The shutdown is not expected to interrupt either existing Medicare or Social Security benefits, as those programs are already funded for the year. However, it could delay those applying for benefits or seeking verification of their status. If the shutdown is extended, over half of CMS’s employees could be furloughed, including the staff members who review MSA’s. It is anticipated that new MSA applications will not be reviewed until the shutdown ends. An extended shutdown is therefore likely to delay settlements in which an MSA is needed, which would of course extend the employer’s and insurer’s liability in accepted cases.
The shutdown would not affect cases in which a $0 MSA is appropriate. As of July 2025, CMS no longer accepts or reviews $0 MSA applications. In the case in which a $0 MSA is applicable, the parties should document how the criteria for a $0 MSA have been met by establishing one or more of the following per Section 4.2 of the WCMSA Reference Guide:
- The individual’s treating physician documents in medical records that to a reasonable degree of medical certainty the individual will no longer require any treatments or medications related to the settling WC injury or illness; or
- The workers’ compensation insurer or self-insured employer denied responsibility for benefits under the state workers’ compensation law and the insurer or self-insured employer has made no payments for medical treatment or indemnity (except for investigational purposes) prior to settlement, medical and indemnity benefits are not actively being paid, and the settlement agreement does not allocate certain amounts for specific future or past medical or pharmacy services as a condition of settlement; or
- A Court/Commission/Board of competent jurisdiction has determined, by a ruling on the merits, that the workers’ compensation insurer or self-insured employer does not owe any additional medical or indemnity benefits, medical and indemnity benefits are not actively being paid, and the settlement agreement does not allocate certain amounts for specific future medical services; or
- The workers’ compensation claim was denied by the insurer/self-insured employer within the state statutory timeframe allowed to pay without prejudice (if allowed in that state) during investigation period, benefits are not actively being paid, and the settlement agreement does not allocate certain amounts for specific future medical services.
We welcome any inquiries you may specific to any of claims. Please reach out to one of our workers’ compensation defense attorneys.