Will I Get a Settlement From Workers’ Comp?

Workers’ compensation is a type of insurance that protects employees if they get hurt or sick as a result of their job. The vast majority of employers in the United States must carry workers’ compensation insurance, and, with a few exceptions, most full- and part-time employees are eligible for these benefits. Your benefits can make up for any lost wages or be used to pay for the cost of any medical care you need. 

After an incident, you need to apply for workers’ comp through the insurance carrier. If your claim is approved, then the insurance company will offer a certain amount of money as compensation for your illness or injury. If you accept that offer, you’ll receive benefits. If you feel that offer is not large enough, you can refuse it and pursue a workers’ comp settlement. 

If you bring up a case, it will likely result in a settlement, though there is a chance you could go to court. Either way, you stand to gain a much larger settlement than what was originally offered by bringing up a case. However, that isn’t guaranteed. Each case is unique and you could win a much smaller amount — if you receive anything at all.

What Is a Workers’ Comp Settlement?

A workers’ comp settlement is a monetary settlement you may be awarded if you choose to take legal action against the insurance carrier instead of accepting their benefits offer. Generally, you’ll need to work with a lawyer to negotiate a settlement with the insurance company. You may have to go to trial if you cannot agree on a settlement, although this rarely occurs in workers’ comp cases.

Many, but not all, workers’ comp cases end in a settlement. If you do win a settlement, it can be paid out in one of two ways: as a lump sum or as a structured settlement. With a lump sum, you will receive the entirety of your award at once. With a structured settlement, you will receive payments, often monthly, over a period of time. Your payments could span several months or even years; the duration of payments will be decided during your negotiations.

Do I Need an Attorney to Get a Settlement?

Though you aren’t legally required to have one, you will likely need to hire an attorney if you are planning to pursue a settlement. Workers’ comp may seem simple and straightforward, but cases can easily become complicated. Without a lawyer, you may end up losing your case and not receive any compensation whatsoever. Essentially, a lawyer can protect your interests, increase your chances of winning your case, and help you win more favorable terms.

Even if you do not plan to seek a settlement, there are certain instances where you may still want to hire a lawyer for your workers’ comp case:

• If your injuries or illness is not clearly related to work;
• If your original workers’ comp claim is denied;
• If you have a preexisting injury or condition;
• If your employer refuses to let you submit a claim;
• If you are struggling to obtain or require extensive medical care;
• If you have become permanently disabled;
• If you are unable to work as a result of the injury or illness;
• If you are receiving government benefits.

A lawyer can help you navigate the workers’ comp application process if you have a complex case, no matter what the reason; otherwise, you may struggle to get the benefits you need. 

Typically, in the workers’ comp claims process, you give up your right to sue your employer for the injury or illness you’ve sustained. However, depending on the circumstances of the incident, you may have grounds to sue your employer. If you have reason to believe that you were harmed intentionally by your employer, you should consider pursuing a personal injury lawsuit instead of a workers’ comp claim. Again, though not required, you will likely need the help of an attorney who specializes in personal injury to build your case.

Additionally, you may need the help of a lawyer if you were harmed due to a coworker’s negligence or malicious intent. You are still eligible for workers’ comp if you were hurt by a coworker, but submitting a claim only prevents you from suing your employer, not another employee, vendor, or client. With the help of a lawyer, you can sue that third party for full damages and circumvent the workers’ comp process altogether.  

How Long Does It Take to Reach a Settlement?

The amount of time it takes to settle a workers’ comp case depends on the severity of your injuries or illness and how long it takes you to recover. Often, you will not be able to negotiate your settlement until you have healed as much as you possibly can. For this reason, it can take anywhere from several weeks to multiple years to settle.

With the help of your lawyer, you’ll determine the amount you’d like to receive in the settlement. They’ll likely consider:

• Cost of medical care;
• Historical or future wages lost due to your injury or illness;
• Cost of retraining;
• Permanent or temporary disability benefits;
• Legal fees.

The insurance company will also come up with their offer. If you accept it, the state workers’ comp agency will review and finalize the offer. You can then close your case and wait to receive your benefits. If not, your lawyer will negotiate with the insurance company to come to an agreement on the amount and terms of the settlement. Both sides will likely have to compromise on the final settlement. Depending on the state you live in, a judge may need to review and approve the agreement before it can be finalized.

If you are unable to reach an agreement, you will have to go to court for a workers’ comp hearing. At the hearing, both sides will present their cases. A judge will ultimately decide on an appropriate settlement amount. Both you and the insurance company must respect and follow the judge’s orders. At this time, the case will be closed.

How Much Is the Average Workers’ Comp Settlement?

Just like the amount you receive in benefits, the amount you can win from a workers’ comp settlement varies greatly from case to case. It could be anywhere from several hundred to several million dollars. In general, more severe illness and injury will result in a larger payout. For instance, a broken arm will result in a much smaller settlement than a permanent disability.

The insurance company will likely try to lessen the amount they must pay in the settlement. You have a better chance of getting a higher payout if you choose to negotiate instead of accepting their first offer. 

You also have to consider how much of your settlement you won’t end up taking home. While both workers’ comp benefits and settlements are not taxable, you still have to pay your attorney, as well as any legal fees. This could end up having a large impact on your payout, depending on the size of your settlement and the fees you and your lawyer agreed upon.

Can I Get Disability After a Workers’ Comp Settlement?

Depending on the severity and permanence of your injury or illness, you may be eligible for both workers’ comp and disability benefits from the Social Security Administration (SSA), including Social Security Disability Insurance and Supplemental Security Income. However, you will not be paid the full amount of your Social Security benefits while receiving workers’ comp benefits. According to the SSA, “If you receive workers’ compensation or other public disability benefits, AND Social Security disability benefits, the total amount of these benefits can’t exceed 80 percent of your average current earnings before you became disabled.”

Workers’ comp settlements are subject to the same offset. If you won a structured settlement with monthly payments, you may encounter a similar reduction in disability benefits. If you won a lump sum settlement, your payment will be prorated to reflect how much you would have been paid in disability benefits if you had not won the settlement. Typically, medical and legal fees are not considered when calculating the offset.

Should I Settle My Workers’ Compensation Case?

Only you can decide whether to settle your case out of court or bring it to trial. Remember, you could end up with a smaller payout or no payout at all if you go to court. However, if you’re lucky, you could also walk away with a much larger payout. When deciding if you want to settle, you should consider your unique circumstances and your willingness to take on that risk.

A settlement can provide you with a large windfall, which is helpful if you need money on short notice. You can also negotiate more favorable terms, such as asking the insurance company to pay for any future medical treatments related to your illness or injury. Settling will also help you avoid the stress of going to trial.

On the other hand, settling is permanent. It will bring your case to a close. You won’t be able to reopen it if circumstances change or if you want to renegotiate. You should be completely confident that your condition will not change, or at least, worsen if you agree to a settlement. 

Can I Reopen My Workers’ Comp Case After Settling?

There are some instances where you may be able to reopen your workers’ comp case. Common reasons cases are reopened include:

• Legal mistakes or clerical errors;
• Proof of fraud by the insurance company;
• Negative impact on your ability to work or earn wages;
• New evidence in the case;
• Changes in your health or condition, including the onset of disability, due to the injury or illness.

Depending on the terms of your settlement, you may not be able to reopen your case, even if you have a compelling reason. There may also be laws in your state that will limit the amount of time you have to reopen your case. You may only have a few years to do so after the original settlement. 

While you may not be able to reopen your case, you may be able to open a new one if your injury or illness “flares up” at a later date. If you sustain a knee injury on the job that resulted in a workers’ comp settlement, you could open a new case if you injure that same knee in another workplace accident. In this situation, it would count as a new injury, making it eligible for a new workers’ comp claim. You can still file for workers’ comp whether you work for the same employer or have a new job.

What Can I Do to Increase My Chances of Settling My Case?

Though there’s no way to guarantee victory in your workers’ comp case, there are a few things you can do to increase your chances of winning a favorable settlement:

• Report your injury or onset of illness to your employer as quickly as possible. If you wait or fail to do so, you may lose eligibility for workers’ comp benefits.
• Get medical care immediately. Doing so will give you the best chance at making a full recovery and create the documentation you’ll need to build your case.
• Tell every medical professional you encounter, including your doctor and the insurance company’s physician, the same, honest account of your accident. Be clear and specific. Do not exaggerate or lie about your injury or illness in an attempt to strengthen your case or increase your payout.
• Follow the treatment plan provided by your healthcare provider, even if you begin to feel better. The insurance company could undermine the severity of your injury to reduce the payout if you do not properly follow treatment instructions.
• Be cautious about giving others, especially the insurance company or your employer, access to your medical records and health information. Though they may need information from your healthcare provider about your accident or injury, make sure they can only access information related to your workers’ comp case.
• Remember that nothing you do is truly private during the settlement process. The insurance company could look at your social media profiles or even hire a private detective to keep an eye on you. They’re looking for any shred of evidence to weaken your claims, deny your benefits, or reduce your payout.
• Attend every single medical and legal appointment. This process is important, and you need to treat it as such. Do not give the insurance company any reason to believe you aren’t committed to your case.
• Hire a workers’ comp attorney you trust to navigate the challenges of this situation and protect your interests while trying to settle.

Finally, be patient during the claims and settlement process. It will take a lot of time, energy, and patience to resolve your case, but it’ll be well worth the wait once you get the compensation you deserve.

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