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Workers comp settlement and then a separate P & S claim

Lansdale, PA |

I posed this question already, but Im correcting the details. The WC carrier paid me for 14 weeks and for a settlement, their entire lien to the responsible 3rd party's insurance carrier is now preparing to pay that lien/claim. The responsible 3rd partys insurance carrier called me to see "how i was doing" and wanted to know If I'd be filing a claim" I told her I wanted to wait and see, that I didn't know yet. She sent me an authorization form to review the documents/files for my injuries... My questions is, if the WC total amount paid to me was 5000 settlement plus 3000 in wages before settlement, and 7000 for physicians/mri... totaling 15000 for a back sprain/foot sprain, where I was in pain for 6 months, can I ask for P &S settlement? Will WC try and get some of that $$, if so, how much

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Attorney answers 4

Posted

Workers' compensation is entitled to be repaid 100% of the medical and wage benefits it paid on your behalf. It must, however, reimburse you for the attorney's fees and expenses you incur in pursuing the third party claim. This usually results in a 33.33-40% redcution in the amount they get back. If you settle without a lawyer, they will not have to reduce their reimbursment claim. sometimes, due to low insurance covverage limits on the part of the defendant, you cannot generate enough settlement funds to cover the lien and have money left over for pain and suffering. In those cases, you need to play lets mmake a deal with WC. I recommend you get a lawyer.

This answer to your legal inquiry is based upon the limited facts stated in your question. Accurate legal advice is based upon an exchange between a lawyer and a client. The lawyer can then ask about other facts that may change or confirm the answer. Without that exchange, this reply should be considered limited in value. You should rely on this answer only at your own risk. Direct consultation with a lawyer is always recommended. Answering your question does not create an attorney-client relationship. The answering attorney is licensed in Pennsylvania and all answers are given pursuant to Pennsylvania law, unless otherwise indicated.

Asker

Posted

so the WC carrier gave me a few weeks pay and then we settled for 5k, w/o attorney, i know, Dumb... but now they have put a lien in to the negligent party's carrier for the amount they paid to me and the dr's. ($15000) So If Erie is calling me to try and settle the P&S claim, and sent me an authorization form to see the medical records and settles with for lets say, 3000, all that goes to the WC carrier? Why would I make a deal with the WC Carrier? Because they would get the first 15,000 of what I recover? How could I make money from the settlement then?

Posted

In light of its payments, workers' compensation has a lien and is entitled to a portion of any settlement with the third party. The amount to which it is entitled will depend on the terms of your workers' compensation settlement and the amount that you recover from the third party.

If, however, it has already been repaid the full amount of its lien by the 3rd party's carrier before your settlement, it would not be entitled to any additional payments.

What is more typical, however, is that the 3rd party's carrier settles with the injured worker, and the WC carrier's lien is then satisfied out of the 3rd party settlement.

Before you enter into any settlement with the 3rd party carrier, I recommend that you consult an attorney who is experienced in handling personal injury claims where there is a workers' compensation lien.

This response given is not intended to create and does not create an ongoing duty to respond to questions. It also does not form an attorney-client relationship, and should not be relied upon as legal advice. It is based upon the limited facts provided by the posted question. To the extent additional or different facts exist, the response may change. I am licensed to practice law only in the Commonwealth of Pennsylvania. Responses are based solely on Pennsylvania law unless stated otherwise.

Posted

Consistent with my response to your previous question, given the factual scenario that you have described it is strongly recommended that you discuss your third-party motor vehicle case with an experienced Personal Injury attorney to determine the proper value of your third-party cause of action which would include not only lost wages and medical benefits, but also "special damages" which would include the claim for Pain and Suffering that you have described in both questions.

If I recall your previous question correctly, the Statute of Limitations shall run in May, 2013 and therefore, if you do not either settle the claim before the Statute runs or file a Complaint and/or Writ of Summons you will lose all rights you may have to secure damages arising out of this third-party motor vehicle accident.

Assuming there is no major issue of liability and that the other driver was clearly negligent in causing your injuries you may be able to receive a far more significant settlement than the $15,000 settlement of your Workers Compensation Claim.

As the other responders have indicated, the Workers Compensation Carrier has an absolute right of subrogation from your third-party settlement. If you settle your claim for $15,000 without an attorney the Workers Compensation Carrier would be entitled to the entire amount.

If you retain the services of an experienced Personal Injury Attorney who also understands the nuances of negotiating with the Workers Compensation Carrier over its subrogation lien, you may be able to receive a significant settlement which would allow not only the Workers Compensation Carrier to receive its entitlement to a subrogation lien, but also pay your attorney and have money left over for you.

Please note that the negotiation of a Subrogation Lien can become complicated, as it does include the Workers Compensation Carrier paying its portion of your Attorneys costs which include the Contingent Fee and any associated litigation costs.

Even given the information that you have provided, one cannot answer how much your third-party case is worth without sitting down and reviewing the facts of the case, your medical records, the defendants motor vehicle policy declaration page etc.

According to, if you have not done so already, it is once again my recommendation that you immediately contact a Personal Injury attorney to assist you with the negotiations of your third-party settlement with the Motor Vehicle Carrier and before retaining his or her services, please ensure that said attorney is familiar with negotiating with a Workers Compensation Carrier in the hopes of reducing its entitlement to a subrogation lien.

Most Personal Injury attorneys will not charge for an initial consultation and will accept your claim on a contingent fee basis.

Asker

Posted

The WC Carrier is trying to get paid from the 3rd party carrier as we speak, which Im assuming ends up in the 3rd party paying the claim to the WC Carrier. If the WC Carrier gets reimbursed and the statute of limitations doesnt run out, Then anything I try to get from 3rd party carrier is mine? Or could I negotiate some type of split with the WC Carrier?

Ross Marvin Miller

Ross Marvin Miller

Posted

As I wrote, I would strongly encourage you to retain an attorney to negotiate for you. These cases are handled on a contingency basis so there is no charge to you, and the involvement of an attorney can really increase your recovery.

Posted

I agree with what has already been written here and I would strongly encourage you to consult with a personal injury attorney about your potential claim. My firm handles both workers comp and personal injury, and I would be happy to provide a full consultation at no charge if you would like. In these types of situations it is always a good idea to retain a lawyer to maximize your recovery.

Ross Miller, Esq.
215-822-7575

Contact me for a more detailed discussion of your issue at 215-822-7575, or by email at rmm@rgsglaw.com. This answer is based on general legal principles only and is not intended to provide specific legal advice. This answer is for informational purposes only and does not constitute the formation of a lawyer-client relationship.

Robert David Elias

Robert David Elias

Posted

I agree that you need an attorney that handles both WC and PI cases. There are a number of issues that would have to be resolved that would require this expertise.

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