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  1. #1
    Join Date
    Aug 2008
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    53

    Default Workers Comp Claim and Personal Injury Claim

    My workers compensation claim was made in the State of: Louisiana

    I have W/C with a PI case both are conneted. If W/C stops paying for further treatment and the auto insurance begins to pick up the tab on needed treatments, will the W/C provider have the right to stop paying benefits at some point? And if so will it give them the right to begin settlement process?

    I am still needing to sign up with a W/C atty. I am very concerned about the time limits here where W/C is concerned. As it stands now I am rec. weekly checks from W/C and they have been paying for my PT and meds up this point.

  2. #2
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: W/C with Pi

    Dougls: actually the 3rd party auto carrier WILL NOT PAY A DIME toward medical expenses as INCURRED.......UNLESS you are in a NO-FAULT STATE..........

    the following info is based on a comparative negligence state only...........

    what a 3rd party carrier does is completely different from WC....3rd party is TORT ie negligence......where as WC is a benefit delivery system govern'd by administrative process.

    You can sue the 3rd party carrier, you cannot sue WC.......

    If you also maintain auto liability coverage and your auto policy has medical coverage benefits attached, you may submit your unpaid medical bills for your MVA to your own carrier......under the terms of your Auto policy.....in addition, dependent upon the extent of your injury, should the negligent parties liability limits ie A/B be less then your own Auto limits you may have the option to file what is referred to an as UNDER insured claim against your own auto policy......

    However, if your own Auto policy pays out medical benefits and WC also pays out medical benefits both have a right of subrogation against the 3rd party who was negligent, ie the tortfeasor....

    Most states are what is referred to as COMPARATIVE negligence meaning that dependent upon the circumstances of the MVA, either you [if you were driving ] or the party to whom's vehicle you were in [ie a passenger] could be found to have contributory negligence......

    Personal Injury claims involving MVAs can sometimes be very complicated and even more so when the injured party is already injured as a result of an industrial accident......

    many twists and turns can and most likely will happen.....

    WC for instance will NOW argue apportionment to the MVA if not argue they are no longer liable at all from the MVA forward as far as PD indemnity goes......under most states WC policies WC is still liabile for the medical treatment to cure and relieve you from the effects of your industrial injury, and that includes treatment for the MVA if necessary....

    the 3rd party carrier will base their evaluation upon your current medical state and determine to what extent your injury has been made worse....

    NO-FAULT is different, as your own policy handles everything underwhat is referred to as PIP ie [personal injury protection] this coverage provide medical, and benefits for lost wages....however unless you are severely maimed you cannot SUE......

    You should have a PI and WC attorney working for you as each specialize in a completely different world.....both however must coordinate those worlds for you.

    You have no easy road ahead of you..........RW......
    Last edited by roofinfool; 05-23-2009 at 04:54 PM.

  3. #3
    Join Date
    Aug 2008
    Posts
    53

    Default Re: W/C with Pi

    roofin,

    I was being transported via paid for transportation by W/C. We were hit by a truck that ran red light. Louisiana is not on the no fault list of states when I googled it. My pi atty has had me to call a W/C atty but they have not returned my call as of yet. Acording to what you posted I take it that W/C still needs to continue paying for the additional treatments I need is this not correct? Thanks for your in put here.

  4. #4
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: W/C with Pi

    For the most part that is correct, WC is still on the hook for medical tx.
    but only for those body parts claimed as and accepted as industrial.

    However, let's say a body part was found to have reached maximum medical improvement/permanent and stationary....meaning that your condition is not expected to change with or without medical treatment......under this scenario, WC could assert that they are NOT liable for the aggravation of this body part from the MVA.

    Since you were being transported via PAID service to a WC appt, the 3rd party carrier will be looking at any potential liability they can reasonably assert to the Paid service for negligence that contributed in part to your MVA injuries.

    You indicated the 3rd party ran a red light......the 3rd party carrier will investigate to determine if in fact their insured [3rd party] actually did run a red light. They will also look at how you were secured with-in the vehicle.

    For example; where you in a wheel chair, did the service vehicle have the appropriate wheel stops and harness's to ensure you were secured safely with-in the vehicle. In not, potential liability may exist to the Service Vehicle.

    Also the point of impact to the vehicle you were in will also provide insight to the cause and effect of your claimed injuries from the MVA.....the newer the vehicle, the better it is designed to absorb the forces of the impact.......speed of the offending vehicle can also determine the force as well as the size of the respective vehicles involved.

    Some vehicles are designed to collaspe, and they do so as they absorb the forces of the impact.....this is to lessen the affect of injuries upon a human being........

    RW......

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
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    17,943

    Default Re: W/C with Pi

    However, let's say a body part was found to have reached maximum medical improvement/permanent and stationary....meaning that your condition is not expected to change with or without medical treatment......under this scenario, WC could assert that they are NOT liable for the aggravation of this body part from the MVA.
    Have to 'agree to disagree' on this one RW... IF you/IW are in a 'medically necessary transport' for the industrial injury... eg. the injury is cervical spine, and going to PT... and the MVA is cause of two broken legs... the ER/IC is liable for those/any injury as a result of the MVA... whether there is subrogation between the parties would be seperate issue.

    Because... IF it were not for the AOE/COE industrial injury, you would not be in the 'medical transport', or be receiving the PT in the first place.

    The MVA is a 'compensable consequence' to the work injury. And will be considered in the final PD/WPI rating.

    Not saying you would not be subject to litigation on this... but WC IC is going to be paying the bills here...
    If there is a TTD cap that has been reached...the MVA IC could be liable to resume those benefits, as there could be 'lost wages' in the PI claim. (Though the money may not be receved until the case settles)

  6. #6
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: W/C with Pi

    Quote Quoting BvIA View Post
    Have to 'agree to disagree' on this one RW... IF you/IW are in a 'medically necessary transport' for the industrial injury... eg. the injury is cervical spine, and going to PT... and the MVA is cause of two broken legs... the ER/IC is liable for those/any injury as a result of the MVA... whether there is subrogation between the parties would be seperate issue.

    Because... IF it were not for the AOE/COE industrial injury, you would not be in the 'medical transport', or be receiving the PT in the first place.

    The MVA is a 'compensable consequence' to the work injury. And will be considered in the final PD/WPI rating.

    Not saying you would not be subject to litigation on this... but WC IC is going to be paying the bills here...
    If there is a TTD cap that has been reached...the MVA IC could be liable to resume those benefits, as there could be 'lost wages' in the PI claim. (Though the money may not be receved until the case settles)
    You are referring to the legal argument known as "BUT FOR"
    and in tort it is used quite extensively....... I believe it would largely depend upon the WC administrative laws relative to Dougls claim........

    I could not answer that for sure because I have NO CLUE about Louisana WC law......

    However, those of us in Cali know that where there is a will, they will find a way when it comes to mitigating their expenditures and this includes medical tx to cure/relieve from the effects of an industrial injury when outside factors contribute.......

    RW.....

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