How Do Workers’ Comp Settlements Work?

Find out more about workers’ comp settlements and how they work.
Warehouse employee sitting on the floor with a feelow employee radioing for help because he is injured in an accident where iron fell on his leg

If you are injured at work you may be eligible for workers’ compensation benefits through your employer. All employers who have three or more full-time employees are required to carry workers’ compensation insurance, that provides benefits to injured workers.

Workers’ Compensation Benefits

Workers’ compensation benefits were designed to provide an injured worker with wage loss benefits to provide financial stability when the doctor keeps you out of work due to your injuries and covering medical bills related to your work accident. It is important to know how these benefits work when you are considering settling your workers’ compensation case.

Wage Loss Benefits

Wage loss benefits from workers’ compensation are paid on a weekly basis at two-thirds of your typical gross pay (pay before taxes are deducted). You can receive up to 500 weeks of wage loss benefits in most cases as long as your doctor keeps you out of work due to your injuries.

Medical Care

Medical care is covered 100% by workers’ compensation. You will not have any out-of-pocket expenses for your medical care. But, if you do happen to incur out-of-pocket expenses for prescriptions or other medical expenses you are entitled to be reimbursed. Although your medical treatment is covered, the workers’ compensation insurance company can always decline to approve medical treatment recommended by your doctor and you would have to go to court to get the treatment covered. As you can imagine, the insurance company does not like to pay for expensive medical treatment and it is common that they will refuse to approve treatment recommended by your doctor.

Unlike a personal injury case, you cannot go to court and ask for a lump sum of money to be paid to you like you can in a car accident case, so the weekly check is the only compensation you are entitled to receive. So any workers’ compensation settlement is always voluntary on the part of the injured worker and on the part of the insurance company.

If you want to settle your workers’ compensation case, or if the insurance company wants to settle your case, you will be asking the insurance company for a lump sum of money to close your case and absolve them from all liability. The amount of money the insurance company will pay is based on numerous factors, including the severity of the injury and the circumstances surrounding the accident.

Eligibility for Workers’ Compensation Settlements

Anyone who is injured at work is eligible to receive a workers’ compensation settlement, but the facts of your case will determine how much your case is worth.

Factors Affecting Settlement Amounts

The amount of money you receive through a worker’s compensation claim can vary depending on numerous factors. Some of the most important factors are:

  • Whether you have been placed under an Award Order by the Virginia Workers’ Compensation Commission (the insurance company formally agreed to accept your case or you won at trial)
  • Whether defenses available to the insurance company to dispute your claim
  • The severity and extent of the injury itself
  • The amount of time you’ve taken off work
  • The impact the injury has on future earning capacity and your ability to return to your pre-injury job
  • The cost of medical treatment and ongoing care
  • The existence of permanent disabilities or impairments

Types of Workers’ Compensation Settlements

Typically, most workers’ compensation settlements are paid in a lump-sum to the injured workers. However, worker’s compensation settlements can be split into three separate categories:

  • Lump-sum settlements
  • Medical only settlements
  • Wage loss only settlements
  • Structured settlements

Lump-sum settlements

Lump-sum settlements are a single payment to close out the entire case and permanently end the insurance company’s obligations to you.

Medical only settlements

In Medical only settlements the insurance company pays you a lump sum payment to close out their liability for your future medical treatment related to your accident. You would remain eligible to receive wage loss payments from the insurance company.

Wage loss only settlement

In Wage loss only settlements the insurance company pays you a lump sum payment to close out their liability for your future wage loss related to your accident. You would remain eligible to receive coverage for your medical treatment from the insurance company.

Structured settlements

Structured settlements are similar to a lump-sum settlement because they close out the insurance company’s liability on your case. However, the lump sum is paid out over time in smaller amounts, which are paid to the claimant periodically.

Process of Negotiating a Settlement

1. Issue a Settlement Demand

To negotiate a workers’ compensation settlement you would issue a settlement demand to the insurance company. It is usually best to retain an experienced workers’ compensation attorney to assist you with settling your case. Experienced attorneys are able to determine the exposure (the amount of money) the insurance company is likely to pay for the time you will remain out of work and the cost of your future medical care (particularly how much it will actually cost the insurance company). An attorney can also use their prior experience to determine how much you can anticipate the insurance company to pay from handling cases similar to yours and can explain the pitfalls and risks of not settling your case.

2. Recieve an Offer

After an initial demand is sent to the insurance company, the insurance company evaluates your case and determines what they believe their exposure is on the case and how much of that exposure they are willing to pay to settle your case. Once this determination is made the insurance company would make an offer to you or your attorney.

3. Ongoing Negotiations Until Agreement

The process going forward is typically a back and forth between both sides until the parties agree on a settlement amount. Remember, since the insurance company does not have to settle your case they do not have to pay what you want them to. And on the same token, you don’t have to settle the case if you do not like the final offer they give you. You can continue to receive your weekly wage loss check and have them pay for your medical treatment. But it is important that you understand the potential risks that develop the longer your workers’ compensation case remains open with the insurance company.

4. Filing with the Workers’ Compensation Commission

After the parties agree on a dollar amount, legal documents are drafted and filed with the Workers’ Compensation Commission. The Commission reviews the settlement to ensure that the settlement is in the injured workers’ best interests.

5. Approval and Payment

The Commission will then approve the settlement, this typically takes about two weeks. Once the settlement is approved the insurance company has 44 days to mail your check to you.

Pros and Cons of Settling Workers’ Compensation Claims

Pros of Settling Workers’ Compensation Claims

There are many benefits associated with settling instead of seeking further action. For example:

  • Settling gives you a lump sum of money you can use for anything you want.
  • Settling means that you can avoid a lengthy litigation process so that you can begin to move on from the incident.
  • You can regain control over your medical treatment.
  • You can return to work on your own schedule based on how you are feeling.
  • You no longer have to deal with the insurance company!!

Cons of Settling Workers’ Compensation Claims

There are also potential drawbacks associated with settling. For example:

  • Settling could mean you forfeit future benefits, even though the repercussions of the injury/accident are long-lasting.
  • You may be required to resign from your employment with your employer.
  • You will likely have to compromise on the amount you actually wanted out of the settlement.

Contact a Trusted Worker’s Compensation Lawyer in Richmond, VA

A workplace accident or injury can have a profound impact on your life. After all, it can take its toll on your physical and mental well-being, finances, and ability to work in the future. For this reason, it’s vital that you seek out compensation.

If you’re looking for an experienced lawyer to support you during this time, please do not hesitate to get in touch today. At Renfro and Renfro, we have years of experience protecting the rights of injured workers and helping them receive the compensation they deserve.



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