Case Study: Workers Compensation and Subrogation Explained

Handling workers compensation claims is no easy task. Some cases are very complicated, as well as very expensive. And every state’s laws regarding the payment of workers compensation claims is different. To add to that challenge, each state’s laws also differ somewhat as to how an insurance company may recoup some or all of the benefits paid. It is sometimes possible to recover money through the process of subrogation when the work-related injury was the fault of an independent responsible third party. In cases where an employee is injured by a third party and the insurance company pays workers compensation benefits as a result, the insurance company (in many states) has an opportunity to assume that injured party’s right to make a liability claim against the responsible third party. So, in these cases the claims adjuster has to switch hats. They essentially go from a workers compensation claims adjuster to a liability claimant.

Subrogation: Assuming the legal rights of a person for whom expenses or a debt has been paid. Subrogation occurs when an insurance company which pays its insured customer for injuries and losses then legally pursues a third party which caused the damages.

Situation

A Society Insurance senior claims adjuster received notice of an incident in Illinois. An employee of a business insured by Society Insurance was involved in a motor vehicle accident while in the course of his work on Aug. 31, 2012.

This employee sustained injuries to multiple parts of his body, including his back. After almost six months of treatment, he required back surgery where vertebrae in his lower back were fused together. This employee submitted a claim for these medical costs, an extended period of disability, as well as permanent impairment.

Get full details on the Society Insurance solution in this case study or download a pdf here.

Society’s experienced claims adjusters work hard to investigate the details of claims in the pursuit of the best possible outcome for everyone involved. Looking at all the angles of subrogation and recognizing the factors that may provide an opportunity for a successful liability claim makes a big difference. To find out how Society can help your business, visit societyinsurance.com to find an agent and request a free quote.

Author

As a mutual insurance company, we operate and exist for the benefit of our policyholders. For more than 100 years, Society has been helping businesses overcome the unexpected with comprehensive coverage packages and outstanding claims handling, underwriting and risk management.

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