accident was January 1993 and the opinion was issued in June 2009, if that ultimately makes a difference under MMSEA.