Legal Question in Workers Comp in California
Reimbursement of attorney and medical fees
Question: If IW prosecutes Civil Case on his own and wins. Than pays all attorney fees, pays 100% of lien to satisfy IW Private Health Insurance Co, who treats for injuries sustained in auto accident. Can IW recover 50% of the paid attorney fees plus 50% attorney�s out of pocket expenses and 50% of IW Private Health Insurance lien claimed for medical rendered at time of auto accident when 3rd party accident is found to be Industrial in origin.
Neck injured in original Industrial accident but apportioned 50% to Industrial and 50% to Auto Accident with no clear proof. Insurance Carrier in Industrial Accident steps it and gets $21,000 credit against benifits towards IW future Medical and Disibility
Auto accident with General Damages to IW in excess of $500,000 but IW has to settle for the policy limits of $50,000.
Which only covered IW for Slight Pain & Suffering. And would not cover him for future medical
Auto accident was a compensable consequence of the original industrial injury because IW was in route to chiro appointment.
Lains vs. WCAB
1 Answer from Attorneys
Re: Reimbursement of attorney and medical fees
Your fact situation is incomplete and complex. You need to discuss this with an attorney that handles workers compensation and third party claims and medical liens.
Generally you need to know that if you are within five years of your original date of injury, you may be able to petition for new and further disability if injured while on the way to get medical care for the original injury.
You also need to know that some medical liens are improperly asserted and some may be reduced because of limited insurance and some may only have to be reduced by a prorata share of fees and costs.
The workers compensation carrier should be liable for all of the medical costs, in which case there would be no medical lien except by the workers compensation carrier. Their participation in the third party case may affect any reduction for fees and costs.
What you have learned is that many injured people are not made whole. You have also learned that many insurance companies are in a position to get their money they agreed to pay, paid back even though premiums have been paid for years to get the benefits of the insurance.
INSURANCE COMPANIES DO NOT PROTECT THE INDIVIDUAL FOR THE INDIVIDUAL'S BENEFIT. INSURANCE COMPANIES WILL DO WHATEVER WE LET THEM DO TO MAKE AS BIG A PROFIT AS THEY CAN. INSURANCE COMPANIES ARE DRIVEN BY PROFIT FIRST.
INSURANCE COMPANIES WILL TRY TO CHANGE THE LAW TO MAKE THEIR PROFIT MORE SECURE. WE CANNOT TRUST INSURANCE COMPANIES.
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