This program will discuss and explore best practices when future “open” medical issues are expected by an award or settlement and the current process in handling such disputes before the LRIC. In 2015 the Missouri Supreme Court held that the LRIC retained jurisdiction of open medical disputes post award and settlement in State ex rel. ISP Minerals, Inc. v. LRIC, 465 S.W.3d 471 (Mo. 2015). The new LRIC regulations regarding this issue, adopted in October 30, 2019, will be reviewed, and discussed as well as commutation of open future medical benefits by an annuity or Medicare Set-Aside trust account.