$175,000 – Settlement With Defense to Fund a $528,881 Medicare Set Aside for Lumbar Sprain.

A machine operator from Mechanicsburg, PA, sustained a work injury while working for a local warehouse, in June 2012. The insurance carrier, New Hampshire Insurance Company, issued a Notice of Compensation Payable accepting the injury as a lumbar sprain/strain. The injured worker had to undergo surgical intervention performed by Dr. Grandrimo. The insurance carrier had the injured worker attend an IME in 2014. Dr. Kline, the IME physician, reported that the actual work injury was a left L3-4 disc herniation, status post operative decompression and resolved chest sprain/strain. He reported that the injured worked had not obtained full recovery and that he had reached maximum medical improvement and that his prognosis for full recovery was poor. The insurance carrier then had the injured worker attend another IME in 2015 with Dr. Kline. He again reported that the injured worked had not obtained a full recovery. The case ultimately settled via a full Compromise and Release for $175,000 for the injured workers’ wage loss benefits. The injured worker was a Medicare beneficiary and therefore the insurance carrier agreed to fund a Medicare Set Aside approved by Medicare in the amount of $528,881 to pay for the injured workers’ future medical treatment related to his work injury.