Under state law, the doctors who treat us must bill the workers compensation carrier directly for their services. The law forbids any medical provider from billing a patient. Any part of the bill not covered under the workers compensation guidelines is written off. You can’t be asked to pay for the portion not covered.
There is also no deductible or co-pay. If wages are missed, your workers’ compensation benefits pay a portion of these. Other benefits are also provided depending upon the nature and extent of your injury. Retraining, disability payments and pension payments are some examples.
What the law doesn’t cover is pain and suffering, or compensation for how the injury affects you in your day-to-day living. Mental and emotional distress are also not covered. Neither is any compensation paid for scarring or the loss of your ability to pursue recreational activities.
However, all of the above are considered fair damages under our tort laws, meaning you can ask the person or company who injured you to pay reasonable compensation for all of these items. If fault for the accident is reasonably clear and the person who caused your injury is insured, their insurance company will typically step in and try to settle.
In theory they should pay you what a jury would consider fair for what you’ve been through. And that includes all of your medical bills, wage losses and reasonable compensation for your personal pain and suffering. Oftentimes this results in you receiving payments for some items that were already paid by your workers compensation coverage.
So what happens to the money you recover? Do you get to keep it all even though you may have received, at least in part, a double recovery? Unfortunately, no. State laws require you pay back the workers’ compensation benefits. Each state has a formula for what must be paid back. Some states require all of it to be paid back, others only a part. The formula can be complicated to apply, depending on the type of claim and what was actually recovered.
Attorney fees and court costs can be subtracted from the reimbursement claim. Many times there is room for negotiation as to what and how much has to be repaid. Certain exceptions and loopholes exist that few consumers know about. An attorney knowledgeable in this area of law can help reduce what has to be repaid and in some cases even rid you of the obligation completely.
If you find yourself in one of these cases, hire an experienced attorney to help. Often times the attorney you choose has a lot to do with how much money you can keep and how much might have to go back to the workers compensation carrier.