Workers compensation insurance is an excellent protection plan for injured workers when they have suffered minor to moderate injuries at work that will only require them to be off for a specific amount of time. When workers are injured seriously, this process can change rapidly even to the point that the employer and their workers compensation insurance provider can become difficult at best and contemptible at worst.
While there is no allowance in the workers compensation system for general damages regarding long-term injury impact, there is still a potential for a personal injury lawsuit when negligence can be proven against the employer by an experienced personal injury attorney. Cases do not always go as expected, and many employers are resistant to workers compensation claims as a matter of company policy.
And their insurance companies usually either support the contesting claims or deny benefits when they think there is a chance of a claim dismissal. Here are a few tips to guide injured workers through a comp claim scenario.
Report the Injury as Soon as Possible
Depending on the work location when the injury occurred, it is important to make sure the injury is reported as soon as possible to eliminate any defense that it is not work-related. Establishing a workers compensation claim depends on this quick response in many instances, and employers will take advantage of any issue they can raise to avoid paying a claim. This helps the injured worker get medical attention as soon as possible where ever is closest. There is no settlement without first having a claim, and especially when there is no potential for a personal injury negligence lawsuit.
Attend All Physician Appointments
One defense that workers compensation insurance companies commonly use for denial or cessation of benefits is that an injury is not as serious as being claimed. One of the excuses they use is when injured workers miss medical appointments. Injured workers can be assured that the insurance company will monitor treatment activity, and even retain a private investigator on occasions to watch the routine of the claimant.
Attorneys can help in the investigations as well, which can give them first-hand information from personal observance. In addition, insurance providers will also regularly request injured claimants seek a second opinion on the injury, including when the attending physician is a specialist. And, the insurance company chooses the doctor. Make sure to meet all doctor appointments and physical therapy sessions during rehabilitation.
Be Prepared for a Cessation of Benefits
Serious injury cases that require high-paid workers to be off for an extended period could result in paying a substantial amount of money in the long run, which many workers comp insurance companies would just soon avoid. The extent of injury is not as important as reducing the total payout over the course of the open injury claim, and one of the methods they employ is stopping benefits after having paid them for a considerable amount of time.
They then use the financial stress put on the injured claimant as leverage in getting them to accept a lump sum with full release of further medical responsibility. This tactic can actually be a bad faith issue when further legal action is taken, but it still happens commonly.
Retain an Attorney Immediately
Potential stopping of benefits is part of the reason it is best to contact an attorney immediately after being injured even when the employer is agreeable and the insurance company begins paying benefits. Not all workers comp cases are equal with respect to financial value, which employers and workers comp insurance companies understand well.
They will actually often protect workplace scenarios that are not exactly OSHA compliant by paying a claim quickly and easily until an unlawful work environment can be rectified. An experienced workers compensation attorney can investigate the claim and look for all potential signs of negligence on the part of the employer or bad faith negotiating on the part of the insurance company.
Either evaluation can result in additional legal action, and especially in cases of debilitating injury that will accrue significant value in lost wages.
How Workers Comp Settlements are Reached
The first factor in workers compensation claims settlements is the length of time insurance coverage applies. Each case is different, and most states use a 10-year maximum coverage. The problem is that the workers compensation insurance company wants to shorten that total amount over time with a lump sum settlement. This can be an advantage for the those who will have a disability claim following the fact.
The average amount of a settlement can vary significantly based on rate of pay and term of disability as well as percentage of inability to work after the injury is rehabilitated as much as possible. In addition, individuals who are approved for disability will have an alternate method of covering medical bills, so some amount of medical bills can also be included in the lump sum when a medical specialist determines the injured worker is disabled.
This can include partial disability as well as total disability, but partial disability often restricts this inclusion. The damages are then totaled and a settlement is negotiated based on the case particulars.
What to Expect in a Lump Sum Settlement
The amount of any workers comp settlement is generally based on the rate of pay and the medical bills generated by the injury. The typical settlement will include insurance company payment of all medical bills directly with the remainder to be paid to the injured claimant.
The amount is based on lost wages at the rate of pay when the injury occurred and the amount of time the injury will last. Permanent injuries will be calculated on the maximum time allowed, but the amount of financial recovery can vary. As little as $2000 is not uncommon for recoverable injuries, but total disability cases can be considerably higher when whole replacement wages are being sought over the remainder of a career.
The importance of discussing any workers compensation case with an attorney cannot be overstated because employers and insurance companies deal with claims daily and have a set policy for avoiding or reducing claim payouts. Your case could be much more valuable than realized, and especially if there is a distinct possibility of a standard personal injury lawsuit stemming from employer negligence or bad faith tactics by the insurance provider.
Always seek the advice of an attorney because some workplace injuries can manifest into major medical issues later in life if not at the time, and workers only have one opportunity for financial compensation.