If you’re in a car accident while you’re working, workers compensation may pay for medical bills and part of your lost wages. If workers’ compensation pays, it has a right to get repaid from your settlement with the party whose negligence caused your injury in Florida.
This legal right to get repaid is called a ‘workers compensation lien’. The injured claimant is responsible for paying the workers comp lien.
Thus, it benefits an injured claimant to use any Personal Injury Protection (“PIP”) insurance to pay a workers’ compensation lien. Then, the claimant will keep more of the injury settlement to himself.
Workers’ Compensation Should Pay Car Accident Related Medical Bills
If you’re entitled to workers’ compensation, it should pay 100% of your medical bills. This assumes that you get treatment from doctors that your workers’ compensation insurer sends you to. Workers’ compensation should also pay two-thirds of your lost wages.
Worker’s compensation will then seek a lien against any third party settlement. Workers’ comp doesn’t have a lien on an uninsured motorist (“UM”) insurance settlement.
Use Your Workers’ Compensation Benefits Before PIP
Workers’ compensation benefits are primary to PIP. Use your workers’ compensation benefits to pay your medical bills and lost wages before using PIP.
If workers’ compensation pays 100% of your hospital bills, you may be able to use PIP benefits to pay off the workers’ compensation lien. This assumes that you’re covered by PIP.
This may put more money in your pocket from your settlement with any party that you make a claim against.
When Does PIP Have to Pay Your Workers’ Compensation Lien?
When you recover from the third-party tortfeasor, you have to reimburse the workers’ compensation insurer for the benefits it has paid.
At that point, you’re entitled to PIP benefits because you had to pay for that which the PIP insurer would have been responsible under the PIP insurance contract. Cannino v. Progressive Express Ins. Co., 58 So. 3d 275 – Fla: Dist. Court of Appeals, 2nd Dist. 2010.
Thus, the PIP insurer has to pay the workers’ compensation lien when you recover from the third-party tortfeasor.
In Canino, Progressive didn’t want to reimburse the injured claimant (Cannino) until he paid the workers’ comp lien. The court disagreed with Progressive.
Don’t believe everything that Progressive, or any PIP insurer, tells you. They aren’t always right.
$300,000 Settlement; Rental Car PIP Pays $10k to Workers Comp Lien
Ryan was driving a rental car on a business trip. Another driver, heading in the opposite direction, made a left-hand turn and crashed into the rental car.
Ryan was injured. He settled with the at fault driver’s insurer, Allstate, for $100,000. Ryan’s underinsured motorist insurer, Travelers paid $200,000 to settle. The total settlement was for $300,000.
The workers’ compensation carrier, Sedgwick, paid about $85,000 in medical bills. I negotiated their lien down to a little over $13,000.
I then used the rental car’s PIP insurance to pay $10,000 to the workers compensation lien. This put an extra $10,000 in my client’s pocket.
We only had to pay a little over $3,000 to pay off the lien.
$125,000 Settlement; PIP Pays Almost $10,000 of the Workers’ Compensation Lien
My client was in the driving a police car, and responding to a police emergency. Another driver made a right-hand turn and they crashed.
Workers’ Comp Paid $33,000 in Bills and Lost Wages
My client’s employer, Miami-Dade County, claimed a workers’ compensation lien of approximately $33,000. The lien existed because his employer paid my client’s hospital bill, surgery bills and 66 2/3% of his lost wages.
GEICO insured the carless driver. We settled the personal injury case with GEICO for $125,000.
Through hard-fought negotiation, I was able to get Miami-Dade County to reduce its workers compensation lien from $33,000 to $12,500.
State Farm Said PIP Doesn’t Have to Pay a Workers’ Comp Lien
State Farm’s claim adjuster told me that my client’s personal PIP coverage could not be used to pay off the workers’ compensation lien.
They refused to pay part of the workers’ compensation lien. I insisted that they pay the lien.
State Farm Agrees to Use PIP to Pay of Work Comp Lien
Shortly thereafter, they agreed to use my client’s remaining PIP benefits to pay off the workers’compensation lien. This put close to an extra $10,000 in my client’s pocket.
$20,000 Settlement With GEICO; Hartford Doesn’t Require Workers’ Comp Lien to Paid
The claimant was driving for work at the time of the crash. Liberty Mutual was the workers compensation insurer.
They paid over $100,000 in workers compensation benefits. I asked Liberty Mutual to waive (give up) its workers’ comp lien.
Liberty Mutual agreed. This allowed my client to keep more of her injury settlement
Will PIP Insurance Pay a Workers’ Comp Lien if You Have a PIP deductible?
Maybe. The case that answers this question is Fortune Ins. Co. v. McGhee, 571 So.2d 546 (Fla. 2d DCA 1990).
Fortune was injured when her car was rear-ended. Her workers’ compensation insurer paid approximately $4,000 in benefits for which it received no reimbursement. This payment more than exhausted the PIP deductible.
The court said that the $2,000 which the employee (McGhee) paid to satisfy the workers’ compensation lien is effectively the last $2,000 of the benefits which she would have paid if she didn’t have workers’ compensation coverage.
If there wasn’t compensation coverage, the PIP coverage would have provided approximately $3,000 in benefits for that portion of the covered claim which exceeded its $2,000 deductible.
Thus, the PIP deductible was already satisfied and must not be applied to the PIP benefits ultimately due, i.e., the $2,000 plus the amount of attorney’s fees and costs, because to do so would not provide complete insurance coverage to McGhee.
The court said that McGhee was entitled to receive $2,000 plus the workers comp insurer’s pro rata share of fees and costs.
What You Need to Know to Have PIP Pay a Workers’ Comp lien if You Have a PIP Deductible?
You need to know:
- Total amount of benefits that workers’ comp paid
- How much money workers comp paid and wasn’t reimbursed by you
- How much you paid to satisfy the workers’ comp lien
If the amount that you paid to satisfy the workers’ comp lien is less than the amount that workers’ comp didn’t get reimbursed by you, then PIP has to pay the entire workers’ comp lien even if you have a PIP deductible.
Pedestrian Hit By Car Has $1,000 PIP Deductible; PIP Pays Workers’ Comp Lien
GEICO told me that GEICO’s PIP didn’t have to pay the workers’ comp lien since the reduced lien was less the PIP deductible. This isn’t true.
GEICO eventually reimbursed us for the entire workers’ comp lien and my client’s first 7 days of lost wages. This put an extra $1,000 in my client’s pocket.
If a PIP adjuster says that they won’t pay the workers’ comp lien because you have a PIP deductible, send them a copy of the Fortune case.
Another case that helps you, if you hired a lawyer, is Delehanty v. Coronet Ins. Co., 619 So. 2d 990 – Fla: Dist. Court of Appeals, 2nd Dist. 1993
Give Your Doctors Your PIP, Even if Work Comp is Paying the Bills
In order to get your PIP insurer to reimburse you for the money that you pay to the workers’ compensation lien, you should give your medical providers your PIP information when you treat with them.
Otherwise, your PIP insurer can claim that they didn’t receive a statement of charges within the period allowed by Florida law. Florida 627.736(5)(c)(1).
They may argue that they’re not required to pay charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement.
On June 15, 2015, a county court in Brevard County, Florida ruled that PIP didn’t have to reimbursement the injured claimant for the workers’ compensation lien since the medical bills weren’t timely submitted to PIP. Maddison Chamberlain v. USAA General Indemnity Company, Case No. 05-2014-SC-049344-XXXX-XX.
That decision isn’t binding on other Florida courts. However, it may persuade a judge.
Send Your Medical Bills to the PIP Insurer
It’s wise for you to also send your medical bills to the PIP insurer and let them know that you are using workers’ compensation as your primary insurance.
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