Detailed Answer
Disclaimer: This article provides general information about Oklahoma law and does not constitute legal advice. Consult a qualified attorney for advice tailored to your situation.
If you suffer a workplace injury in Oklahoma and a third party is liable, you may pursue a personal injury claim while receiving workers’ compensation benefits. Oklahoma law requires you to coordinate these benefits to prevent double recovery.
1. Third-Party Liability and Insurer Reimbursement
Under Oklahoma Statutes Title 85A, Section 43 (85A O.S. § 43), if your workers’ compensation insurer paid benefits for an injury caused by a third party, you must reimburse the insurer from any recovery against that third party. The insurer’s lien typically covers:
- The total compensation paid for wage loss and disability benefits.
- Reasonable costs advanced by the insurer in pursuing the third-party claim.
2. Mandatory Notice Requirements
You must provide written notice to the workers’ compensation insurer and file a claim in the Workers’ Compensation Court within 30 days of filing your third-party lawsuit or reaching a settlement. Failing to notify on time can jeopardize the insurer’s lien rights.
3. Structuring the Settlement to Protect Non-Reimbursable Benefits
Work with your personal injury attorney to allocate settlement proceeds among:
- Reimbursable items: Medical expenses and wage-loss benefits paid by the insurer.
- Non-reimbursable items: Pain and suffering, mental anguish, and punitive damages.
- Future medical care: You may negotiate to spread future care payments over time to defer or reduce immediate reimbursement.
By clearly itemizing each category in the settlement agreement, you protect amounts for pain and suffering from the insurer’s lien. Remember, Oklahoma law caps reimbursement at the total benefits paid by the insurer.
4. Calculating Net Recovery
Oklahoma courts generally allow you to deduct reasonable attorney fees and litigation costs before calculating the insurer’s reimbursement. Confirm this net-recovery approach with your attorney to maximize your share.
5. Resolving Reimbursement Disputes
If you and the insurer disagree on the lien amount, you can petition the Workers’ Compensation Court to resolve the dispute. The court will review the benefits paid, costs advanced, and reasonableness of fees to determine the proper reimbursement amount.
Helpful Hints
- Send written notice to the workers’ comp insurer and file with the court within 30 days of your third-party action.
- Itemize settlement proceeds to separate reimbursable and non-reimbursable amounts.
- Negotiate payment of future medical costs over time.
- Deduct reasonable attorney fees and costs before calculating insurer reimbursement.
- Consider filing a pre-settlement lien clarification with the Workers’ Compensation Court.