Is Medicare Being Denied to Texas Workers’ Comp Claimants?

The Division of Workers’ Compensation (DWC) has received numerous complaints from Medicare beneficiaries, because the Centers for Medicare and Medicaid Services (CMS) has been denying medical care to Texas citizens that have workers’ compensation claims.

Photo of a medical bill

Rod Bordelon, now the former Commissioner of the DWC, sent an open letter concerning the matter to Marilyn Tavenner, Administrator for CMS. He wants to ensure that people who make a workers’ comp claim are still eligible for Medicare coverage for injuries or illnesses that are unrelated to the work injury.

Can Worker’s Comp Claims in Texas Be Settled?

CMS is denying people medical coverage because of workers’ comp claims made years ago. It wants Medicare beneficiaries to confirm that a previous workers’ comp claim has been closed or settled before paying for treatment.

However, Bordelon says that in Texas, a workers’ compensation claim is never closed or settled, because the Texas Labor Code does not allow medical benefits to be settled. In other words, DWC cannot tell CMS that a beneficiaries workers’ comp claim is “closed,” because it never is “closed.”

The Texas Workers’ Compensation Act (TWCA) explains that a claimant’s case is never closed, because they may need additional health care if issues persist that are related to the work injury.

CMS has mandatory reporting requirements, which include receiving notifications from workers’ comp insurance carriers of any claims that are still “open” or “closed.” However, it does not have any guidance on how to handle Medicare claims for Texas citizens that have a workers’ comp claim that by law can never “close.”

Before ending the letter to Tavenner, Bordelon says, “CMS should not make coverage determinations for Medicare beneficiaries based solely on the existence of an open workers’ compensation claim without additional information.”

Workers’ compensation can be complicated to handle. It is important to hire an experienced workers’ comp attorney to help you get all of the benefits you deserve. 

The Law Offices of Aaron Allison – Austin Workers’ Compensation Attorney

Source: http://www.workerscompensation.com/compnewsnetwork/news/19447-letter-from-tx-dwc-to-cms-regarding-medicare-coverage-determinations-for-beneficiaries-with-prior-workers%E2%80%99-compensation-claims.html