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Why Would You Have to Pay Back Workers’ Comp Benefits?

Published June 17, 2024 by Matt Fendon Law Group | Workers' Compensation

Workers’ compensation benefits in Arizona are based on the principle of fairness: If you have been hurt on the job and qualify for workers’ compensation, you are entitled to receive fair compensation for your recovery costs, like medical expenses and lost wages.

Employers and workers’ compensation insurance companies also seek fairness in benefit claims, mainly by not paying too much. The insurance company may seek to recover what it overpaid or they may seek to get their money back if a third party (someone that does not work for your employer) caused the injury. 

If a workers’ compensation insurer has told you that you must repay benefits you have received, then call the Matt Fendon Law Group at (800) 229-3880. We can help ensure you receive all the worker’s comp benefits you need as an injured employee, even when the insurance company challenges your claim.

List of reasons an employee would have to pay back workers compensation.

Unjust Enrichment in Workers’ Compensation

Unjust enrichment is a legal term used to describe when a person receives two of something when entitled to only one. In workers’ compensation, an unjust enrichment situation can happen if you are compensated twice for the same work injury or illness.

A double-compensation case can arise when a third party other than your employer is at least partly responsible for your work injuries.

Examples of Unjust Enrichment in Arizona Workers’ Compensation

Challenges to receiving workers’ compensation benefits as a form of unjust enrichment can happen in several ways.

Insurer Subrogation of Double Recovery From a Judgment Award or Settlement

If you were driving on company business and another driver collided with you, the other driver may be liable to you for the medical treatment expenses. At the same time, because your accident happened to you as an employee, your work-related injuries also qualify you to receive workers’ compensation benefits.

In this example, you can sue the other driver in a personal injury claim under Arizona law. You can seek from the defendant driver many of the same types of compensation that injured workers seek in workers’ compensation claims, like medical treatment costs and lost wages.

Civil actions like a personal injury claim will typically settle out of court. What you receive in your settlement or judgment award in a personal injury lawsuit against the other driver will pay for your injuries and include monetary damages to compensate you for your lost future earning capacity.

Suppose your workers’ compensation claim includes payments for the same things your lawsuit judgment paid for. In that case, the workers’ comp insurance company may consider you as the beneficiary of unjust enrichment through double recovery.

Insurance Company Subrogation Rights to Workers’ Compensation Claims

As is the case with most states, “subrogation” is the term that Arizona law uses to describe the right of the workers’ compensation insurer to take over your claims against third parties. This includes the extent that recovery amounts from the lawsuit go to pay back workers’ comp benefits.

Under Arizona law, you have one year from the date of injury to commence a third-party lawsuit for a third-party workers’ compensation personal injury claim and to notify the workers’ compensation insurer of your intent to file suit.

If you do not act within that period, your claim for work-related injury against the third party passes to the workers’ comp insurer.

Also, after you reach a settlement agreement in a third-party lawsuit against a third party for a personal injury claim, Arizona subrogation law requires you to get written approval from the workers’ compensation insurance company. The insurance carrier may be entitled to a workers’ compensation lien on the settlement against settlement amounts that workers’ compensation would otherwise pay. The workers compensation insurance carrier also may seek to apply a future credit, which is essentially the amount you receive from settling your personal injury case after all fees and liens are paid.

Double Billing Private Insurance and Workers’ Compensation

There may be times that you need to seek medical treatment that another health insurer covers under its benefits plan.

If a health insurance company pays a workers’ compensation related bill, the health insurance is going to want its money back. 

In a worst-case situation, the insurer may even accuse a double recovery beneficiary who makes multiple claims for the same injury or illness of fraud.

Reimbursement of Temporary Disability Benefits

If you have received payments for temporary disability benefits and then return to your regular job duties at work, then you might need to repay some or all of those benefits.

Paying Back Workers’ Compensation Benefits

If you are overpaid workers’ compensation benefits because you went back to work and were not entitled to further compensation, the workers’ compensation insurance carrier will usually apply a credit against any future compensation. It is important to pay close attention to Notices of Claim Status issued by the workers’ compensation carrier that allege these overpayment credits, because you only have 90 days to appeal these. 

Talk to a Phoenix Workers’ Compensation Lawyer Today

If a workers’ compensation insurance company is coming after you to repay benefits, call the Matt Fendon Law Group first. Our skilled and compassionate workers’ compensation lawyers can help you with all aspects of your workers’ compensation claim, including challenges to your benefit amounts or demands for repayment. 

We can help you:

  • Understand what is happening. Negotiating with workers’ compensation insurers can be stressful and complicated, even when they are not demanding money back from you. It’s critical that you have an experienced Arizona workers’ comp lawyer on your side.
  • Receive the compensation you deserve. While you recover from your work injury, workers’ compensation benefits pay a portion of your lost wages and medical bills. Our attorneys will fight to get you the benefits you need and deserve, including payment for your related legal fees.
  • Represent you at hearings. A hearing before an administrative law judge could be required. When that is the case, our attorneys will represent you and argue on your behalf.
  • Handle your appeal. If your workers’ compensation claim is denied, our experienced workers’ compensation lawyers can help you to put together the strongest argument on your behalf within the tight 90-day appeal deadline.

Call us today at (800) 229-3880 to schedule a confidential, free consultation with an experienced workers’ compensation lawyer in Phoenix. Or, if you prefer, you can contact us online to ask a question or to schedule a free consultation.

We have offices in Phoenix, Prescott, Flagstaff, Scottsdale, and Tucson. Let us show you how we can help you receive benefits for your Phoenix workers’ comp claim. We will provide straightforward advice and help you understand your legal options.Visit the best workers’ compensation law firm near you.

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