Speedy Medicare Set Asides and Re-Employment

Medicare Set-Aside Reference Guide:

Claimant Information

			Claimant birth date
(MM)	(DD)	(YYYY)
$			Projected settlement amount
Disputed / denied claim ?

SSDI Status

On SSDI for 24 or more months ?

On SSDI for less than 24 months ?

Applied for SSDI ?

Not SSDI

End Stage Renal Disease (ESRD)

ESRD with Medicare approval ?

ESRD, but not yet approved by Medicare ?

Not ESRD

Injury Type and Accepted Body Part

Injury Description

Accepted Injury body part

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