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  1. #1
    Join Date
    Jan 2009

    Exclamation 3rd Party Settlement and Comp Claim Assistance

    About 2 years after being involved in an automobile accident the workers comp carrier forced me to settle with the 3rd party insurance carrier because they wanted reimbursement for the medical bills they paid. The settlement was finalized and the attorney received his 1/3, the workers comp carrier received 1/3 and I received 1/3. I thought that was it. About a year later I finally had the workers comp hearing and received a 65% disability award. I was awarded an 8 year award for weekly benefits. The question I have is that I did not receive any weekly benefits for almost 3 1/2 years because of the money I received from the insurance company in the earlier settlement. Since I missed several months of work because of surgery and doctor appointments I had to borrow money form anybody I could find and I used the money from the settlement to pay them back. Since the accident my income has been reduced by 80%. I probably only work 3-4 days a week and the weekly benefit would have helped. I just don't understand why the insurance carrier was allowed to withhold weekly benefit payments for 3 1/2 years because of the money I received from the settlement. Can anybody tell me if this is normal?

  2. #2
    Join Date
    Oct 2006

    Default Re: 3rd Party Settlement and Comp Claim Assistance

    workers compensation subrogation rights are not just limited to reimbursement for the past medical bills. all the comp carrier's costs including disability payments are recoverable from your 3rd party settlement. once it reaches the amount of the settlement then they have to start paying again. Your atty should have explained the rules at the time of the settlement.

  3. #3
    Join Date
    Feb 2007

    Default Re: 3rd Party Settlement and Comp Claim Assistance

    Go back to your settlement documents...there should be an allocation there that explains how the WC carrier is to be reimbursed, and what medical treatment you will be responsible for in the future. There is generally an agreement of some sort between the parties...often the carrier doesn't take a full reimbursement...then sometimes they take a credit for future medical...a % you pay and a % they WC the employer is still liable for your injury after the 3rd party settles, until you close out the claim by a lump sum payment.

    Benefits post settlement by the 3rd party for PPD indemnity should not be subject to subrogation rights by the carrier. That is an award of indemnity due to your injury, not wage loss the 3rd party is liable for.

    There are lots of times where the CA/IC is in error as the CA doesn't always understand the full settlement agreement. The IC has attorneys too, and they don't always get the CA involved.

    You should also go back to your atty who handled the 3rd party claim and settlement for an explanation of the agreement.

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