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 who is not your employer or a co-employee. For example:
- A working delivery driver who is rear ended on the highway, by someone who is 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 both 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 good because one injury = 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 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, with the same set of facts. These two claims will affect each other in very important ways.
- A third-party settlement will affect 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 just ruin your L&I claim.
- 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.
- An L&I claim can be minimized and oppressed by L&I or the self-insured and thereby severely limit the third party recovery. Don’t let this happen.
- Working to fully develop the L&I claim can be very helpful to the third party claim and the bottom line.
How to Settle Both Claims
- Worker is injured on the job by someone or something not his/her employer or co-employee.
- The worker files an L&I claim
- The worker and his lawyer file a third party claim. Filing the third party claim tolls the statute of limitations and commences the lawsuit. Get a good lawyer to help with this.
- You win both and work out L&I’s subrogation.
- Third Party Election Form – L&I. The third party election form is a formal notice given by you to L&I on the subject of whether or not 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 to the form see Third Party Election Form. The third party election form also serves to designate 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 smart choice
- Option B you give up your right to take legal action. L&I takes over your third party claim. Not usually the good choice
Third-Party Claim Value
- To figure out 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 do the calculation for you. You can also call us to discuss claim value.
- L&I is a no fault system
- Third party claims are negligence based lawsuits, so 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.
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