Claimant is a 42 year old quadriplegic as a result of a fall from a second story balcony. He required 24/7 home health care which was being provided by the workers’ compensation carrier.
At a mediation, the parties were able to successfully resolve the case for a total upfront cost of $3.9M. The claimant is not eligible for Social Security Disability (SSDI) or Medicare because he has insufficient deposits paid into the Social Security system. Because of his ongoing weekly compensation checks, he was also ineligible for Supplemental Security Insurance (SSI) and Medicaid. The settlement proceeds were placed in a Special Needs Trust (SNT). The SNT is a pooled trust which reduces the cost of management of the claimant’s money. Because of the SNT, he will become eligible for both SSI and Medicaid. With upfront settlement monies, he purchased a home and a handicap van which will be exempt resources not disqualifying him from receiving SSI and Medicaid. As a result of his Medicaid eligibility post settlement, Medicaid will pay for his hospital bills, doctor bills and prescriptions as well as 40 hours per week of his home health care at no cost to him. An annuity sufficient to cover the additional cost of his home health care needs for the remainder of his lifetime was be funded by the settlement. The claimant will become the employer of his home health care aides through an inexpensive payroll service paid out of the SNT. As a result of this change, the cost of his home health care aids is much lower than the amount being paid pre-settlement by the carrier to an agency. In addition, an annuity was set up to cover the cost of a nurse case manager to help handle his significant medical needs and arrange treatment and appointments. Additional annuities are also funding his ongoing living expenses. Claimant may potentially qualify for Medicare and SSDI upon reaching his full retirement age. An opinion was obtained from a Medicare expert lawyer that a Medicare Set Aside was not needed.