Sooner or later, workers’ comp insurance companies usually make settlement offers. About 95 percent of civil claims settle before trial. Unfortunately, a reasonable settlement offer almost always comes “later” rather than “sooner.” Frequently, insurance company adjusters offer pennies on the dollar, often while a victim is in a hospital room.
Later, when the case goes to court and an Administrative Law Judge hearing date draws near, insurance companies get serious about settling cases. Especially if a lawyer is well-prepared and has a successful track record, they don’t want to risk a trial. Additionally, many insurance defense lawyers charge over $2,000 per hour. That expense adds up. If a case lasts six or eight months, many insurance companies are eager to make reasonable settlement offers and stop the bleeding.
What Are the Issues in Workers’ Comp Claims?
Job injury claims with no contested issues often settle quickly. In fact, they may settle within a few weeks after an injury. However, even though insurance companies cannot contest fault, they usually find something to disagree over. These disagreements, which always delay settlement, usually involve the amount of benefits.
In most states, workers’ compensation insurance companies must pay reasonably necessary medical bills. To most insurance adjusters, “reasonably necessary” means “cheapest possible.” Making matters even more complex, in many states, job injury victims must see company doctors. In the event of a billing dispute, you can probably guess whose side these doctors take.
Insurance companies could contest lost wage replacement as well. Typically, workers’ comp pays two-thirds of the victim’s AWW (average weekly wage) for the duration of a temporary disability.
As for the amount, the “average” doesn’t mean “past average.” Assume Bill gets hurt a week before his probationary period ends and his wage increases. If he misses ten weeks, nine of those weeks must reflect his newer, higher income. Additionally, Bill’s AWW must reflect things like future lost overtime opportunities.
The “duration” could be an issue as well. As mentioned, many job injury victims must see company doctors. These doctors often try to rush victims back to work before they’re ready. Usually, job injury victims are entitled to second opinions.
On a related note, workers’ compensation also covers occupational diseases, like hearing loss, that occur slowly over time. These claims have some additional issues, mostly because these victims don’t immediately report their injuries and a pre-existing condition is usually involved.
How Does a Lawyer Settle a Workers’ Compensation Case?
The settlement process in a workers’ compensation claim is like the settlement process in most other civil claims.
First, an attorney establishes a claim’s settlement value. This figure includes prior and future losses. Prior losses are usually straightforward, subject to the issues discussed above. Future losses are a different kettle of fish. Most job injuries never completely heal. Victims must strill miss work and see doctors, even years later. If a settlement doesn’t account for these charges, victims are normally financially responsible for them.
Next, when negotiations begin, a good workers’ comp lawyer knows when to compromise and when to stand firm. The settlement value, like a new car’s sticker price, is a starting point for negotiations. There’s always some give and take. A well-prepared and highly experienced lawyer ensures that the insurance company does most of the giving.
Written by
Bret Thurman
