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How Are Workers Compensation Cases Settled?

by Clare Louise

Getting injured on the job can be quite stressful to deal with. You would need to deal with your injuries and worry about your lost hours as you recover. Unfortunately, work-related accidents in the U.S. are not an uncommon occurrence. In 2019 alone, approximately 5,333 workers died from work-related injuries.

In the U.S., employers are expected to carry worker’s compensation insurance to protect their employees from financial risks caused by workplace injury. It usually covers the following costs:

  • Attorney fees
  • Disability payments
  • Medical bills and ambulance rides
  • Surgery and future medical treatment
  • Lost wages and future wage loss

If you have been injured while you were at work, you must immediately file a worker’s compensation claim. Although filing one is relatively easy, settling one is more difficult. To successfully settle a worker’s compensation claim, you would need the help of experienced workers’ compensation lawyers.

Your worker’s compensation lawyer will be able to calculate the value of your claim and will properly explain the legal process to you.

Here are some basic things you need to understand when filing a worker’s compensation claim:

The Amount of Your Worker’s Compensation Claim Depends on the Following:

  • Injury
  • Type of work performed when the injury occurred
  • The risk associated with the job
  • State your business operates in

The insurance company will evaluate these factors and attempt to determine how much your claim will be worth. Of course, there will be some instances where the amount may not be as much as you expected it to be. In that case, you can ask your attorney if the amount the insurance company is offering you is fair or not. Your attorney will be able to calculate the value of your claim and negotiate with the insurance company on your behalf.

How Does a Worker’s Compensation Claim Process Work?

When an employee gets injured at work, it’s important that they immediately alert their employer. Otherwise, they may risk losing their benefits. Each state has different deadlines for filing a worker’s compensation injury claim, but it usually ranges from 72 hours to 2 years, depending on where you live. Regardless of where you’re from, it would help if you still informed your employer about your injuries immediately.

Here’s the process that employers and employees usually follow after a work-related injury:

  • Give the employee immediate medical attention.
  • Conducting a proper investigation of the accident.
  • Both the employee and the employer have the right to document what happened. As the employee, you can take pictures of the possible safety issues that caused the accident. You can also collect witness statements.
  • File a claim.
  • The injured worker usually does this step. They are responsible for filing their own worker’s compensation claim with their insurance provider. Once they filed a claim, the insurance company will either approve or deny it.

How Are Workers Compensation Cases Settled

Once a worker has fully recovered from their injuries and has gone back to work without any pending bills or unpaid benefits, the claim can be closed.

Generally, when closing a claim, a settlement between the insurer and the injured worker must be reached. This negotiation must be done with the help of an attorney. If both parties still have not agreed, then a judge will decide through a hearing.

The settlement process usually begins when the employer and insurance company offers the injured party a settlement amount. This amount must include payment for unpaid benefits, medical bills, and costs of future treatment. If the injured worker were permanently disabled due to a work-related accident, they would be entitled to a disability reward.

The injured worker can receive the payment through either a lump sum or a structured payment plan.

A lump-sum payment will let the employee receive the whole amount in one payment. The payment will include all the medical costs and benefits under the claim.

Meanwhile, through the structured payment, the injured employee will receive the settlement money over a specified period of time. This may include payment for future medical care.

Is It Smart to Accept a Worker’s Comp Settlement in Lump Sum?

Although a $40,000 lump sum may be hard to resist, you have to remember that this is a one-time payment, which means that you may be unable to seek any future reimbursement for the injury.

In the end, it is still up to the injured worker to decide. However, it’s always good to never settle for the first number the insurance company offers you. You must seek the advice of an experienced worker’s compensation lawyer first to ensure that the settlement amount will be fair to you.

Your worker’s compensation lawyer will serve as a helpful legal guide throughout the settlement process. Your role will be minimal as you are expected to focus on recovering from your injuries.

Your lawyer will calculate the costs and negotiate with the insurance company on your behalf until a compromise is reached.