Take Those Legacy Claims to Settlement!

July 13, 2021

a gavel and a magnifying glass to represent Medicare Set Aside settlement process

Tower’s Legacy Claims to Settlement Initiative identifies claims that can settle now or with intervention and produces smooth, efficient settlements.

Legacy claims. Old dog claims. Whatever you call them, these are the claims that languish on the books and just won’t close for any number of reasons.  If you missed Tower’s webinar hosted by Hany Abdelsayed, EVP of Strategic Services last month, here is a synopsis:

Legacy Claims Defined

Legacy claims can fall into one of several categories:

  • Long-term open medical claims
  • Run-off claims
  • Claims from mergers and acquisitions
  • Claims in a guaranteed cost program
  • Loss portfolio transfers
  • Non-acute cases with a high monthly medical and/or prescription drug spend

Often, legacy claims are left in the rear-view mirror as claims representatives take on new claims.  Sometimes, the injured worker or their attorney has an issue that needs to be addressed or the anticipated high cost of the Medicare Set-Aside stops the insurance carrier or employer from heading to the settlement table.  However, these legacy claims can represent significant reserves and liability for these payers that impact their entire workers’ compensation programs.

Tower’s Legacy Claims Initiatives service reviews your portfolio and identifies claims that have the potential to close, both those that that can close immediately and those that can close with intervention. We provide interventions for those that need them, customizing them to your needs and workflows.  We also identify claims that have no possibility of settling and position those for ongoing cost reduction. As the settlement project manager, Tower assembles a team with our partner professional administration Ametros and a structured settlement broker to smoothly and efficiently bring your legacy claims to closure.

We know that an MSA’s cost can pose a barrier to settlement. And we know exactly how to reduce unnecessary medical and pharmacy costs.  When scrutinizing medical records, we often find inappropriate use of opioids, muscle relaxants and benzodiazepines, often with multiple prescribers. Our free Physician Follow-up service contacts treating physicians and obtains written changes to the drug regimen. In addition, the switch of brand drugs to generics and verification of discontinued drugs and confirmation of ongoing treatment when properly documented so Medicare can approve the MSA, can result in thousands of dollars of savings on claims.

Injured workers and their attorneys can also be reluctant to settle claims.  This is where Tower’s partner Ametros, as the MSA professional administrator, can step in to talk with the injured worker and their attorney to allay any concerns they may have with closing out medical care and utilizing the MSA for future treatment.  Ametros provides medical and pharmaceutical discounts and has 24/7 care advocates available to help injured parties find providers. While injured workers often complain about the workers’ comp system, some don’t want to lose their adjusters help navigating the healthcare system, and Ametros gives them that post-settlement support.  Structured settlements help people who are afraid of spending all their money in a few years.  Tower, Ametros and the structured settlement broker also may attend mediahttps://ametros.com/tions when in-person settlements return.

When injured workers and their attorneys understand the post-settlement benefits available Ametros and structured settlement partners, they often agree to settle.


 In a settlement initiative for a large national employer, Tower and its partners were able to work with the client to settle cases with MSAs that resulted in a 43% reduction in open claims and 26% reduction in total claim costs along with a 55% reduction in CMS-approved MSA amounts compared to prior MSAs.

In a current settlement initiative started in March 2021, so far 23% of pursued claims have been settled with $60K in MSA savings because of Tower interventions.

Goal is Claim Closure

Keeping claims open is usually not the answer.  At no cost, Tower is ready to assist you as your project champion in selecting the right partners for the legacy claim settlement project and developing a plan which is customized to your type of claims and your claims team.  Further, this plan will identify and implement interventions to mitigate the MSA amount and alleviate the injured workers’ concerns in closing out their medical.

For more information or to consult on a potential legacy claims project, please contact Hany Abdelsayed at (916) 878-8062 or hany.abdelsayed@towermsa.com.