WHICH WORKERS’ COMPENSATION “BENEFITS” CAN BE SUBROGATED? Recovery of Case Management Costs, Medical Bill Audit fees, Rehabilitation Benefits, Utilization Review Costs, IME’s, Nurse Case Worker Fees, Attorneys’ Fees, and Other “Allocated” Loss Adjustment Expenses

It’s the question every claims professional and trial attorney claims to know but few fully understand. In addition to paying for medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, independent…

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Texas

TEXAS COURT MAKES IT EASIER FOR WORKERS’ COMPENSATION CARRIER TO SETTLE DIRECTLY WITH THE TORTFEASOR AND AVOID PAYING ATTORNEYS’ FEES TO THE EMPLOYEE Sentry Casualty Company v. Bravin, 2024 WL 3083299 (Tex. App. 2024).

A new Texas Court of Appeals decision has clarified the process by which a workers’ compensation carrier can settle directly with a third-party tortfeasor and thereby avoid having to reduce its lien by a pro rata share of the employee’s attorneys’ fees. Meanwhile, the process of “selling your lien” has never been less complicated and…

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“MY INSURED’S BRAKES FAILED!”: The Oldest and Newest Excuse in Denying Auto Liability Claims

If you are a subrogation professional sending out demand letters and attempting to recover property damage, medical payments, or PIP benefits from a tortfeasor who is obviously at fault in an automobile collision, your worldview is one in which 50% of vehicle brakes in America are seemingly defective. It isn’t possible to go a week,…

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COLORADO SUPREME COURT DENIES DOCTOR’S EFFORTS TO REDUCE DAMAGES UNDER COLLATERAL SOURCE RULE Scholle v. Ehrichs, 2024 WL 1710169 (Colo. 2024)

An April 22, 2024 decision by the Colorado Supreme Court considered the confusing interplay between Colorado’s statutory Collateral Source Rule and medical malpractice actions under the Health Care Availability Act (HCAA).[1] Specifically, the Court addressed the question of whether the “contract exception” to the collateral source statute applies in a medical malpractice case where the…

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HOW TO SUE YOURSELF AND WIN: Nuances of Subrogating Workers’ Compensation Death Claims

The American horror film “Split”, directed by M. Night Shyamalan, is a psychological thriller which centers on a bizarre antagonist with 23 separate personalities. Without spoiling the plot, suffice it to say that it focuses on the fact that there is something to the adage “mind over matter.” They say that life imitates art. If…

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Lease

Pennsylvania Appellate Court Says Silent Lease Means Tenant Is Not Considered A Coinsured And Carrier Can Subrogate

The law in Pennsylvania regarding the ability of a landlord’s property insurer to subrogate against a tenant whose negligence causes damage to the landlord’s building has been very slow to develop. But they are quickly making up for lost time. Until recently, Pennsylvania had only one case speaking to this issue. In 1990, the Pennsylvania…

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