No one wants to go through the lengthy process of litigation. If someone is filing a worker’s compensation claim through an employer, that injured employee arguably needs those benefits as soon as possible.
Going through the legal systems and taking the case through court will only prolong receiving those benefits. Is it worth it, or is it better to settle a workers’ compensation case out of court?
We have asked a legal expert, attorney Alaina Sullivan, about what you should do. Here is what she had to say:
Giving Up Weekly Benefits
One of the first questions that may come to an employee’s mind when it comes to settling a claim versus taking it to court is: “what will I lose?” A workers’ compensation attorney will be able to advise the client through what the pros and cons are for settling before the employee can make the best decision.
One benefit that the employee will lose by settling is that once the workers’ compensation claim is settled, he or she will not be able to receive weekly benefits for that injury. Essentially settling a workers’ compensation case closes that “part” of the total case.
Keeping Medical Payments
However, while the employee may lose his or her weekly benefits, that person may still be able to keep medical payments. Many states require that the insurance company keep paying medical benefits to the employee, even after settlement.
However, other states allow the insurance company to end the benefits. It depends on the state, as well as the terms of the agreement, as to whether the employee will continue receiving the medical benefits.
Keep in mind that the insurance company may still try to stop payments for medical benefits, even if the case is in a state where the medical benefits are supposed to continue, even after settlement.
It may pay to have the assistance of an attorney to keep things moving and to ensure that the benefits continue to be paid.
Settlement Must Be Approved
Before the settlement can go through, it must be approved by the state workers’ compensation agency. Once the attorneys and all sides agree, the proposed settlement must then be sent to the state workers’ compensation agency for official approval.
That agency will hold a hearing before a worker’s compensation judge who will review the settlement and approve if he or she is satisfied with the terms, that the employee understands and voluntarily agreed to the settlement terms and that the terms are in the best interest of the injured employee.
This “hearing” is not meant to delay proceedings but to make sure that the employee’s well-being is being protected. On occasion, the judge will reject the settlement if he or she believes that the employee was not treated fairly and did not receive a proper settlement.
How Are Workers’ Compensation Settlements Determined?
Unlike a personal injury claim, a workers’ compensation settlement is calculated based on:
- The amount of benefits he or she might be entitled to in the future; and
- The likelihood of receiving those benefits.
Future workers’ compensation benefits look at the medical evidence in the case in determining the level of disability for the employee. If the employee is determined to be on temporary total disability and doctors believe that this disability will be for two years, he or she may be entitled to two years of temporary total disability benefits.
If the attorney and insurance company try to get the employee to take anything less than that for a lump sum, this offer may raise some red flags as to how the employee is being treated unfairly.
Likelihood of Receiving Benefits
If the employee has a hearing upcoming and the insurance company believes that the employee can return to work before then, the benefits might be terminated. The employee would need to get medical testimony from his or her own doctor to go against the insurer’s doctor to state that the likelihood of returning to work that soon is not actually true.
Otherwise, an opinion like that would do nothing but hurt the employee’s chances of getting benefits in the future.
Permanent Total Disability
Matters can become complicated quickly if the employee is found to be on permanent disability. Permanent means forever, indefinite, correct? Does this mean that benefits can continue forever? It all depends.
The settlement would be valued by taking what the employee’s present value of his or her future entitlement to benefits would be. Present value determines the value of what a future stream of income would be if it were given all today in one lumpsum to be used for the next “x” number of years.
It is not an easy calculation to come to and may be debated between the employee and his or her insurance company. A workers’ compensation attorney would be best at advising the employee on what his or her chances would be at receiving the best outcome for a permanent total disability.
Contact an Attorney Today
If you have been involved in an accident during the normal course of business and are unsure about how to proceed with a workers’ compensation claim, it is highly recommended that you contact an attorney to answer your questions.
A licensed attorney trained in workers’ compensation law will be able to review your case and determine your best course of action. To receive the compensation you deserve, contact an attorney in your area today.