Work Injury - Is a Claim Limited to Workers’ Comp Benefits?

Work Injury - Is a Claim Limited to Workers’ Comp Benefits?

Workplace injury claims may not be limited to workers’ compensation benefits alone.

Find out what other options are available.

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Workers’ compensation provides benefits for workers injured on the job and the benefit amount varies among different states in the U.S. Workers’ compensation attorneys and the medical record review companies that assist them with reviewing the injured employee’s medical records know that there are occasions (such as when the employee suffers a severe or life-changing injury while on the job) when workers’ compensation benefits alone may not provide sufficient coverage. That is when the plaintiff may have to try and find another way to recover compensation in addition to workers’ compensation benefits.

Any industry carries the risk of workplace injuries. Many workers have to travel as part of their job and auto accidents are a real possibility. If a worker operates a vehicle in the course of his/her employment and is involved in an accident, he/she is entitled to workers’ compensation benefits.

Apart from this, the worker may also be eligible for No-fault insurance benefits.  Workers’ compensation applies to injuries that arise out of and in the course of employment.

This does not include driving to and from one’s primary place of employment, but can apply to transportation such as the following that happens while on the job: o Traveling during working hours o Employer-provided transportation o Work associated with excessive exposure to traffic risks (e.g. construction zones) Injuries sustained while working are typically compensated for reasonable medical treatment, 85% of the worker’s gross weekly wage, and the set rates of compensation based on the nature of the disability/injury.  After an auto injury, No-fault insurance benefits under the injured employee’s own insurance policy may be available for all medical expenses including attendant care costs and 3 years of lost wages at 85% of his/her salary, and replacement services (up to $20 per day). These benefits may be available provided the injury is the result of the use of a motor vehicle (loading/unloading of a car or truck; using equipment mounted to the vehicle etc.)

Most states laws prohibit “double recovery,” or being paid twice for the same injury. If the amount paid by the No-fault insurance provides ample coverage, the employee may have to reimburse the workers’ compensation benefits. However, filing for both workers’ comp and an auto insurance claim makes sense. Where both insurances would pay for the same expense such as medical

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treatment or lost wages, the workers’ compensation claim would pay out first, and the No-fault claim would make up the difference.

What if a third party’s negligence caused the accident and injury? In more serious auto accidents, the victim may be subject to long-term disability, suffering and pain. In such cases the victim can bring a personal injury lawsuit against the at-fault driver directly. Let us consider an example of an auto injury claim that involves workers’ compensation, the employee’s own No-fault insurance, and personal injury due to third party negligence.  Worker A is driving a delivery truck for her employer, and is struck by a car that speeds past a red light.  A is seriously injured and will be out of work for several years.  She files a claim with her employer’s workers’ compensation insurer, and with the appropriate no-fault insurance company.  The workers’ compensation claim paid first, providing coverage for her reasonable medical expenses, 80% of her net wages, and a flat rate for her temporary disability.  Worker A’s No-fault auto insurance company will pay any eligible lost wages over and above the workers’ comp benefits as well as attendant care costs and replacement services.  Worker A decides to bring a lawsuit against the negligent driver who hit her. She receives a favorable jury verdict that includes an award for her long-term disability, pain, suffering and other damages.  Worker A will be required to reimburse the workers’ compensation insurance for the money she has already received for her disability, and for lost wages paid for the 3 years covered by her No-fault insurance. The rest of the award would come to her to compensate for her injuries.

A Real-life Example This is in Minnesota, where the appellant was injured when a stolen vehicle crashed into the school bus she was driving for her employer. She received payment for 12 weeks of chiropractic treatment from the workers’ compensation carrier. However, the carrier did not continue with the benefits further because additional treatment was not indicated in the workers’ compensation parameters.

Under the relevant Minnesota Statute, chiropractic care is generally limited to 12 weeks though the

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rules allow for more if required. It is based on this rule that the workers’ compensation insurer terminated payment after 12 weeks, determining that additional treatment was excessive.

Following this, the appellant approached a different clinic for treatment and made an uninsuredmotorist claim to her personal insurer, who is the defendant or respondent in this case. Since the respondent did not pay the bills, the appellant filed a petition for no-fault arbitration. She received a favorable ruling from the arbitrator, and the insurer sought to vacate the compensation award on the grounds that the arbitrator exceeded her authority. Though the District Court judge granted the motion to vacate the award, the Court of Appeals reversed.

The Court of Appeals held that No-fault insurance provides for payment of economic loss benefits, including chiropractic services. Since the respondent did not, during arbitration, dispute that the chiropractic services that the appellant received were reasonable and necessary, the appellant is entitled to reimbursement for the expense of the services. The Court found no basis to conclude that the legislature intended the general provision in the workers’ compensation act to prevail over the special provisions of the no-fault act when an insured auto driver seeks no-fault benefits. The Court said that therefore, they must construe the special provisions of the no-fault act as an exception to Minn. Stat. § 176.83, subd. 5(c) (2016) that precluded no-fault benefits. If it is later determined that the chiropractic treatment the appellant received was not excessive, the respondent would be entitled to reimbursement from the workers’ compensation insurer. If it is determined that the treatment was excessive, the respondent will have the obligation to pay the benefits. According to the Court of Appeals, in either situation, the appellant would have received prompt payment of medical benefits to which she was entitled. This is consistent with the legislature’s intended purposes of both the nofault act and the workers’ compensation act.

Recovering adequate compensation is easier with the support of a workers’ compensation or personal injury attorney. A good attorney would first ascertain, with the support of accurate medical review solutions, that the injury sustained is compensable. Professional legal counsel is important to address the complexities inherent in Workers’ Compensation, Personal Injury and No-fault laws.

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