Gaithersburg: 301-670-7030
Baltimore: 410-769-5400
Frederick: 301-668-2100
Contact Us For Legal Help

Workers' Compensation Blog

Medicare and Old Workers’ Compensation Claims

Monday, September 19, 2016

A letter from Medicare is in the mail. The envelope doesn’t look much different from others you have received from Medicare. You open it without thinking or much concern.

What it says shocks you.

Medicare (actually an outfit called MSPRC) is alerting you that it no longer will pay for treatment or wants money back for bills they have paid. Why?

Because you filed a Workers’ Compensation claim more than ten years ago - it makes no sense to you. The Workers’ Compensation claim was for your right leg, the treatment you now need is oxygen for your lungs!

How Could This Happen?

Insurance companies are now required to send Workers’ Compensation claim information to Medicare. If:

  • bills are coded incorrectly by a medical provider
  • a medical report erroneously says the treatment is for a job related injury
  • Medicare makes a mistake; or
  • who knows why

The letter you get may be a:

  • Rights and Responsibilities Letter (RAR) - The letter informs you that Medicare is aware you have filed a Workers' Compensation claim. Sixty-five days later a Conditional Payment Letter is sent to you (see below)
  • Conditional Payment Letter (CPL) – This letter specifies what Medicare has paid that it believes are related to your Workers’ Compensation claim.
  • Conditional Payment Notice (CPN) - This letter tells you what you should do if Medicare has paid bills and wants its money back.
  • Demand Letter (DL) – Medicare tells you that you must repay Medicare for the payments listed in the letter. A Demand letter is issued thirty days or more after the Conditional Payment letter.

If payments are not made within sixty days of the Demand Letter and Medicare does not agree to modify or waive the demand interest is charged from the date of the Demand Letter.

If no payments are made within 120 days of the Demand Letter, an "Intent to Refer" letter will be mailed to you. Medicare may send the matter to the Department of the Treasury for collection from 120 days to 240 days from the date of the Demand Letter.

You or your attorney can request a “waiver” after a Demand Letter is issued even if the treatment is related to your old Workers’ Compensation claim. To do so:

1) you must not be at fault for the overpayment; and

2) it would cause you financial hardship to repay Medicare .

There also is an appeal process for disputes over more than $130.00.

How to Solve the Problem

The only clear statement that can be made at this time about resolving Medicare/Workers' Compensation disputes is that there is no clarity. However, the first step is to call the Medicare number listed on the form and find out what the problem is. If there is a clear error by Medicare, your phone call may take care of the problem. It is also possible that some documentation from the Workers’ Compensation claim and/or your medical providers will be required. The issues will be more complicated if the new treatment is for the same part of your body that was the subject of your Workers’ Compensation claim. The argument is, for example, that a back strain of ten year ago could not possibly be related to a need for back surgery now. It is possible medical records will be required to support that position, and/or a hearing before the Workers’ Compensation Commission to determine whether the treatment is related. Even then, Medicare may not agree to be bound by a Commission decision.

The Bottom Line

The only sure thing to say about Medicare and Workers’ Compensation claims is that nothing is sure. Rules and procedures change. Simple issues may be resolvable without an attorney, more complex ones, perhaps not.

Recent Posts




What Our Clients Say

Known for our unwavering commitment to clients, for our integrity, and for delivering the best results, our clients continue to refer their friends, families and neighbors to us for their legal needs.

"One year ago today I made the call to your office. The best decision I could make. I wanted to share with you how impressed I am with your staff and your professionalism."

Heather P.

"Craig did a great job representing me! He's the lawyer I have trusted with my legal needs because he's professional, knowledgeable, and keeps me informed about my case."

Jaclyn K.

" wanted to thank you, in writing, for your kindness and prompt response. Customer service is a dying art, and you gave me hope for my family."


"I would like to express my gratitude for your efforts and dedication for my disability case. It's has been quite a long and upsetting process but you have handled my case in an extremely competent and responsible manner."

Leo H.

"I have recommended Mr. Feldman to several of my friends and colleagues and have heard nothing but excellent reviews. He is the best lawyer I have ever used."


"I received the check today. I could not believe it until I saw the check. Thank you so much. You have improved my family's quality of life tenfold."

Mike F.

"These guys go above and beyond! They always have your best interest in mind."

Mike W.

"I would like to express my thanks to Amanda Knott and Gretchen Rogers for their patience with me through my ordeal with my workers comp claim. I was impressed from the very beginning when I spoke with G. Rogers on the phone and although she did not have to, she met with me personally and walked me through the steps of what to expect in this process."

Mr Sagal

"You have been kind throughout this process and I appreciate your professionalism as well as your gentle concern. Thanks for helping us and all the others who need your legal expertise. We are grateful."

Nancy F.

"Thanks to Mr. Shultz's aggressive and professional work ethic style I was able to receive the medical services and compensation pertaining to my case."

Navdeep C.

"I can honestly say this firm is simply TOP NOTCH! They not only have handled countless cases for my members that require their services, they also have gone well beyond their "scope" to help some of my folks in other areas of need. "

Rick H.

"I wanted to compliment your law firm on having Amanda Knott as a paralegal. She worked tirelessly for almost 2 years making sure I understood what was happening and at the same time keeping all my records straight and in order, which allowed Gretchen Rogers to represent me in the best way possibl"

Terrye G

"The attention and professional care the staff has taken toward my needs has always been excellent. I have no complaints nor worries that my issues discussed are not addressed."

Tim T.

"I just got off the phone with Craig and let him know how thankful we are to you, him and Ken for all your efforts – you are all really terrific to work with!"

Val K.

Locations Throughout Maryland & Washington DC

Gaithersburg Office

481 N. Frederick Avenue, Suite 300
Gaithersburg, MD 20877
301-670-7030 / 800-248-3352
Fax: 301-670-9492

Lutherville Office

1301 York Road, Suite 600
Lutherville, MD 21093
410-769-5400 / 800-248-3352
Fax: 410-769-9200

Frederick Office

30 W. Patrick Street, Suite 105
Frederick, MD 21701
301-668-2100 / 800-827-2667
Fax: 301-668-2000