panel-says-workers-compensation-insurer-can-seek-reimbursement

If you have been in a work-related motor vehicle accident and you file a third party claim for injuries suffered in the crash, your company’s workers’ compensation insurance carrier may be entitled to a portion of any recovery you receive in the personal injury lawsuit, if you also received workers’ compensation benefits. A New Jersey appellate court came to that conclusion in August, 2016.

In an appeal that consolidated claims from three different insurers, the court was asked to reconcile competing provisions of two New Jersey statutes: the Workers’ Compensation Act and the Automobile Insurance Cost Reduction Act. All three cases involved public workers who were hurt on the job and who had recovered damages in personal injury actions for medical expenses.

At the trial level, all three courts held that workers’ compensation insurance companies could not seek reimbursement of medical expenses in such occasions, as the Automobile Insurance Cost Reduction Act prohibits reimbursement of medical expenses collected or paid under personal injury protection (PIP) policies. The trial judge concluded that, because an injured employee in a work-related accident is treated as a “no-fault” insured, the worker can’t recover medical expenses from the defendant if those medical expenses have been paid by an insurance company—that would be a double recovery. The judge concluded that, because the injured party could not recover medical expenses, the damage award could not and did not include compensation for medical expenses, so that workers’ compensation insurance company had no basis for reimbursement.

The appellate court disagreed, finding that the Automobile Insurance Cost Reduction Act seeks to minimize insurance costs by guaranteeing medical expense coverage. Since the recovery could include reimbursement of medical expenses, and since the Workers’ Compensation Act allows a workers’ compensation insurance provider to seek reimbursement of any medical expenses paid, the requests of the insurance companies were permissible.

Contact Us

At Taylor & Boguski, we bring more than 70 years of combined legal experience to men and women throughout New Jersey. For a free initial consultation, contact our office online or call us at 856-200-8989.

When you have been injured at work in New Jersey, your exclusive remedy will typically be through a workers’ compensation claim. It’s often referred to as the “grand bargain,” as it is designed to benefit both employers and employees. Business owners (and workers’ compensation insurance companies) don’t have to worry about large damage claims from a judge or jury because the workers’ compensation laws establish specific payouts. Workers generally have access to compensation more quickly, as they don’t have to go through all the procedures involved in a lawsuit.

At its best, it’s a straightforward and simple system—you see a doctor, get a medical opinion that you’ve suffered an injury and can’t work. You file your claim, continue to see the doctor regularly, and receive temporary benefits until you can return to work, or permanent benefits if you can’t go back to your job.

Workers’ compensation insurance companies, though, take a completely different view of your claim. It’s all about their bottom line, and the way they maximize their bottom line is to minimize what they pay you. It’s how their business model works. They charge premiums, which represents the bulk of their income. In order to maximize their profits, they need to maximize income and minimize expenses. The more they pay out in claims, the less profit they’ll show at the end of the year.

So it’s really in the workers’ comp insurance company’s best interests to make the process difficult for you. They may refuse to pay for necessary testing, or they may allege that you can return to work, or that your injury is less serious that you know it is. That’s why you need an experienced and aggressive workers’ compensation attorney to protect your rights.

Contact the Law Office of Taylor & Boguski

At Taylor & Boguski, we bring more than 70 years of combined legal experience to injured workers throughout New Jersey. For a free initial consultation, contact our office online or call us at 856-200-8989.