Issues in Third-Party Injury Claims: Workers’ Compensation Liens & Credits

Issues in Third-Party Injury Claims: Workers’ Compensation Liens & Credits

工伤赔偿不能为受伤的工人提供足够的赔偿, particularly in cases involving serious injuries, lasting disability, and wrongful death.

Though workers’ comp is the exclusive remedy for injured workers in California, 在某些情况下,在其雇佣过程和范围内受伤的工人可以通过民事人身伤害索赔获得损害赔偿, in addition to benefits received from workers’ compensation.

同时获得工伤赔偿的工人的人身伤害诉讼被称为“第三方案件”.“这是由雇主以外的人造成的伤害. For instance, 一工人在执勤时驾驶车辆,因另一司机疏忽而引致事故者, 这名工人既有工人补偿索赔要求,又有针对另一名司机的“第三方诉讼”.

对于许多受伤的工人来说,两者兼顾在经济上都是有利的 workers’ compensation benefits and civil damages. 为有可行的第三方索赔要求的受伤工人辩护的律师必须意识到来自第三方案件的许多挑战——包括那些可能影响受害者康复的案件——以便最大限度地提高受伤工人最终获得的赔偿.

No Right to Double Recovery

California Labor Code § 3852 entitles employers (i.e. their workers’ compensation insurance carriers) to a reimbursement of benefits paid to or on behalf of workers (e.g. (医疗费用)从工人在第三方民事诉讼中获得的任何赔偿.

有许多类型的福利,可以支付给或代表一个受伤的工人通过工人补偿系统, including:

  • In wrongful death cases, death benefits and funeral / burial expenses
  • In all cases, hospital and medical expenses
  • In very serious injury cases, costs of a nurse case manager
  • 临时残疾津贴,在工人的医疗状况得到最大限度改善之前发放. 这些福利比雇员的工资要少得多,而且最多只支付两年.
  • Permanent disability benefits, 谁补偿受伤的工人被发现永久残疾的百分比, according to a formula. 员工福利永远不足以弥补未来失去的工资,也不足以弥补因员工受伤而造成的人类痛苦.
  • Vocational rehabilitation costs
  • 非常严重的伤害(70%或以上永久性残疾), 雇员有权享受因受伤而支付的终生医疗费用和养老金.

雇主留置工人补偿的前提很简单:受伤的工人没有获得双重补偿的权利.

How Employers Can Seek Reimbursement

受伤工人的雇主可以通过三种不同的方式,向第三方申领其已支付给工人的福利:

  1. The employer can file a lawsuit directly against third parties 它认为从事了导致工人受伤的过失行为.
  2. The employer can intervene in the injured worker's third-party claim. 这是雇主向第三方索取补偿的一种更常见的方式.
  3. The employer can chose 不直接参与第三方诉讼,而是 file a lien against the injured worker's recovery. 雇主通常只在他们认为自己没有切实可行的索赔要求时才会遵循这第三条途径, because when they only lien the worker's recovery, 他们没有参与或控制第三方诉讼.

The employer's right to reimbursement is not, however, absolute. 发包人对造成劳动者受伤事故负部分责任的, its right to reimbursement is reduced proportionately. So, (三)用人单位对造成事故负有三分之一责任的, 它只有权报销其支付给工人的福利的2/3.

Strategies for Dealing with the Employer’s Reimbursement Claim

提起第三方诉讼要求受伤工人的律师预见可能影响客户最终净恢复的潜在问题. 除了每个人身伤害案件中存在的责任和损害问题, 在第三方案件中,原告的律师必须制定策略,如何处理雇主的索赔要求,以最大限度地使受伤工人的净恢复. Though these are nuanced matters of law, 了解他们在第三方伤害案件中的作用是很重要的.

一般来说,原告(受伤的工人)和雇主的利益是相同的. Both want to prove the third party(ies) are liable; e.g., 是否有过失行为或其他错误行为导致工人受伤的事故.

一般来说,原告的十大电子游艺网站排行联系工人赔偿承运人,建议他们共同证明第三方被告的责任是一个很好的做法. 这可能包括共享事故调查和信息. Many times in significant injury cases, 如雇主已支付可观的工人补偿福利, 他们的保险公司将同意分担第三方案件的费用.

Of course, 以便让工人补偿承运人与原告合作, 任何一项协议都需要事先就工人补偿承运人将从和解中偿还多少达成一个协议, 或者至少是原告律师的承诺,如果雇主与原告合作, 雇主(通常指其保险公司)在解决问题时将受到公平对待.

Agreements between the employer and the plaintiff are, for the most part, only important when the case is settled. If the case goes to trial and the defendant is found liable, there are complicated rules for how the employer is reimbursed. 简单地说,如果判决足够大,雇主可以得到补偿. If, however, 雇主从事的疏忽行为导致了事故的发生, that would proportionately reduce the employer's recovery.

在结算中,处理雇主留置权的方法有很多种:

  • The third-party defendant can make a global settlement offer (e.g., 处理所有索赔),原告和雇主可以就是否接受报价以及如何分配达成一致.
  • The third-party defendant can choose to settle only with the injured worker and leave the workers’ compensation insurer to fend for itself. 因为很多时候雇主并没有积极参与第三方诉讼, 雇主可能无法证明其负有责任,因此第三方被告将不必赔偿. Generally, 如果工人补偿保险公司与原告律师合作, the plaintiff would not leave the employer in this position.
  • The third-party defendant can choose to settle directly with the employer, often buying the lien for pennies on the dollar, 然后要求抵消原告的全部留置权. Again, if the employer and plaintiff have been cooperating, 雇主一般不会让原告这样任其自生自灭. Indeed, 原告律师的一个好策略是预先达成协议,工人补偿保险公司将不出售留置权给第三方被告.

Sometimes, 工伤赔偿案件在当事人试图解决第三方案件之前尚未定案. This raises an entirely different set of considerations.

工伤赔偿案件尚未解决的情况有两种. 第一个是永久性残疾问题还没有诉讼的地方. 第二种情况是,永久性残疾已被提起诉讼,而工人赔偿法官已发出裁决和裁决(“F&A"), 但雇主选择继续支付奖金中要求的增量付款, 而不是根据目前的总支付价值一次性支付.

以下是未解决的工伤赔偿案件通过第三方案件处理的方式:

  • In a case that is unsettled (no F&A), 受伤劳动者与用人单位可以约定一次性解决,作为第三方解决的条件. This requires processing a Compromise & Release ("C&R”)文件,并获得工人补偿法官的同意. 第三方和解直到获得批准才算完成.
  • Where there has already been an F&A made in the workers’ compensation case, 工人和雇主可以同意一次性解决未来的支付金额代表当前的价值. That settlement would also require a third-party C&R.
  • In the case of an already issued F&A,劳动者赔偿承运人可以选择不处理赔偿案件. Instead, 雇主的留置权将按上述讨论解决,雇主将有义务继续付清F&A. However, 雇主将获得与该工人从第三方案件中获得的净赔偿金额相等的信用额. 同样,这是为了防止工人进行二次回收.

然而,在一个案例中,F&第三方案件解决后,A仍在支付中. If the employer is found to have been negligent, 然后,它不能利用信用,直到它支付的工人补偿福利等于其过错适用于第三方案例的全部价值的百分比.

Here is an example of how it would work:

The injured worker has been paid $200,(三)在第三方案件解决前,应向劳动者支付3万美元的劳动报酬. The worker has an F&A要求雇主再支付50万美元的增量支付. The third-party case is worth a total of $4 million. The third-party defendant has admitted fault. But, the employer's negligence was 25% of the cause of the accident, 将第三方被告的责任按比例减少到300万美元, which it offers to globally resolve the case.

双方同意工人赔偿承运人将获得150美元,000 in satisfaction of its $200,000 reimbursement lien for benefits already paid; the 25% reduction because of the employer's negligence. 在费用和费用被进一步从员工的解决份额中扣除后($2,850,000), the employee recovers $1.6 million; more than enough to cover the employer's obligated future worker's compensation credits.

However, the employer does not get to use the credit until it has paid benefits equal to the amount the worker lost on the third-party case because of the employer's negligence; in this case $1 million (25% of the total value of $4 million). Since the employer has only paid $200,000 in benefits so far, 它必须先多付800美元才能申请贷记,000 in workers’ compensation benefits.

In this example, since the employer only owes another $500,000 in benefits, 除非发生什么事情增加了工人享有的福利, 雇主永远也达不到可以利用信用的门槛.

当涉及到在代位权谈判中驳倒留置权或在第三方和解谈判中获得影响力时,战略准备和合理的论点可以大有帮助. 只有在处理第三方案件方面经验丰富的律师才能充分了解案情的来龙入海,从而制定策略,使受害的原告获得最大程度的恢复.

Biren Law Group在涉及严重伤害的民事诉讼中一直是受害者的代理律师, workplace accidents, and construction accidents for decades. 我们屡获殊荣的律师明白两者之间复杂的相互作用 third-party actions and workers’ compensation, 并与受害者和律师谈论潜在的索赔以及我们如何提供帮助.

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