Workers’ compensation is a type of insurance for employees who suffer work-related injuries or illnesses. Its importance goes beyond assisting workers who’ve been injured while on the job; it contributes to a safer work environment. This article covers some of the most important things you should know when using a workers’ comp settlement calculator to estimate the settlement you or a loved one might be entitled to.
Common Expenses to Include In a Workers’ Comp Settlement Calculator
Workers’ comp settlements include various benefits designed to address the specific needs arising from work-related injuries or illnesses. Here’s what’s usually included in this insurance:
Medical Expenses
These include all healthcare-related expenses due to the injury. It covers emergency treatments, surgeries, medications, and any ongoing therapies or rehabilitation.
Lost Wages
Workers’ comp insurance also provides compensation for wages lost while an employee cannot work. This is usually a percentage of the worker’s regular income.
⚖️PRO TIP: In most States, eligible workers usually receive between 60 to 75 percent of their pre-injury or illness wages when they file a workers’ compensation claim.
Disability Benefits
In permanent injuries, settlements may include compensation for the long-term impact on the worker’s ability to earn. If the injury makes it impossible for the worker to return to their regular work, then the party who caused the injury must make payments in the form of a settlement.
Note that “disability” doesn’t necessarily mean complete inability to work. It is enough that the victim is unable to practice their regular work before the accident. For example, a painter who suffers blindness as a result of a may still be able to earn income in a different profession.
Rehabilitation Cost
If any injury prevents a return to the previous job, settlements may cover the costs of retraining, therapy, or education for new employment opportunities.
Death Benefits
In the event of death, the settlement shall include funeral and burial costs. Such a claim is usually filed by the family of the deceased.
How to Calculate Workers’ Comp Settlement
The formula for computing workers’ comp settlement can be complex and varies significantly based on individual cases. It usually starts by distinguishing between temporary and permanent disabilities.
From there, several factors come into play, such as the severity of the injury, average weekly wage, medical costs, and the disability rating of the injury.
Disability rating (or impairment rating) is an assessment of how the injury affects a person’s life in different aspects. Doctors will check how the impairment changes your way of communication, movement, independence, travel, use of hands, self-care, and other normal living functions.
⚖️PRO TIP: Different States also have different approaches to settlement, which can heavily impact the calculation.
Settlement charts are often available to serve as a guideline when calculating a proper amount. For example, in most States, a mild head injury or concussion has an average settlement payout of anywhere from $1,000 to $30,000. A severe eye injury resulting in permanent vision loss, on the other hand, can cost as much as $48,000.
Due to the complexity of these calculations and the uniqueness of each case, seeking professional assistance is always advisable. A workers’ compensation attorney can help negotiate a fair settlement, taking into consideration all factors.
Procedure for Workers’ Comp Settlement
Ideally, you should receive your settlement in a matter of months. This is if both parties reach an agreement during the negotiation stage. However, a dispute between yourself, the insurance company, or even your employer could push the timeline further.
That said, before opting for a lawsuit, here’s the typical procedure for filing a workers’ comp claim:
Notification
Start by reporting the injury to the employer as soon as possible. Do this in writing so that you can have a paper trail of the incident. Ideally, your employer will create an incident report about the situation, which you can use as additional evidence for your case.
Medical Treatment
As soon as possible, seek medical treatment and appropriate care. Keep all the documents given by your attending physician; you’ll use them as evidence when filing your claim.
Filing your Claim
File your workers’ comp claim by providing all the necessary details about the injury and the circumstances that led to it. A lawyer should be able to help you at this stage and ensure that all papers have been submitted. This can be a technical and challenging phase of the workers’ comp settlement process, so having someone who understands the procedure is highly advisable.
Claim Review
Once you’ve filed your claim, your employer or their insurance company will evaluate all the information you submitted. You might have to wait a few weeks to get a response from the insurance company.
⚖️PRO TIP: Each State has a period in which the employer should file a response. If they go beyond this deadline, they risk facing penalties and other legal consequences.
Settlement Offer and Negotiation
After reviewing your claim and confirming it’s validity, the insurance company should contact you to propose a settlement. Negotiation may occur with each party armed with a lawyer to help them through the settlement process.
Now, an insurance company may choose to pay the full amount you asked for or try to negotiate a specific amount. This is why having a legal professional in your corner is important. They can help advocate for your rights and ensure that you receive the compensation you need and deserve.
Agreement and Finalization
If you agree to a settlement, the next step involves putting the terms in writing and submitting it for finalization. Ideally, the insurance company should make payment within a specific period stated by law.
⚖️PRO TIP: The time it takes for the workers’ compensation settlement to be issued varies from state to state, so be sure to ask your lawyer about the specific timelines that apply to your case.
If both parties don’t reach an agreement, then proceeding to court becomes a possibility.
Returning to Work after Workers’ Comp Settlement
If you’re wondering – can you still go back to work after a workers’ comp settlement? Of course, you can. That’s especially true if the injury isn’t as serious.
Right after coming back, your employer should adjust your duties depending on the nature of the injury. In some cases where the injury is severe or permanent, coming back to work may not be an option.
A good example is the case of Holland vs Schwan’s Home Serv Inc. Holland was injured while at work and filed a workers’ comp claim.
Upon returning to work, his employer failed to adjust the nature of his work which aggravated his previous injury. The jury sided with Holland, awarding him around $4.2 million, covering emotional and punitive damages. These additional damages were added because the jury determined that the acts of the employer were in retaliation to Holland’s initial work comp settlement.
Statute of Limitations on Workers’ Comp
Understanding the statute of limitations when it comes to workers’ compensation is a crucial safety net for employees injured on the job. This refers to specific legal timeframes within which claims and benefits must be filed for the claimant to be eligible for compensation.
⚠️ IMPORTANT: Please note that the timelines discussed below are only estimates based on national averages. The specific deadlines for your case will depend on the laws of your jurisdiction.
Notice of Injury
In most States, injured workers have two years from the date of injury to notify their employer and make a claim for benefits. For occupational illnesses developing gradually, this period starts when the worker becomes aware of the nature of the injury and how it is related to employment.
Filing a Claim
Claims for rehabilitation, disability, medical, or death benefits must be filed within three years after the injury. If the injury’s nature and its relation to employment are not initially apparent, the timeframe begins when the employee becomes aware of these details.
Review of Eligibility
An employee’s right to insurance benefits is barred if four or more years have passed since the last receipt or denial of the benefits. In other words, if your claim was initially denied after filing, you need to contest this within four years or lose your right entirely.
How to Maximize Your Settlement Value
Understanding how workers comp settlement are calculated is important. However, keep in mind that, chances are, your employer and their workers’ comp insurance company may try to work against you.
Their goal is to keep their expenses minimal, which is why there’s a need to be firm during the settlement process. Here are some tips on how to maximize your settlement value:
Immediately report the injury to your employer and seek prompt medical attention. This establishes a clear record of the incident and injury.
Understand how disability ratings work. These ratings can influence your settlement amount. Disability, in these cases, fall under four categories: permanent total, permanent partial, temporary total, and temporary partial.
Keep detailed records of every injury-related expenses you’ve had. Keeping note of the changes and difficulties in your life also gives you a strong case for emotional damages. All of these can help support your claim.
Do not commit to anything just yet. If the insurance company wants to talk to you, make sure to engage the services of an experienced workers’ compensation lawyer to help with the negotiation process. Engaging the insurance company without legal counsel may cause you to say something that they could use against you.
Be wary of the statute of limitations but do not agree to a settlement without first talking with your lawyer.
Finally, you may need multiple medical evaluations to record your injuries before settling.
Things that Can Jeopardize Your Settlement
Knowing what actions can jeopardize your claim is key to securing the compensation you deserve. Here are some things that you will need to watch out for:
Failure to Disclose All Injuries
Report every pain or soreness to your doctor, no matter its severity. Not understanding the extent of your injuries can lead to inadequate compensation and premature return to work.
Always be honest about any symptoms you’re experiencing and any movement limitations. Keep in mind that health problems can develop over time, and these must be anticipated before arriving at a settlement.
Ignoring Medical Advice
Skipping appointments or not following treatment plans can signal non-compliance. This can lead to reduced or even denied benefits. If your condition worsens, the insurance company may even deny the settlement on the ground that you intentionally caused the injury.
Engaging in Prohibited Activities
Engaging in activities that contradict your injury claim can be misinterpreted as fraud. There have been cases where claims have been denied because the injured persons engaged in activities that “worsened” their condition. In such a situation, the insurance company may deny all other treatments for the condition caused by the prohibited activity.
Refusal of Light Work
If you have been cleared for light-work after a Functional Capacity Evaluation, but you decline to work, this can be seen as non-compliance. Remember that filing a workers’ comp settlement claim doesn’t automatically mean you can no longer work or are terminated from your employment with that particular employer. Employees are required to provide you with light work in consideration of the injury.
Settling Without Legal Assistance
Don’t accept settlement without consulting a legal professional. If you do, you risk settling for less than the deserved amount.
While initial amounts offered may seem significant, they may not be enough when future medical expenses and other damages—such as pain and suffering, emotional distress, and the loss of enjoyment of life—come into the picture.
What Is the Most Common Cause of Workers’ Comp Settlement Claims?
The most common causes of injuries in the workplace are related to overexertion and slip and falls. These incidents often occur due to lifting heavy objects, walking on slippery surfaces, and lack of proper warning signs.
For context, more than 30,000 people die annually in the United States due to slip and falls.
How Long Do Most Workers’ Comp Settlements Take?
The duration of settlements varies but typically takes several months to a year or even more. The difficulty of the case and the extent of injuries are significant factors in determining the timeline.
Can I Lose My Health Insurance While on Workers’ Comp?
While on workers’ comp, your health insurance status depends on the employer’s policy. In some cases, employers may continue providing health insurance, but it’s not guaranteed.
How Long Does Compensation Take To Pay Out?
Payout timelines vary on a case-by-case basis. After a settlement is reached, it may take a few weeks or months to receive compensation. Delays can happen because of processing or negotiation issues. If you’re concerned about the payout taking too long, you may raise the issue with your attorney or employer.
