Insurance Dispute Lawyer Blog
When you are injured on the job, it’s not always your employer’s or fellow employee’s fault. If you are injured while working by a third party, there are rules to follow when settling your claims. Following those guidelines is important because if you don’t, you may alter the workers’ compensation benefits owed to you.
Below is a story of one worker’s workplace injury and his path to physical and financial recovery. This case shows the importance of getting authorization from your workers’ compensation carrier before settling with third parties. It also helps answers the question; When does the date of disability start for a workers’ compensation claim?
While driving at work in early August 2012, Clyde Tolley was injured in a car accident. He continued to work until he was fired. Tolley then moved to Florida, where his injuries worsened. Tolley consulted a Florida doctor who recommended seeing an orthopedic specialist. Unfortunately, Tolley waited a year before engaging with the specialist.
In November 2013, Tolley entered into a settlement with the driver of the car who injured him. However, it appears Tolley did not get authorization from his workers’ compensation insurance before accepting the settlement. When such a settlement occurs, the court deems the settlement an “unauthorized settlement.”
An unauthorized settlement is one that is not pre-approved by a disabled person’s employer before acceptance; by accepting this unauthorized settlement, Clyde was forced to forfeit part of his disability payout, which he is required to pay back to the insurance company. Tolley initially brought his case to the office of worker’s compensation, where most of his claims were denied. However, after two retrials, Tolley moved on to the Court of Appeal Fourth Circuit in hopes of overturning the workers’ compensation judge’s rulings against him.
First, Tolley argued the date of disability was incorrectly determined at the trial court. The argument brought up the question; When does your date of disability start?
The date the disability develops is usually determined as the time when it becomes clear the worker can no longer satisfactorily perform their employment duties. Seven v. Schwegmann Giant Supermarkets, Inc. For disability for workplace accidents, a party must have a doctor find that they are, in fact, disabled and that disability resulted from their workplace accident. After an individual is considered occupationally disabled by a medical professional, they are usually entitled to receive disability payments from their employer’s insurance. This date will be calculated from the date of their diagnoses to the date of their recovery or other payment-ending circumstance, such as accepting a non-approved settlement.
When did Tolley’s disability date start? Tolley was fired from his occupation for unsatisfactory performance due to factors other than his disability. Tolley was designated as “non-occupationally disabled on August 22, 2012, which means he was disabled for reasons other than his workplace accident. Tolley didn’t receive treatment until July 10, 2013, when a doctor found him disabled and attributed that disability to his workplace accident. The court of appeals found the district court did not err when determining Tolley is to be considered disabled as of July 10, 2013, because Tolley failed to prove he was disabled due to his workplace injury before the July date.
Once the court determined when Tolley was disabled, they considered what benefits he was entitled to and for what duration. The appeals court awarded damages from July until Tolley accepted the unapproved settlement. But, Tolley was required to pay his entire unauthorized settlement, less attorney’s fees, back to the insurance company.
Usually, when you have a disability payment scheme, you cannot settle with outside sources without prior approval from your employer’s insurance provider. Louisiana Revised statute 23:1102(B) states that if an employer failed to receive approval from his employer before settlement with the third party, they owe money back to their employer’s insurance in a “dollar-for-dollar credit for future medical expenses equal to the settlement, less attorney’s fees. Mercer v. Nabors Drilling USA, L.P.
By accepting an unapproved third-party settlement, Tolley lost out on future medical expenses from his employer’s insurance. However, he could still recoup the costs of his disability before he accepted the unauthorized settlement.
Personal injuries while on the job present challenges to daily life. These challenges manifest themselves as both physical and financial hurdles to get over. Disability payment insurance provides a means to alleviate the financial woes of a workplace injury, but obtaining these payouts can take years and multiple court dates. While a one-time settlement may seem like a good deal and a quick payout for your lawyer, it is sometimes worth fighting the good fight in the courts to get the just compensation you deserve. Dedicated lawyers with experience in workplace injury disputes can help you fight to get what you deserve.
Additional Sources: CLYDE TOLLEY VERSUS JAMES CONSTRUCTION GROUP, LLC
Written By Berniard Law Firm Writer: Ethan W. Seitz
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