Claimant is a 30-year-old incomplete quadriplegic as a result of a fall to a concrete floor from the upper level of a home construction site. Claimant now lives with his mother in a rental house. He filed a claim to obtain 24/7 home health care.
The employer has been only paying for 8 hours a day of home health care from the time of his work accident in 2012 until the present time. His mother has been providing the additional care that he needed. Claimant relocated out of state in order to facilitate a better living situation and treatment with new healthcare providers. Due to the Corona Virus Pandemic, all of the parties including the claimant, the carrier, the excess carriers, the lawyers, and the annuity experts convened by WebEx to hold a mediation conference over the course of two days. As a result of the mediation, the parties were able to successfully resolve the case for $3.8M. The claimant is receiving Social Security Disability and Medicare. As a result, a portion of the settlement includes the funding of a CMS approved MSA (Medicare Set Aside) and administration of a sum amounting to the cost of $1.5M. The balance of the settlement is being used to fund lump sum up front money to the claimant and an annuity to provide for ongoing monthly checks for life. Prior to the settlement, because of his ongoing weekly Workers Compensation checks, the claimant was ineligible for SSI (Supplemental Social Security) and Medicaid. However, post settlement his monies will all be placed in a Special Needs Trust (SNT). An attorney practicing where the claimant lives was hired to advise on Medicaid issues and the SNT. The SNT is a charitable pooled trust which reduces the cost of management of the claimant’s money. Because of the SNT, claimant will become eligible for both SSI and Medicaid. With the upfront settlement monies, the claimant will purchase a home and a handicap equipped van which will be exempt resources not disqualifying him from receiving SSI and Medicaid. As a result of his Medicare eligibility post settlement, the MSA will be used to pay for the cost of his work injury related hospital bills, doctor bills, and prescriptions. An annuity which is sufficient to cover the additional cost of his personal needs for the remainder of his lifetime will also be funded by the settlement. In addition, after the settlement, the claimant will be seeking to have Medicaid pay for a portion of his home healthcare. We have also retained an attorney in his new home state to assist him with that effort. The settlement will allow claimant to have a much better quality of life in his new home state.