If you’re in pain because of a work-related back injury, you’re not alone. Across the nation, back conditions are the most commonly reported work-related injuries. Workers who suffer a back injury may experience mild, sharp, or gnawing pain. These injuries can cause brief impairment, short-term difficulties, or long-term problems that become difficult to resolve. They can even result in permanent disabilities, as well as a lifetime of pain and suffering.
When your priority is bringing home enough money to care for your family, you may just want to try to heal and move beyond the pain. However, that can often seem impossible when you have a lingering injury affecting everything you do.
The workers’ compensation system has a solution for injured workers who simply want to stop focusing on their injuries. Even if you’re still undergoing treatment for your back injury, you can negotiate a settlement with your employer’s workers’ compensation carrier. A settlement will allow you to obtain a lump sum in exchange for releasing your right to make future workers’ compensation claims. While a settlement may be attractive to some, it isn’t the best option for everyone.
On-the-Job Back Injuries
A back injury affects the body’s musculoskeletal system, which includes soft tissues, cartilage, nerves, joints, discs, and spinal structures. The pain often changes the way people live, work, and play. In addition, a back injury can lead to other types of injuries as your body attempts to continue moving through this injury. This can cause pain and reduced motion in the extremities, neck, and hips.
Unfortunately, back injuries are often a major health issue when a job includes manual labor tasks. They affect employees in jobs across all industries. In one year, the Bureau of Labor Statistics documented 97,990 lost time injuries caused by overexertion while lifting or lowering. Lifting and lowering actions primarily caused back injuries. Your work-related back condition is likely attributable to the same heavy lifting, repetitive motions, or awkward work positions that cause workers’ back injuries across the country.
Unfortunately, back injuries spark doubt and mistrust from an insurance company’s point of view. They occur so frequently and in so many different situations that they often come across as suspicious. When an injury involves soft tissues only, physicians often rely on a patient’s subjective feelings to diagnose the condition. This makes many back injuries often difficult to verify. When an injury is subjective, insurance company representatives sometimes question both the injury and its severity.
How Does the Workers’ Compensation Settlement Process Work?
In Florida, for example, workers’ compensation statistics revealed a total of 8,119 work-related back injuries during one year, in which workers’ compensation insurers settled 2,057 of these cases. A settlement involves paying the injured worker a lump sum and ending the claim process.
Initial settlement negotiations are often informal and unstructured. Some injured workers begin the process when they’ve reached maximum medical improvement. For you, a settlement might feel right when you grow tired of dealing with the worker’s comp claim process. If an insurance company doubts your injury and refuses to pay your claim, settlement is an option you may consider.
There’s no right or wrong way to initiate settlement negotiations. You or your workers’ compensation attorney can start by contacting the insurance representative handling your claim. Negotiation begins by presenting the insurance company with a demand. This is the dollar amount you want to pay for your back injuries. The adjuster then reviews the claim file and makes a counteroffer. This is the dollar amount that the insurance company is willing to pay.
Back injury negotiations are rarely a speedy process. They often involve back-and-forth discussions and disagreements on value. And, occasionally, they may include an angry outburst or two. As long as your actions move the negotiations forward, you will eventually reach a workers’ compensation back injury settlement.
The conclusion of a workers’ compensation settlement, initiates a more formal process. You will be required to sign documents releasing your right to future benefits for your injury. If you chose to proceed without a lawyer, a workers’ compensation judge will review and approve your settlement. If you work with an attorney, a judge will approve your fee agreement.
What Is the Average Payment From a Workers’ Compensation Settlement?
Workers’ compensation settlements are different from lost time payments. They don’t have a set formula or a specific dollar amount. As with liability injury claims, a compensation settlement is unique to the injured individual. Settlements are unique as well. For the 2,057 back injury cases settled in 2018, $14,949. was the average lump-sum payment.
Factors Affecting Your Workers’ Compensation Back Injury Settlement
When insurance companies negotiate settlements, they often use average injury settlement data as an evaluation reference. They also consider other factors including:
- Your back injury, its severity, and how it affects your ability to work;
- Any permanent impairments;
- Potential for additional treatment and costs;
- Changes in income related to your permanent impairments;
- Unreimbursed medical bills;
- Unpaid temporary disability benefits;
- Incurred DWC penalties;
- Unresolved issues about how your injury occurred; and
- Your personal profile—age, life expectancy, marital status, employment potential, etc.
The Consequences of Your Settlement Decision
Never negotiate your own workers’ compensation settlement. Once you formalize your back injury settlement, you can’t go back and change your mind if you discover your back injuries are far worse or more expensive than you thought—and they usually are.
Before you sign away your rights to future benefits, you should learn everything you can about your back injury’s value. Consider any impairments, work restrictions, and future medical issues that may affect your ability to work.
You must also recognize whether you are being treated fairly throughout negotiations. Always call a workers’ compensation attorney to review your case before you settle.
Here are some additional points to keep in mind:
- When you reach a workers’ compensation back injury settlement, you give up your rights to collect future medical and wage loss benefits.
- You can’t reopen your claim if your injury causes additional problems.
- To help you gain a better understanding of future medical issues, you should discuss your prognosis with your doctor.
- Once you settle, you’ll be responsible for current unpaid bills and future medical costs.
- Many states have a Department of Revenue that has the right to take some of your settlement funds and apply them toward any unpaid child support obligations.
Who Benefits When You Settle Your Workers’ Compensation Claim?
No one can force you to settle your workers’ compensation claim after suffering a serious back injury. A workers’ compensation judge can’t even force you to accept a pending lump sum offer. A workers’ compensation settlement is a voluntary process. The process was intended to create a resolution that benefits all parties involved. Of course, the benefits are completely different for the insurer, the state, and the injured worker.
Benefits to the Insurer
For each claim reported, insurers have a legal duty to set up a claim file, investigate the circumstances, and establish a reserve. The reserve is the claim representative’s best guess as to the ultimate future claim payout. It also establishes the amount of money an insurer must legally set aside to pay a claim when it’s time.
Claim representatives, supervisors, managers, and higher-ups periodically review open claims. They reevaluate the claim and increase the reserves as necessary. If the handling officer Even if the handling office doesn’t increase the reserve, it will automatically increase for each year your claim remains open. These supplemental reserves acknowledge the fact that the longer a claim stays open, the higher the value increases.
When a claim is open, an insurer must comply with state workers’ compensation guidelines. The guidelines require insurers to provide the state with information concerning their pending claims. When an insurer settles a claim, their primary benefit comes from eliminating their claim-handling responsibilities.
Benefits to the Florida DWC
Florida Statute 440.525, requires the Florida Department of Workers’ Compensation to periodically audit the insurer’s workers’ compensation claim files. The Centralized Performance System reviews claims to ensure their compliance with state guidelines. Also, the system addresses claim delays, payment histories, evidence of coercion or harassment, and other issues. The Audit Section provides for audits of insurers, self-insurers, and self-insurance fund payments and practices. Additionally, the Department of Workers’ Compensation will hold hearings to address workers’ complaints, unpaid benefits, and other issues involving your claim.
Settling a claim benefits Florida’s DWC by reducing the number of open claims and eliminating the responsibilities associated with handling those claims.
Benefits to Injured Workers
When a worker suffers a back injury on the job, they often struggle financially, emotionally, and physically. Workers’ compensation benefits can help reduce this strain, but often, you receive minimal benefits over time. The workers’ compensation payment rate only affords you a portion of your pre-injury wages. Depending on a worker’s back injuries and injury-related impairments, this process can continue indefinitely.
A lump-sum back injury workers’ compensation settlement may give injured workers the power to change their financial circumstances. A lump sum may allow you to better plan your finances and live more comfortably. This can give injured workers the freedom to begin to pay off accumulating debts while relieving financial stressors.
The Potential Disadvantages of Settling Your Back Injury Workers’ Comp Claim
As you examine your workers’ compensation settlement options after a back injury, you will likely realize that you have a lot at stake. Settling your claim too early or for an unreasonably low amount can adversely affect you, your family, and your future.
Minimal Disadvantages for Insurers
Insurance companies design their injury claim departments to ensure they incur minimal risk when settling a workers’ compensation claim. Because money is involved, supervisors closely monitor claim representatives and must authorize all settlement figures. The settlement authority system makes it difficult for a claim representative to overpay a workers’ compensation settlement. Although you may only have direct contact with the claims representative, an experienced supervisor usually controls the negotiations.
In exchange for your settlement check, you must agree to release all current and future workers’ compensation claims. The insurers want to close the file and any possibility of subsequent claims. Releasing your rights to future claims means you will be solely responsible for any future expenses related to medical care, surgeries, or hospitalizations.
Minimal Disadvantages for the DWC
Settling your claim has no adverse effects on the Department of Workers’ Compensation. Rather, your release allows the DWC to eliminate any active monitoring because settlement eliminates the risk of a future complaint. The DWC has no responsibility to provide any further services related to your claim.
Potential Disadvantages for the Injured Worker
Your workers’ compensation settlement may proceed exactly the way you anticipate. A settlement may support you financially as you work your way back to health and productivity. However, if you require unanticipated medical treatment, you may find that the settlement amount is too low to meet your needs.
If you have medical issues related to your settled claim, you’ll have to pay the bills out-of-pocket. If you are unable to work and have no income, your lump sum will eventually run out. You must negotiate a settlement you deserve, or settling may create more problems than it solves.
A Workers’ Compensation Attorney Makes the Process Easier
When you evaluate your claim settlement options, you should consider connecting with an experienced legal representative. An experienced workers’ compensation lawyer can reduce stress and efficiently navigate the settlement process.
Work-related back injury cases are inherently complicated. The rules and guidelines are generated from complex state statutes. Insurance companies who handle workers’ compensation cases often have no problem questioning the validity of a back-injury claim. Insurance companies will conduct personally invasive investigations attempting to discredit your claim of injury. Some methods of investigation include: surveillance of your daily life, social media investigations, and activity checks to confirm your injury. When an insurance company negotiates injury claims, the primary goal is to pay as little as possible.
Workers’ compensation attorneys will engage with insurance companies on your behalf. Knowledge of state statutes and guidelines allows attorneys to ensure you receive a fair settlement. An attorney’s understanding of the workers’ compensation system enables a fair evaluation of your injuries before settlement. Workers’ compensation attorneys have experience dealing with insurance companies and can confidently negotiate your settlement.
When you consult a reputable workers’ compensation attorney at Sibley Dolman Gipe Accident Injury Lawyers, PA, your initial visit is complimentary. You’ll have an opportunity to hold a commitment-free discussion and learn if legal representation will help you resolve your case. Call us today to learn more about your legal options and protect your rights to full compensation and benefits.
Sibley Dolman Gipe Accident Injury Lawyers, PA
800 N Belcher Rd
Clearwater, FL 33765
Phone: (727) 451-6900