In Ramos v. Becco Contractors, Inc., No. 111367, 2013 Okla. Civ. App. LEXIS 105 (Okla. November 21, 2013), an injured worker who did not speak English settled a claim with his employer. The settlement included a Medicare Set-aside (MSA), which would only be paid once CMS approval was obtained. Upon submission of the MSA to CMS, the parties discovered that the claimant was not Medicare eligible and thus, the Defendant refused to issue the MSA funds to the Claimant. The number reported by the Claimant as his Social Security number (SSN) was, in fact, only a taxpayer identification number.
The Claimant argued that he did not intentionally misrepresent his Medicare eligibility but, given his lack of sophistication and education, he did not appreciate the difference between his nine-digit taxpayer identification number, which later became his SSN, and the requirements for Medicare eligibility. The Court agreed that the Claimant’s misrepresentation of his SSN was not intentional. Ultimately, however, the Court held that the MSA provision of the settlement was unenforceable based upon the terms of the settlement. The parties had agreed that the MSA would not be paid without CMS’ approval and CMS approval was not obtained.
If the claimant’s public benefits status had been verified prior to settlement, the parties could have avoided the confusion over the Claimant’s SSN and Medicare eligibility as well as the subsequent litigation concerning the MSA provision. In order to avoid issues such as those in Ramos, parties should verify a claimant’s public benefits status prior to reaching a settlement agreement. Doing so will enable parties to correctly evaluate the need for a Medicare Set-aside and determine whether CMS approval is warranted.
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