No, not all workers comp cases end in a settlement. Though most of them do. In Florida, for instance, more than 77% of workers comp cases from 2011 to 2020 ended in a settlement. This figure does not necessarily reflect the workers comp settlement statistics for the entire country. But in general, more than half of workers comp cases do end in a settlement.
Whether the injured workers received a “fair settlement”, however, is another matter.
As you know, getting injured on the job entitles you to workers compensation benefits. Depending on the state, those benefits are generally paid by a private insurance provider. If they approve your claim, you’ll receive a settlement offer. You can usually choose whether to receive it as a lump sum or in structured payments.
While it can be tempting to agree to a workers’ comp settlement, you need to make sure you’re not getting the short end of the stick. Insurance companies are not exactly known for their generosity. So expect that they’ll pay you the lowest possible amount they can get away with.
This is why hiring an experienced workers comp attorney will be a great help. They know the law and they’ve handled hundreds if not thousands of workers compensation claims like yours. As such, they can help you get the workers’ comp settlement amount that you deserve.
As an employee, it’s also important that you know how the workers compensation system works. Your employer and insurance provider will usually tell you that all workers comp cases end in a settlement in an effort to convince you to accept the settlement amount they’re offering. But that’s not the case at all. You can always challenge that amount if you feel that you’re being shortchanged. Being familiar with the workers’ comp settlement process will give you an edge when things come to that.
The Workers Comp Settlement Process
Workers’ compensation is implemented on a state level. As such, workers’ comp laws tend to vary per state. But if you have a work-related injury, you’ll surely be eligible for workers’ comp benefits. In some states, it doesn’t matter whose fault the injury was as long as it happened at the workplace.
Certain businesses are required to provide workers comp coverage to their employers too. If you’re from a high-risk industry like construction, then all the more reason your employer needs to get you a workers comp policy. In some states, you can get this from private insurance companies. While some places have state-funded workers compensation programs.
When you get injured, the first thing you need to do is report it to your employer. If you have workers comp insurance, your employer will then report it to your insurance provider. Make sure to report your injury immediately. Some states only give you up to 30 days to file a claim after you got injured or had known about your injury. Otherwise, you won’t get any benefits.
After you’ve filed a claim, the insurance company will evaluate your case. They’ll check your supporting documents and may even conduct an in-person investigation. If your state implements a no-fault policy, all you need to prove is that you’re really injured and your injury is work-related.
When they’re satisfied that your claim is legit, they’ll compute your settlement amount. If you agree with their offer, you’ll receive benefits according to your agreement. Otherwise, you can take your case to court.
If they deny your claim, you can also take it to court. The judge will decide if you should get benefits or not and if you do, how much you’ll get.
What Will Your Settlement Amount Include?
Your settlement amount will include all the workers compensation benefits you’re entitled to. Depending on the severity of your injury, you may be entitled to:
1. Medical Benefits
In most states, the workers compensation law requires employers to pay for all the medical costs necessary for the injured worker to recover. This includes emergency care, medications, medical treatments, doctor’s fees, medical supplies, surgery, and rehabilitative care (if necessary). To be eligible for medical benefits, however, your treating doctor must be accredited by your insurance provider.
2. Lost Wages Compensation
If your injury causes you to miss work, you may be entitled to lost wages compensation. In Florida, however, you can only receive lost wage reimbursement if your injury extends to over 7 days. Also, you can only be paid for the first seven days if your injury extends to over 21 days.
Lost wages are computed based on your average weekly wage from before you got injured. In most cases, it will be about 66 2/3% of your average weekly wage.
How Much Workers Comp Settlement Should You Receive?
There’s really no standard amount when it comes to workers compensation settlements. There are a lot of factors that affect how much you’ll receive. This includes:
- Your state. Workers’ comp laws and rates vary per state. Some states pay up to 80% in lost wages compensation while in others, you can only receive up to 60%.
- Your injury. The severity of your injury and how it affected your earning capacity also determines how much you’ll receive. In general, the worse your injury is, the bigger the settlement you’ll receive.
- Necessary medical procedures. As mentioned, the insurance provider will have to pay for all medical costs and expenses. So if you need surgery or multiple surgeries, you’ll receive funds to pay for such making your settlement a lot higher.
- When you’ll return to work. Aside from your state, your lost wages benefit will also depend on how long you’ll be out of work. So if your injury is so bad that it will take months or years for you to return to work or reach maximum medical improvement (MMI), the larger your settlement will be.
What Happens If You Accept a Settlement?
Accepting a workers’ comp settlement means that you’re absolving your employer and insurance provider of any future obligations that may arise. This means that you won’t be able to get any more benefits from them no matter how long your injury may last or any medical procedures that you might need.
But in some states, you cannot waive your rights to medical benefits. So even if you’ve already accepted a settlement, your insurance provider will still have to pay for any medical expenses that may arise.
If you’re not sure about your state’s workers comp laws, make sure to consult a workers comp attorney before accepting a settlement.
What If You Can’t Agree on a Settlement?
If the settlement negotiation falls through, the next step would be taking your case to court.
Before you face the judge, however, a mediation will be scheduled between you and your insurance provider with the help of a neutral third party. If you still can’t agree on a settlement after the mediation, then a hearing will be scheduled.
During the hearing with the Judge of Compensation Claims, both sides will argue their case. You will need to produce more evidence to convince the judge that you are indeed eligible for workers compensation. A large percentage of workers compensation cases get a settlement after the Judge of Compensation Claims hearing. But if your claim is denied once again, you can file a final appeal. Just make sure to file it within 30 days, otherwise, the judge’s decision will be final.
How Long Do Most Workers Comp Cases Take?
Most workers compensation claims are approved for settlement after a few weeks or a month. But if you can’t agree on a settlement amount or your claim is denied, your workers comp case may drag on for several months. That’s why it’s crucial that you can get a settlement after the initial application but don’t just settle for any amount. Familiarize yourself with the workers compensation process and hire an experienced workers compensation lawyer to make sure you get a fair settlement.
VICTOR MALCA – Florida Workers Compensation & Social Security Disability Attorney
Victor Malca P.A. has over 27 years of litigation experience in Workers Compensation and Social Security Disability lawsuits. His experience and continued success when fighting for his clients puts him among the most trusted workers’ compensation attorney’s in Florida. He specializes in representing injured workers on compensation benefit cases and disabled individuals claiming lost social security disability benefits.
Book a free consultation today. Our unwavering advocacy for employee rights and privileges are recognized by our past clients across South Florida.
About The Author
Judy Ponio is a writer and editor for the Victor Malca Law P.A. website and blog. She enjoys helping people in need with questions about social security disability and workers compensation law. She has a passion for helping those in need and the elderly with accurate legal information that can make a positive difference in their lives.