It is not unusual for entities other than the workers’ compensation insurance carrier to pay medical expenses following a work-related accident. The most common payors are health insurance carriers, Medicare, and Medicaid. (PIP (a/k/a “No Fault”) insurance also pays if the accident involves motor vehicles, but since their rights are different than those of the other entities mentioned above for purposes of this blog, PIP will not be addressed in this blog.)
Since workers’ compensation is supposed to be the primary payor — PIP can add a wrinkle to this concept. See section 627.736(4), Florida Statutes — the other entities are entitled to reimbursement for the payments they have made. How the reimbursement is made depends on when, during the life of the workers’ compensation case, the payment is made. If it is made post-settlement, the payment is typically made as part of a negotiated agreement between the entities and the injured worker’s attorney. This is always the situation when the workers’ compensation employer/carrier denies responsibility for the accident and injuries throughout the entire case. Alternatively, when the carrier has accepted compensability of the claim it may agree as part of the negotiated workers’ compensation settlement to satisfy the liens. In this circumstance, hold harmless language should be included in the settlement agreement to protect the claimant in case the carrier fails to be proactive in resolving the liens and the entities come after the claimant for repayment.