Frederick Domingue v. Cedar Sinai Medical Center
Settlement—Compromise and Release Agreements—Medicare Set-Aside—California WCAB, upholding WCJ's order, held that compromise and release agreement under which applicant/lead craft worker settled his claims for injuries to psyche, respiratory system, spine, upper extremities, cardiovascular system, and in forms of hypertension and cancer on 10/14/2005 and during cumulative period ending on 12/6/2005, was valid and binding on defendant, notwithstanding that Medicare set-aside was not approved by Centers for Medicare and Medicare Services (CMS) prior to applicant's death, when compromise and release was fully executed, although not yet approved by WCJ, and contained an elaborate Medicare set-aside addendum, compromise and release made no mention of need for prior CMS approval, and there was no evidence that prior approval was necessary as a "condition precedent" to enforceability of compromise and release agreement. © Copyright 2010 LexisNexis. All rights reserved.
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This is another example of misunderstanding the CMS MSA review thresholds. Review was not even available for this case ($99K settlement for someone who was not a Medicare beneficiary.) Yet the C&R was supposedly contingent upon CMS Approval, and this opinion discusses whether Approval was "necessary." Approval is NEVER "NECESSARY."