Medicare Set-Asides

A CMS-approved Medicare Set-Aside is required following a Workers Compensation Settlement when the recipient is either a Medicare Beneficiary at the time of the settlement AND the total settlement is more than $25,000 or they have reasonable expectation of being a Medicare Beneficiary within 30 months and the total settlement exceeds $250,000. Medicare may also require proof that their interests were considered, even CMS approval is not required.

Spruance & Associates, Inc. has trained professionals on staff who have experience preparing Life Care Plans, Medical Case Management, and training from Medicare. We have three certified Medicare Set-Aside specialists.

Items needed for Medicare Set-Aside include: proposed settlement agreement, payout ledger from the past two years, and signed authorization forms.

Please contact our office if you have any questions as to whether an MSA is needed. You can refer an MSA to our office for either an allocation, submission or letter by contacting our office via phone or email.

Medical Management

A Case Manager is responsible for all aspects of service delivery to physically and/or mentally impaired clients. Case managers communicate with the injured employee, and the medical team to assess, plan, implement, coordinate, monitor and evaluate medical management needs and services. The goal of medical case management is to assist the injured worker in attaining an MRM, as complete a recovery as possible and returning to work.

It is important that the Medical Case Manager is familiar with Medicare Set-Aside issues!

Medical Appointments are often attended by the medical case manager with the patient and immediate feedback is received regarding the status of the medical condition. The medical recommendations are obtained and reviewed with the employer/carrier to prompt handling. The medical status and office notes are faxed to the employer/carrier immediately.

The Medical Recommendations and status are reviewed with the injured worker, to assure his understanding of complying with medical advice.

The medical case manager will obtain the date of maximum medical improvement, obtain the PPI rating and determine if the client has any permanent work restrictions. The case manager will maintain contact with all members of the team to assure that the patient, physician, and employer/carrier are well informed of the case status.

Vocational Assessments

  • Assessment/Evaluation
  • Vocational Testing
  • Vocational Goal Development
  • Alternative Placement
  • Expert Witness
  • Computerized Transferable
    Skills Analysis
  • Job Analysis
  • Labor Market Surveys
  • On the Job Training Development

Services are provided by Certified Rehabilitation Counselors or Certified Vocational Evaluators

Explanation of Services

A thorough Vocational Evaluation includes a complete file review, initial interview, and the development of a rehabilitation plan. The Rehabilitation Consultant will assess the client's medical stability, job readiness, and establish appropriate vocational goals. An evaluation of the client's physical capabilities, transferable skills, and vocational strengths and weaknesses will assist in determining the person's rehabilitation potential.

Vocational Testing involves a battery of paper and pencil tests to include aptitude, academic achievement, and intellectual interest. The testing results assist in development of vocational goals and a rehabilitation plan.

Computerized Transferable Skills Analysis was designed to identify job goals from the "Dictionary of Occupational Titles." This computerized analysis considers prior work experience, acquired aptitudes and physical capabilities. The purpose is to identify job goals related to the client's work history and work-related skills.

Job Developement and Labor Market Survey consists of determining the existence of available jobs relative to an established job goal within a specific geographical area. Contact is made with prospective employers through telephone contact and/or personal visits.

Job Analysis is an onsite evaluation of specific occupations regarding the essential functions of the job related tasks. Evaluation is made of the tasks performed, educational requirements, physical demands and environmental working conditions. The written analysis and/or videotaped analysis can be reviewed with the treating physician for medical approval.

Labor Market Surveys are conducted by CRC and CVE level professionals. Job openings are identified in the claimant's labor market, consistent with their skill level and physical abilities.

Wage Earning Capacity Assessments

Due to our knowledge and understanding of the labor market, Spruance & Associates, Inc. can also assess or testify as to an individual's wage earning capacity in family law cases. The evaluation consists of client interview/evaluation, testing if necessary, labor market research and/or gathering of statistical data to support our findings.

Life Care Plans

Life Care Planning typically involves an evaluation of the individual in their home environment, thorough review of an individual's medical records, interview with the individual's family members if necessary, and recommendations or approval from the primary treating physicians to summarize the individual's future medical needs, as a result of the onset of disability.

Future Medical needs may include: routine treatment, aggressive future needs, medications, supplies, orthopedic equipment, therapeutic treatment, orthotics, prosthetics, home care, transportation, home modifications, and such related medical needs to increase and promote satisfaction of activities of daily living.

Social Security Representation

As Social Security Representatives, Mr. Spruance, Ms. Susan Butler, and Ms. Terri Smith are available to assist you or a family member with your application for Social Security Disability Benefits. If you have an impairment that prevents you from working, then you should talk to our professionals. We can assist you with the process through Social Security Claimant Representation, Application Assistance, Benefit Explanation, Hearing Representation, and Frequent Case Status Checks.

Please see us for a FREE assessment/evaluation! There is NEVER a charge for this service until we are successful in obtaining your Social Security Disability Benefits.

  • Over 20 years of experience as Disability Managers have made us experts in the field
  • Over 20 years of experience have made us experts regarding the world of work
  • We have been a member of the National Organization of Social Security Claimant Representative since 1996 (NOSSCR)
  • We are members of the National Association of Disability Representatives (NADR)

Please visit for more information

Expert Witness

  • Medicare Set-Aside Consultation
  • Medical Case Management
  • Vocational Assessment
  • Wage Earning Capacity Evaluations
  • Life Care Planning
  • Social Security Disability Services
  • ADA Consulting
  • Long Term Disability Evaluations
  • Labor Market Surveys

Worker's Compensation, Social Security, Family Law, FELA, Jones Act, Longshore & Harbor Worker's Act, Americans With Disabilities Act, etc.