How Do Workers’ Compensation Settlements Work?

According to the Bureau of Labour Statistics, there were 2.8 million nonfatal occupational injuries (and illnesses) in 2018. It’s no wonder, then, that the vast majority of U.S. workers, about 90%, are insured by workers’ compensation insurance, which is required by federal law.

A workers’ compensation settlement may be required in such a case. Let’s talk about how this process could function and what roles employees, businesses, and state officials have in dealing with workers’ compensation settlements.

Understanding the Workers Comp Settlement Process

When a workplace injury occurs, a workers’ compensation claim is filed with the insurance provider, who normally accepts it and offers a specified sum as recompense. It is then up to the employee to accept the offer and receive the appropriate amount of remuneration.

Employees may, however, choose to decline this offer. An injured worker may employ a lawyer instead of accepting the insurance company’s offer and demand a greater payment.

If this is possible, why don’t all injured workers do so in the hopes of collecting more money for their injuries? Because if the employee decides to pursue a workers’ compensation settlement, there is a potential that they will be granted less than what was first provided by the company.

• The injury’s current medical expenditures and potential future costs
• Wages lost and prospective future earnings lost
• Disability benefits
• If necessary, the cost of retraining to perform the job.
• The rules and regulations governing workers’ compensation in the state where the injury happened
• The employee’s claim’s strength (weighing elements that could potentially reduce the amount they’ll receive)
• Legal expenses

If the two parties are unable to reach an agreement on the amount of compensation, the only option is to let the courts decide.

Insurers may also initially accept the claim and begin paying benefits but later challenge the claim if there are reasons to believe that the injury was not real or was not work-related. A legal struggle is once again the most likely conclusion in such a situation.

To collect the agreed compensation in a standard settlement process, the worker who was injured must surrender their right to sue their employer. However, if they claim that they were injured as a result of their employer’s or a third party’s negligence, they can avoid the workers’ compensation system entirely and sue the responsible party for damages.

What Happens When a Workers Comp Claim Goes to Trial?

When a workers’ compensation lawsuit is filed in court, the judge will analyze the case to decide if the claim is valid and, if so, offer a fair settlement sum. Once the sum is determined by the court, both the insurer and the employee who filed the claim can either comply with the ruling or choose to challenge the entire settlement or sections of it.

An appeal usually has a 30-day time limit. If the insurance company fails to dispute the court decision or accepts the suggested sum outright, the settlement is final, and the carrier will pay the agreed-upon amount.

How Are Workers’ Compensation Settlements Disbursed?

A workers’ compensation claim can be handled in two ways: as a lump amount or as a structured settlement. A lump-sum settlement occurs when an employee signs a settlement agreement that concludes the lawsuit and receives a one-time payment from the employer or insurance company. The employee will receive payments over a predetermined length of time under a structured settlement agreement.

What is the Employer’s Role in a Workers’ Compensation Lawsuit?

The employer’s role is often limited in the event of a workers’ compensation dispute between the employee and the insurer. The majority of the interaction will take place between the worker and the insurance firm that handles the company’s worker’s compensation policy. Employers, on the other hand, should take an active role in facilitating excellent.

communication between the insurer and employee and staying up to speed on the situation.

The more involved and diligent you are throughout this process, the less likely it is that your organization will be implicated in the lawsuit. It’s also an excellent method to express your support for your injured colleague.

Being upfront and providing the relevant papers and contact information to both the insurer and the employee would go a long way in ensuring that the situation is resolved as quickly and as fairly as possible.

State Rules on Workers Comp Settlements

A settlement cannot be offered at all stages of a workers’ compensation claim in every state. In many states, for example, whether a claim is allowed or denied cannot be the basis of a settlement. Either the claim fits the requirements for acceptance or it does not.

Furthermore, some states will not allow the settlement to alter medical benefits. The employer or the insurance provider may include a provision prohibiting the employee from requesting that their medical bills be covered at a later date. The state may consider this element of the settlement to be unjust to the employee and may order that the medical expenditures be paid regardless of the settlement.

Many states will demand that the proposed settlement be reviewed by a court to ensure that it does not violate any state laws. This is especially true in the case of post-litigation settlements.

If you’d like to learn more about workers’ compensation lawsuits and potentially acquire the best possible coverage for your company and your whole crew, please contact one of our knowledgeable Lawsuit Experts at any time to get your workers’ comp quote.