Category: Workers Compensation

What Does It Mean To “Settle” A Workers’ Compensation Case?

Few things throw a wrench into your life quite the way becoming seriously injured at work can. Whether you’re the sole breadwinner for your household or you share that burden with someone else, the vast majority of workers aren’t in a position to simply go without income until they recover. Workers’ compensation can help make up for the loss of income, but at some point there’s a good chance that you’ll be asked to “settle” your case. Thus, it’s important to have an understanding of what it means to settle.

What It Means to “Settle”

If you are unable to work, upon approval, , you begin to receive periodic payments based on what you had been earning. The insurance company or employer would also likely cover your medical injury-related expenses. Don’t let the payments you’re receiving fool you though. Insurance companies are in the business of making money, not handing it out. If there’s a way to stop paying you for time off work, they will find it.. Settling the claim is one way to do that. It means that you’ll receive a lump sum of money and the claim will be closed. The insurance company or employer won’t have to pay for ongoing time off work or, depending on the settlement language, for ongoing medical expenses.

Immediate Consequences

The immediate consequences of settling are as previously stated: you receive a settlement check, your claim is closed, and that is the end of the money you’ll be receiving, unless the details of your settlement indicate otherwise. Under some circumstances, the insurance company may attempt to recover the money they spent on your benefits from third-parties that contributed to the accident. This is called subrogation and may impact the amount you retain from the settlements of those other claims. Even though settlements are often made after your doctors determine whether you are able to return to work, the settlement has little to no bearing on when or how you return to work. That is between you and your employer.

Long-Term Consequences

In the case of some injuries, you may experience flare-ups, or your condition may worsen to the extent that you require additional medical care. This is where the details of your settlement become a critical factor. You may be entitled to having additional medical expenses covered if they are due to your injury, but that isn’t always the case. Because of this, it is absolutely critical that you carefully consider what care you are likely to need in the future because of your injury and factor that into the settlement you feel you should be receiving.

Your Responsibility

At the end of the day, you need to make the best decision for yourself. That can be tough, when you consider all the details involved in navigating a workers’ compensation claim and the fact that the insurance company absolutely has a lawyer working on their behalf. Your responsibility is first and foremost to yourself and making sure you obtain the best outcome for yourself. You need to take into account what your medical expenses have been, are likely to be in the future, and the wages you’ve lost as a result of your injury. All of that should have a role to play in the settlement amount. It may be tempting to take the first settlement you are offered, but it may not be a fair offer. It’s best to consult an attorney before accepting any settlement, regardless of whether or not you had one up to this point. 

Finding a good attorney for your case can be a challenge, but worth the time you’ll invest to do so. A good attorney can help you figure out what medical expenses you could reasonably expect to encounter in the future. Based on that, and other pertinent information, they can argue on your behalf to reach a fair settlement that gets you the money you are entitled to. If you sue more than one entity and the workers’ compensation insurance company is entitled to some or all of their money back, your attorney can help you navigate that too. 

Keep in mind that if you want to get temporary or permanent disability for time off work in the future as a result of your injury, you’ll need to reopen your case with the insurance company. It’s a good idea to familiarize yourself with your state’s restrictions and time limits regarding the reopening of a case.

The Insurance Company’s Responsibility

The insurance company has the responsibility to pay out the settlement to you, subtracting whatever your lawyer is due and paying that to them directly. Their responsibilities beyond that are dictated by state laws and the wording of your settlement agreement. Some states require ongoing medical coverage for care received because of the injury, while others don’t. If your agreement stipulates it, you can be reimbursed for such expenses. It’s your responsibility to submit the bill, though, at which point it becomes the insurance company’s responsibility to reimburse you.

People don’t plan to get injured on the job, but it does happen. If you’re receiving workers’ compensation as a result of a work injury, you’ll likely be approached about settling your case at some point. Make sure you know what it means to settle your case, the consequences of doing so, and what each party’s responsibility is going forward. This will help you make the best decision for yourself about whether or not you should agree to settle.

What Does Workers’ Compensation Cover?

Workers’ compensation can seem like the most elusive form of insurance. How does it work? What does it actually cover? And how does the claims process work? This article will go into each of these questions to help you better understand workers’ compensation.

What is Workers’ Compensation?

Workers’ compensation is a form of insurance that provides wage replacement and compensation for medical bills in the case that an employee is injured during the course of their employment. This form of insurance not only protects the worker, but it also protects the employer.

While this insurance assures workers that they will be properly cared for in the case of injury, they are also required to waive the right to sue their employer. What does this mean? Basically, when workers waive the right to sue their employer, they waive the possibility of being awarded a potentially larger sum than they could receive otherwise.

However, the employer in turn waives the employees burden of proving the employer was at fault.. For the employer, waiving the employee’s right to sue ensures that they will not have to deal with costly and painful lawsuits. Practically all states in the United States require employers to have some form of workers’ compensation.

What Does It Cover?

While every state has different laws governing to what extent workers’ compensation is required to cover employees, there are some general guidelines. Typically, workers’ compensation will cover medical expenses, lost wages, and funeral costs. 

When it comes to medical expenses, employers are usually required to reimburse you for any ER visits, check-ups, prescriptions, or surgeries that are directly resulting from the work-related accident. Once the employer accepts the claim they will generally pay for medical services directly.

In situations where the injury is more enduring, workers’ compensation will also give you more enduring reimbursement. For example, if a construction worker fell from a roof and broke his neck resulting in paralysis and the need for in-home care, workers’ compensation would likely cover the ongoing cost.

In addition to covering medical expenses, workers’ compensation also covers lost wages due to time away from work. The way this compensation works varies by situation. But generally, workers’ compensation ensures that you will receive a fair wage for necessary time off to recover.

Finally, in the rare and painful case of death, workers’ compensation will cover funeral costs and provide death benefits to dependents.. 

How Does a Claim Work?

There are two main steps to putting your claim through the system. First, you will want to report the incident to your employer as soon as you become aware of the injury. And second, you’ll need to file the claim.

 Reporting the incident may look a little different depending on the state that you live in but generally, there is a 30-day window after the accident occurs in which you can report the injury. After that window, you may not be eligible to receive compensation.  

To prove that your injury should be covered under workers compensation you must demonstrate that your injury was connected to work. In legal terms, this means that you have to show both that your injury arose out of your employment and that it occurred during your employment.

These requirements are more straightforward when it comes to on-the-job injuries such as cutting your hand using a tool at on your job..However, it gets a little trickier when it comes to illnesses that develop over time or injuries that occurred outside of an obvious workplace setting. In situations like these, you will want to look up the specific laws for your state that govern when an injury is covered by workers’ compensation and how that compensation works or consult an attorney.

After you’ve gone through the process of reporting your injury, your company will then give you paperwork to fill out to file the claim. After you’ve filled out this paperwork, it will typically be sent to the employer’s insurance company and/or to the state to be filed and processed.

If your employer does not dispute the claim that your injury was work-related, your claim will be processed, and you they will start paying your medical bills and compensating you for time off work. If your employer disputes your claim, you will have to file a claim with the labor commission, most likely with the help of an attorney..

When it comes to workers’ compensation, you want to know that your back is covered. This guide can give you a foundation to better understand how workers’ compensation works. But be sure to do your research regarding your state’s laws as well as the coverage offered by your employer to ensure that you understand what compensation you are entitled to in case of injury.

How to Avoid the Common Workers’ Compensation Pitfalls

If you are applying for workers’ compensation, there are some important things you should know. Because workers’ compensation is an insurance program, your employer will often try to pay as little as possible when you file a claim. But if you are careful about following the rules, you’ll be able to avoid the common pitfalls associated with workers’ compensation while receiving all the benefits you deserve.

Notify Your Employer Immediately

One of the most common mistakes employees make when filing a workers’ compensation claim is being denied your benefits because you didn’t make a claim in time. The typical filing period is 30 days from the date of your injury, but it’s better to notify your employer of your injury as soon as possible. If you inform them verbally, make sure to give them a written notice as well.

In most cases, you’ll be given a form and required to fill it out. If your employer doesn’t give you this form, take initiative by typing up the date, time, and details of your injury.

Visit an Approved Doctor

According to workers’ compensation law, your employer or their insurance provider is allowed to choose the doctor who treats your injury after you file a claim. In order for your claim to go through, you must visit this doctor for treatment. This doctor’s reports and assessments will be important information for your claim.

If you don’t visit this appointed doctor, your employer or their insurance provider may dismiss your claim. You can see your own doctor as well, but this must be in addition to visiting the doctor they choose. If for some reason you are uncomfortable visiting the assigned doctor, you are allowed to ask the workers’ comp. insurance carrier for permission to see another doctor.

Be Honest

It is crucial that you are open and honest about your injury when you visit the appointed doctor. Don’t exaggerate your condition, but don’t hide it either. Make sure to explain the whole truth behind your accident, injuries, recovery, and setbacks. Providing false information or withholding true information from your doctor can cause your claim to be denied. 

Return to Work at the Right Time

Many employees are anxious to return to work, so they skimp on following their doctor’s treatment plan. While this behavior might be tempting, it can cause your claim to be denied because your workers’ comp claim administrator can decide you’re not trying, or that you’re faking your injury.

To avoid this pitfall, make sure to obey your treatment plan to the very letter: go to all appointments, do your physical therapy, and follow any other instructions your doctor gives you.

Remember that you have a right to your medical safety. If you and your doctor disagree about your treatment, or on your timeline for returning back to work, you are allowed to appeal to the Worker’s Compensation Commission.

Get a Second Opinion

Although you are required to visit the doctor assigned to you by your employer, you can (and should) get a second opinion on your treatment. If your own doctor’s treatment plan varies significantly from the insurance company’s doctor, you should notify the Worker’s Compensation Commission. A disagreement such as this could impact your claim statement.

When your health, safety, and livelihood are on the line, it’s worth the time and effort it takes to go get a second professional opinion about your injury.

Work with a Trusted Legal Professional

Unfortunately, complications often arise when you file a workers’ compensation claim. Your claim may be denied, your employer could deny that your injury is work-related, or your company might claim you’re not an employee. You could be accused of faking your injury, or your paperwork could slip through the cracks. You may have requirements that seem unreasonable placed on you in order to qualify. You may run into other complications as well.

If you feel your claim was wrongly denied, you should stand up for yourself and fight the committee’s decision. In order to avoid having to pay out of pocket for your treatment, you should work with a trusted legal professional who can help you receive your benefits and be treated fairly. It can be difficult to go through this process all on your own. Surround yourself with a support network who can speak on your behalf and be a strong advocate for you. Going it alone can be a costly mistake.

Even though all the rules surrounding workers’ compensation can seem complicated and overwhelming, it’s important to do the work to obey them. Doing your due diligence when it comes to all the paperwork and doctor’s appointments will pay off when you’re able to receive the benefits you deserve. Make sure to keep copies of all your medical records and compensation applications. Work with trusted professionals when necessary and be open about communicating with your employer. And above all, take care of yourself and your body.