Employees who sustain work injuries are entitled to worker’s compensation benefits to cover the cost of medical bills, lost wages in the healing period, and permanent disability. However, when a worker’s compensation claim is disputed, an injured worker might initially need to rely on other sources of payment, like their health insurance, Medicare, Medicaid, or the VA, to cover the cost of their medical bills. Short- and long-term disability insurance can also assist the injured worker in making up at least a portion of the lost wages during that time.
When their claim for worker’s compensation benefits is later approved or settled, health insurers and disability insurers can seek reimbursement through their contractual rights. Injured workers must understand that they may need to provide reimbursement for these health insurance or short- and long-term disability insurance payments if a request is made, and must account for them when negotiating a settlement.
Subrogation is an insurance principle that is intended to prevent an injured person from “double-dipping.” When an injured worker settles a worker’s compensation claim, their health insurance provider, short- and long-term disability insurers, and other entities may be entitled to reimbursement out of any settlement amount.
Most health insurance policies include contract language that allows the health insurer to be reimbursed if an injured person receives financial compensation for medical treatment of work injuries that were paid by a health insurer. In situations that involve both worker’s compensation benefits and a health insurance carrier, the health insurance carrier may initially cover the injured worker’s medical bills, then seek reimbursement once the worker’s compensation claim is settled. This right of reimbursement is contained in the health insurance policy contract, typically a long document that is provided by your health insurer or employer-sponsored plan upon request.
Government health insurance providers like Medicare, Medicaid, and the Veterans’ Administration have an automatic right of reimbursement under federal law. Their interest must be considered in any settlement. All other entities—such as private health insurance and short- and long-term disability providers—are not parties to a Wisconsin worker’s compensation claim. They must rely on contract rights to assert their subrogation rights. However, when a worker’s compensation matter proceeds to a hearing, the hearing order may instruct the worker’s compensation carrier to reimburse these entities even if they did not assert a reimbursement request.
When an outside party other than your employer or coworker caused your injuries, a third-party lawsuit can arise. In these situations, if you receive compensation from the third party or their liability insurance carrier, the worker’s compensation insurance carrier can seek reimbursement for amounts they paid related to your injuries.
Under Wisconsin’s third-party liability law, Wis. Stat. §102.29, funds from a third-party settlement are divided as follows:
This formula is complex and it is wise to seek representation by a skilled worker’s compensation or personal injury attorney in a dual worker’s compensation/personal injury case.
Subrogation law is highly technical and can be challenging to understand. The worker’s compensation attorney team at Kingree Law Firm will build your case and seek the maximum benefits reasonably possible, given the facts and the law. Then, we will work with your health insurance carriers to ensure only valid and enforceable subrogation claims are asserted, and negotiate the subrogation amount to optimize your financial recovery.
Kingree Law Firm is a premier worker’s compensation law firm in Wisconsin. Our team of skilled and experienced worker’s compensation attorneys exclusively represents injured workers in claims for worker’s compensation benefits. We primarily represent injured workers outside the Milwaukee area and have earned a reputation as one of the top worker’s compensation law firms in the state.
If you experienced a workplace accident or suffered an occupational injury that caused significant lost time from work, permanent disability, permanent wage loss, or if your claim for worker’s compensation benefits was denied, contact Kingree Law Firm today to schedule an appointment to discuss your situation and how we can assist you.
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