SOMETHING YOU SHOULD KNOW IF YOU HAVE A WORKERS’ COMPENSATION CASE AS WELL AS A THIRD PARTY PERSONAL INJURY CASE
1. If both a pending Workers’ Compensation Injury claim as well as a Third Party Personal Injury claim arising from your work-related injury, it is important that you have a basic understanding regarding the issue of “Credit”;
2. The issue of credit often arises when you settle your third party injury case and you “net” a certain sum of money in-pocket;
3. By “net” money, we are referring to the amount that you receive in-pocket after deducting attorney fees, costs, or other contracted (i.e. agreed upon) deductions from your personal injury settlement or judgement. These deductions can also include any outstanding medical liens/expenses that you are obligated to pay at the time your case settled;
4. When you receive your settlement, judgement or award in your personal injury matter and you net a certain sum of money, typically the workers’ compensation insurance company (on behalf of the employer) or self-insured employer will claim a “credit” against any and all benefits due & owing to you in your workers’ compensation matter. This includes, most importantly, temporary disability payments, permanent disability payments and future medical care;
5. What this means to you is that if the credit is allowed, by agreement or by order of the Workers’ Compensation Appeals Board (which it often is), the workers’ compensation insurance carrier or self-insured employer may lawfully stop and/or refuse to pay any further monetary benefits to you which are typically paid bi-weekly as temporary disability or permanent disability, as well as cease providing for and paying for your approved medical care;
6. This can result in an immediate termination of any payments you are receiving at that time as well as a denial of any further medical care–even if it has already been authorized and/or a procedure (e.g. surgery) is pending;
7. Stated differently, after the payment of attorney fees, litigation expenses and other allowable liens/deductions, the employer is relieved of its liability to pay any further compensation (monetary or medical care);
8. This “credit” even applies despite the fact that the employer or workers’ compensation insurance carrier has already obtained reimbursement of some or all monies it has paid in your matter up to that point in time–paid from the settlement, judgement or award in your third-party personal injury case;
9. Please note that the amount of the credit which is asserted can be reduced in certain specific circumstances. This would include cases where negligence of the employer was deemed a cause or contributing factor to your injuries;
10. Likewise, if there are expenses that you have paid for or will pay for in the future, or other benefits received on your behalf from another entity, these may be claimed to offset (or reduce) the amount of the claimed credit. This can include such things as out-of-pocket co-pays and deductibles you pay to obtain medical care for your work injuries, as well as, the cost of medical care paid through private or other insurance and short or long term disability paid in lieu of benefits you would have otherwise received, absent the agreed or awarded credit.
Please note that this is not a complete discussion of all of the implications regarding such credits and is only intended to give you a basic understanding of such. Every case is different and there may be, given the specific facts of your case, factors which would impact any credit differently in your case than someone else’s.
Please be sure to discuss, at length, this issue with the attorney who has been assigned to represent your interests in both your workers’ compensation and your personal injury cases.