It’s rare that you must pay back your workers’ compensation benefits. In most instances, if the insurance company feels you have broken any of their rules for receiving compensation, they will simply deny your claim or stop your payments. This isn’t always the case, so let’s examine 3 reasons you’d have to pay back your workers’ comp benefits to the insurance company.
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When Would You Have to Pay Back Workers’ Compensation Benefits?
Pennsylvania workers’ compensation insurance providers are like any other insurance company: they are always on the lookout for fraud. Although they claim to benefit the employees, the truth is they want to protect their bottom line first. Because they are constantly verifying claims and bills you submit, they usually catch any issues that might be worthy of denial.
In some cases, they may pay you but change their mind later. Here are three situations when you may receive benefits but then have to pay them back to your workers’ comp insurance company:
1 – You Tried to Double Bill Workers’ Comp and Private Insurance
Workers’ compensation covers all medical expenses related to any injuries you suffer while on the job. It can take time to get approval from the worker’s comp insurance company. To get treated faster, you may decide to bill the costs to your private insurance instead.
If you then submit your doctor bills to worker’s comp in an effort to get paid a second time, you may be accused of insurance fraud, which is illegal in Pennsylvania. Not only will the workers’ comp company deny your benefits, but they’ll also demand you refund previous payments by filing a lawsuit against you. They may even report you to the authorities.
The best action is to hire a worker’s compensation attorney to help speed your claim along so you get your benefits quickly. Even if you are honest about using a private insurance provider, your workers’ comp company may claim your injuries do not qualify to avoid paying what you deserve.
2 – You Contributed to Your Accident
Workers’ compensation covers injuries you suffer on the job, but there are exceptions. If you contribute to your accident by being intoxicated, violating safety rules, or being involved in a fight, you could be denied benefits.
If the insurance company discovers that you are ineligible after you have already been receiving payments, they are likely to cut off your benefits and demand you give back what you’ve already received.
3 – You Settled a Third-Party Lawsuit That Fully Covered Your Damages
It’s common for those hurt at work to file for workers’ comp benefits and to initiate a lawsuit against any third parties who caused or contributed to their injury. For example, if you were in a car accident as a traveling supervisor for construction sites, you can receive workers’ comp and file a personal injury claim against the person who crashed into your car.
However, if you win your lawsuit and receive a settlement for all your damages, your workers’ comp company may ask you to pay back some or all of the medical bills and benefits they gave you. Whether you must do this or not depends on the specifics of your situation, so it’s in your best interest to speak with a highly skilled and experienced Pennsylvania workers’ compensation lawyer. They can examine your circumstances and advise you on how you should proceed.
Don’t Take Chances With Workers’ Compensation
Workers’ comp is meant to help you out when you’re hurt, but insurance companies are ruthless when it comes to getting back money if possible. You need a skilled attorney to guide you through the process and provide experienced legal representation.
Don’t risk having to pay back workers’ compensation benefits after a lawsuit or when something goes wrong. Schedule a free consultation with the team at Krasno Krasno & Onwudinjo to learn more about your options today.