Workers’ compensation benefits must be provided no matter who was at fault for the job-related accident. An injured employee can bring a claim for more medical coverage and disability benefits, even if the employer did nothing wrong. That being said, it is important for insurers, claims administrators, and employers to determine exactly how an accident occurred.
In some cases, workplace injuries occur because of the negligence of a third party. In this context, a third party means any party other than the employer. A third party’s liability may give the employer or their insurance carrier a path to obtaining a reimbursement through a principle called ‘subrogation’. Below, our Fresno workers’ compensation defense attorneys provide a more detailed overview of subrogation and California work injury claims.
Subrogation and Workers’ Compensation: The Basics
As a general rule, workers’ compensation insurance allows immediate benefits to be paid to the claimant. Through subrogation, some of those costs may be recouped. Simply defined, subrogation is the legal right to pursue legal action against a third party for reimbursement of insurance loss. In California, Sections 3850 through 3865 of the Labor Code govern workers’ compensation related subrogation claims.
The key thing to know about state law is that insurance carriers/employers are only permitted to bring a subrogation claim for a share of benefits out for a reason other than the employer’s negligence. In other words, there must be a responsible third party to bring a subrogation claim against.
Workers’ Compensation and Subrogation: The Importance of Immediate Investigation
Handling workers’ compensation claims is complicated. It is crucial that insurers, claims administrators, and employers are able to identify potential recovery through subrogation as early in the process as possible. Otherwise, important evidence or information could be lost and a successful subrogation claim may no longer be an option.
A comprehensive investigation is often required into exactly how and why a job-related injury occurred. An insurer/employer has subrogation potential if any party other than the employer, fellow employees, or the company’s product was responsible for the accident. Some notable examples of workers’ compensation cases in which subrogation may become an issue include:
- Motor vehicle accidents;
- Accidents occurring on another company’s premises;
- Defective machinery or other industrial products; and
- Repair and maintenance problems.
In reviewing a workplace accident, an insurer or claims administrator may want to consider medical records, initial employee reports of injury, and witness statements. If there is evidence of possible third-party liability, an immediate follow up investigation is required. Due to the inherent challenges of bringing a subrogation claim, compelling supporting evidence is needed.
At Yrulegui & Roberts, our California workers’ compensation defense attorneys have deep experience handling complex subrogation claims. If you have questions about subrogation and workers’ compensation insurance, we are prepared to help. To request your completely confidential consultation, please contact us at (559) 222-0660. With office locations in Fresno, Bakersfield, and Sacramento, we are well-positioned to serve insurers and employers throughout the wider region.