Subrogation - Workers Comp Money Left On The Table
I have covered subrogation a few times in prior posts. I am bringing it up again due to our recent Workers Comp file reviews. One area that we have noticed a lack of training or knowledge in Workers Comp files is subrogation. One of our trucking clients had left $240,000 on the table due to the TPA not pursuing subrogation before the statutes tolled. Many of my readers will likely know the definition of subrogation. I will not use the classic definitions as they are confusing.
An example of subrogation is when a delivery driver is rear-ended in an auto accident while making his/her deliveries. He/she suffers injuries and files a Workers Comp claim for benefits. The driver of the other car is responsible for reimbursement of the benefits to the Workers Comp carrier. The Workers Comp carrier has the responsibility to protect their client's interests and to pursue subrogation. This is an easy example.
There are many instances that we find in files where the situation is more complicated, or the initial notice letter to the responsible party is sent, but then there is no follow-up. We also see where the subro check is received by the carrier, but is not properly credited to the file. This can cost an insured many times over as their E-Mod would be affected.
Why does this happen? I think it is that Workers Comp adjusters have such a hybrid job to do from a regular liability adjuster. How often does a liability adjuster have to make sure that an injured employee's weekly check made it to them? The volume of communications or mail is huge for a Workers Comp adjuster.
The bottom line is that they are so busy,it is just part of the file that cannot be tended to in their normal job duties. I have also noticed that liability adjusters receive a large amount of training in subrogation while the Workers Comp adjuster does not receive that much training in third party liability.
I think that I may have come upon a solution. Check back with me on the next post. I try not write posts that are too long as insurance is not the most exciting subject.
An example of subrogation is when a delivery driver is rear-ended in an auto accident while making his/her deliveries. He/she suffers injuries and files a Workers Comp claim for benefits. The driver of the other car is responsible for reimbursement of the benefits to the Workers Comp carrier. The Workers Comp carrier has the responsibility to protect their client's interests and to pursue subrogation. This is an easy example.
There are many instances that we find in files where the situation is more complicated, or the initial notice letter to the responsible party is sent, but then there is no follow-up. We also see where the subro check is received by the carrier, but is not properly credited to the file. This can cost an insured many times over as their E-Mod would be affected.
Why does this happen? I think it is that Workers Comp adjusters have such a hybrid job to do from a regular liability adjuster. How often does a liability adjuster have to make sure that an injured employee's weekly check made it to them? The volume of communications or mail is huge for a Workers Comp adjuster.
The bottom line is that they are so busy,it is just part of the file that cannot be tended to in their normal job duties. I have also noticed that liability adjusters receive a large amount of training in subrogation while the Workers Comp adjuster does not receive that much training in third party liability.
I think that I may have come upon a solution. Check back with me on the next post. I try not write posts that are too long as insurance is not the most exciting subject.
Labels: Subrogation Concerns
posted by James J Moore at 4:27 AM
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