What is a Worker’s Compensation Third Party Claim?
A Third Party Claim is an L&I Job Injury Claim and a Personal Injury Claim with the Same Set of Facts
You have a third-party claim if you are injured on the job by someone not your employer or a co-employee. For example:
- A working delivery driver who is rear-ended on the highway by someone, not his employer or co-employee, has both an L&I claim for the job injury and a third-party claim for the highway accident.
- A subcontractor injured by the general contractor or a different subcontractor has an L&I claim for the job injury and a third-party claim because of who caused the injury.
A third-party claim can be beneficial because one injury equals two claims, both L&I and third-party. Some third-party claims can be worth a lot of money.
The downside of a third-party claim is that L&I or the insurance company has a lien on your third-party recovery. That means because they have paid money on your L&I claim, they will get some of that money back from you when you recover on the third-party claim. The exact amount they get from you is subject to the worksheet formula and possible compromise. Compromise is difficult because L&I or the self-insured has lien rights, which are stronger than state subrogation rights. Sometimes, the amount L&I or the insurance company will take from your settlement or award is shockingly large. Sometimes, the third-party settlement will ruin the remaining L&I claim. Understand how this third-party formula applies to your L&I case before you consider settling any third-party claim.
An L&I Claim and a Third Party Claim Affect Each Other.
- They are two different claims based on the same facts. However, they will affect each other in significant ways.
- A third-party settlement will affect ongoing and future L&I benefits because L&I gets reimbursed for a percentage of the money they have paid. Sound simple? It’s not. The third-party settlement might ruin your L&I claim. Get your lawyers involved here to reduce or eliminate any deficiency. This is important!
- L&I orders affect the Third-Party claim.
- A bad order or unfavorable IME can result in a big problem for the third-party claim.
- A favorable order and good medical opinions can be very helpful to the third-party claim.
- This is way more important than it may look. Be careful. Pay attention now, or you might get a rude surprise later.
- A third-party claim can create a deficiency and ruin the L&I claim.
- L&I or the self-insured can minimize and oppress an L&I claim, severely limiting third-party recovery. Don’t let this happen.
- Working to develop the L&I claim fully can be very helpful to the third-party claim and the bottom line.
- Get legal advice about this. It is more important than you think.
Has Medicare Made Payments in Your Case?
If Medicare has made payments in your injury case – beware. They may have a legitimate interest in some of your settlement money. They want to be paid back the money they have paid for your treatment.
The law allows Medicare to be repaid from your settlement. Before you agree to any settlement for your job injury claim, understand what Medicare wants for past and future medical care.
How to Settle A Third-Party Claim and an L&I Claim
- 1. The worker is injured on the job by someone or something, not his/her employer or co-employee.
- 2. The worker files an L&I claim within one year of the injury or two years of the manifestation of the occupational disease.
- 3. The worker and his lawyer file a third-party claim before the statute of limitations runs. Filing the third-party claim tolls the statute of limitations and commences the lawsuit. Get a good lawyer to help with this.
- 4. Third Party Election Form from L&I should be completed and filed. The third-party election form is a formal notice you give to L&I on whether you believe you have a third-party claim. Even though L&I is asking, as a practical matter, you don’t have any choice whether you have a third-party claim. The facts decide that. For more information and a link, see Third Party Election Form. The third-party election form also designates who will be in charge of the third-party claim, you or L&I.
- Option A puts you in charge of your claim and its future. Option A is usually the wise choice.
- Option B gives up your right to take legal action. L&I takes over your third-party claim. Not usually a good choice
- 5. You win both claims and determine L&I’s subrogation and Medicare’s interest.
Third-Party Claim Value
- To calculate the value of a Third-Party claim, use the interactive worksheet formula. If your numbers aren’t set yet, you can make estimates. You can also request the L&I Third-Party section to calculate for you. You can also contact a lawyer to discuss claim value. This initial case consultation is free.
- Fault is an important concept.
- Third-party tort claims are negligence-based lawsuits, so the fault is very important. Not being at fault is a good thing. Having the person who hurt you being at fault is a good thing. To win a third-party claim, you must prove that the third party’s negligence (fault) contributed in some way to your injuries.
- L&I is a no-fault system, so you can file a claim and get a settlement without proving fault.
Are You Still Wondering about Third-Party Claims?
It’s easy to understand why. Third-party Claims are complex! Schedule a complimentary consultation—get help and make third-party claims understandable.
