The Benefit of Worker’s Compensation Insurance

Worker’s Compensation can be a great benefit to a worker who is injured while performing his or her job. In Pennsylvania, regardless of who was at fault for causing the injury, if you were injured while working, your employer is required to have Worker’s Compensation insurance to cover you.

Your Worker’s Compensation benefits will pay for your work-related injury medical expenses and will pay you roughly two thirds of your lost income up to certain statutory maximum rates.

The benefit of such a system is that if you suffer a serious injury and need extensive medical treatment and miss substantial time from work, your medical bills had lost wages will be covered.

The Worker’s Compensation system, however, does not provide injured workers with complete compensation. Although you receive medical bill payments and partial lost wage coverage, you are not reimbursed for all of your lost wages and you do not receive any compensation for any non-economic damages, like physical or emotional pain and suffering or the negative impact of the injuries on your life and activities.

Why You Should Also Consider a Third Party Lawsuit for Certain Work Accidents

Nevertheless, if the work accident was caused by someone other than the employee, the employer or a co-employee, then then you can consider filing a lawsuit for further compensation.

By way of example, if your job involves driving your car to visit clients and during the course of the workday you are involved in a car accident caused by somebody else, you could make a claim against that driver for compensation above and beyond what you are entitled to under Worker’s Compensation.  You could make a claim for for full reimbursement of any lost income as well as compensation for pain and suffering and the negative impact of the accident on your life and activities. Similarly, if you were involved in some other workplace accident that was caused by the negligence of someone other than your employee or a co-employee, like a slip and fall caused by the negligence of an independent contractor who was cleaning your workplace, you could likewise make a claim for full compensation.

The Catch With Pursuing a Lawsuit After Receiving Worker’s Compensation Benefits

There is a catch, however, when you receive Worker’s Compensation benefits and then choose to pursue a lawsuit arising out of the work accident.

Under Pennsylvania law, your Worker’s Compensation insurance carrier has a Lien on any recovery that you receive in your Personal Injury case. What that means is that the insurance company has the right to be reimbursed for any payments made on your behalf for medical bills or lost wages through the Worker’s Compensation system. So, if you receive compensation from your Personal Injury case, you have to pay back the Worker’s Compensation insurance company what it paid on your behalf in the Workers Compensation claim before you can receive any additional compensation from the lawsuit.

Mechanically what happens is that if you settle your lawsuit or receive a verdict at trial, then you have to report the resolution to your Worker’s Compensation insurance company and a strict formula is used to calculate the amount that you have to pay back to satisfy the Lien.

In my view, this Lien payback makes some sense, but it’s not entirely fair.

It makes sense that the Worker’s Compensation insurance company should be able to recover what it paid on your behalf because the third party caused the accident in the first place and it isn’t fair for you to receive double recovery, Worker’s Compensation benefits and lawsuit money. However, I do not think it is fair that the Worker’s Compensation insurance company is entitled to automatic full reimbursement based upon a rigid formula.

There are many cases in which you cannot recover full and fair compensation in a Personal Injury case, such as the case being risky so it is unwise to take it all the way to trial or the responsible party might not have enough insurance coverage to pay for all of the damages. In these cases, rather than being paid the entire Lien out of the lawsuit recovery, it seems more fair for the Worker’s Compensation insurance company to be reimbursed part of what they paid on your behalf, but for you to still receive some monies to make up for your pain and suffering in the negative impact of the injuries on your life and activities. Nevertheless, under Pennsylvania Law, the Worker’s Compensation Lien payback is absolute, automatically earmarking the money to be paid to the insurance company rather than to the injured person.

In certain circumstances, the Worker’s Compensation insurance company may agree to compromise or reduce its Lien in order to facilitate a settlement so that the injured party receive some money and the insurance carrier is reimbursed some money. This is a more equitable result compared to the insurance company receiving every dollar based upon a strict formula.

So, if you were injured at work in Pennsylvania and believe someone other than your employer or a co-employee is at fault, you should investigate your ability to pursue a lawsuit for compensation, but should also be aware of the Worker’s Compensation Lien that can impact the amount of money you may actually receive.

Tim Rayne is a Personal Injury Lawyer with the Chester County based full-service law firm MacElree Harvey.  For over 25 years, Tim has been helping accident victims understand their legal rights and the insurance claim process and has been fighting with insurance companies for fair compensation.  Tim handles a diverse mix of accident cases from Car, Truck, Motorcycle, Bicycle and Pedestrian Accidents, to Slip and Fall, Dog Bite and Medical Malpractice cases.  Tim has law offices in both Kennett Square and West Chester, Pennsylvania and also meets with clients at their homes or virtually via Zoom or FaceTime.  Tim offers Free Consultations regarding any Pennsylvania Injury Claim and can be reached at 6108400124 or [email protected]  For more educational information on Pennsylvania Personal Injury Claims, check out Tim Rayne’s website TimRayneLaw.com.  

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