It’s not uncommon for someone injured on the job to wonder what their workers’ compensation case would be worth if they were to discuss settlement with the workers’ comp adjuster. In pondering a settlement, questions regarding what amount would be fair, what amount would be reasonable, and ultimately what amount would be offered, frequently cross the minds of those considering a settlement of their workers’ comp claim. Unless you have the depth of experience we do with respect to workers’ comp claims, composed of a thorough knowledge of the laws that determine your eligibility and entitlement to workers’ comp benefits, and an understanding of how the value of a workers’ comp claim is considered from the carrier’s perspective, any answer you may come up with as to the potential value of your workers’ comp case is not likely to be accurate. Please understand that suggesting you’re not likely to come up with an accurate value is not intended as any kind of insult. We have no idea how to do the job you do just as much as you aren’t likely to understand ours. When it comes to representing individuals in workers’ comp claims, or any of the other areas of law we handle, we pride ourselves on ensuring that we know everything there is to know. If the matter falls outside the scope of our expertise, more often than not, we will utilize our resources to refer you to a law firm with such expertise.
Workers’ Comp Claim Strategy
We have a proven strategy for handling claims in which we undertake representation. In order to implement our strategy and provide representation at our level, you’ll find that our discussions with you will be candid, direct, and honest. There are firms that will tell you they have expertise in areas they don’t. There are firms that will tell you whatever they think will work in order to persuade you to allow them to handle your case. Promising that your case will settle for nothing less than a specific amount, promising that your case will settle will settle within a certain time, are the kinds of guarantees that are unethical and should serve as huge red flags about the integrity of that firm. We have not, and will not, ever stoop to such a level. We say what we mean and mean what we say. We’re happy to discuss your case with you and if you ask, provide an opinion as to the potential value. However, our opinion is just that; nothing more than speculation based solely on the information available to us as the time you ask.
Workers’ Comp Settlement
Workers’ compensation settlements are similar to personal injury settlements in that a common occurrence involves a client to telling us about how a friend or relative told them how much of a settlement they received in their case. You would be surprised how often people misrepresent the amounts their case settled for. So, don’t be inclined to consider such statements as any kind of absolute truth.
It’s important to understand that quite a number of significant differences exist when determining the potential settlement value of a workers’ comp case in comparison to a personal injury case. One of the most common misunderstandings concerns damages. There are certain damages considered in personal injury cases that are not available for consideration when evaluating the value of a workers’ comp case. Specifically, non – economic damages such as pain and suffering, loss of consortium, loss of enjoyment of life, and emotional distress are examples of damages that are not subject to consideration or inclusion in determining the potential value of a workers’ comp case. Such damages are subject to potential recovery and can be included in connection with auto accidents, slip and falls, or other type of personal injury matters. Such non – economic damages do not come into play in workers’ comp cases because when creating the laws that govern workers’ comp claims in Florida, our Legislature did not make any laws requiring a workers’ comp carrier to pay for such non-economic damages.
So, the end result is that an accident and resulting injuries suffered by someone while in the course and scope of their employment will have less value than if that same exact accident and the same resulting injuries arose out of circumstances unrelated to their job. However, if the claim is not governed by workers’ comp laws, the issue of liability must be established. Proving negligence is necessary and is not always as clear cut as you may think. Not only is proving negligence necessary, the means to pay any settlement, verdict, or judgment must also exist. That means confirming that the defendant (negligent party) had an insurance policy in effect on the date of the accident, or is otherwise sufficiently financially solvent to pay.
There is an article we published a few months ago discussing the fact that someone can have both a workers’ comp and personal injury claim simultaneously and from the same accident. Please review our past workers’ comp articles to gain an understanding of the particular circumstances that must exist for someone to have both such claims at the same time – a workers’ comp claim and a personal injury claim.
Florida Workers’ Comp Cases
In addressing what factors determine the value of a Florida workers’ comp case, it is important to understand a few essential factors. First of all, there is no right to a settlement in a workers’ comp case. Meaning, the workers’ comp insurance company (hereafter referred to as “carrier”) cannot force you to settle and you cannot force them to settle. The adjuster for the carrier cannot tell you, “We’re going to pay $1,000.00 and be forever released from any and all obligations regarding paying lost wages or medical bills.” Similarly, you cannot call the carrier and demand $1,000,000.00 or threaten to take them to trial. No judge or jury will ever determine the amount that a carrier should pay to settle a workers’ comp claim. We mentioned the fact that non – economic damages such as pain and suffering are not considered earlier in this article.
Another factor to keep in mind is that settlements of workers compensation claims are voluntary. As noted, neither side can force the other to settle. Though no right to a settlement exists, the vast majority of all workers’ comp cases settle. Quite often, it is your best option. You can always ask us to inquire as to whether the carrier has an interest in settling and how much they would be willing to pay. Such an inquiry does not have any negative impact on your claim whatsoever.
There is no perfect time to settle. Settlements take place when you have been advised of the pros and cons and believe it is in your best interest to do so. Sometimes a workers’ comp case will settle within weeks or months after an accident. Sometimes it takes place years later. Each case, just like each individual, is different.
The value of a workers’ comp case is determined primarily by one single factor more than any other – future exposure. Future exposure is what the carrier can reasonably anticipate having to pay as future wage loss and medical benefits. These future benefits are limited to what the carrier considers the foreseeable future. The “foreseeable future,” from the perspective of a carrier consists of approximately the next 3 to 6 months. They do not consider what it will cost to treat you for your anticipated life expectancy, or until age 75; the age at which benefits ultimately cease for someone injured so severely that they are rendered permanently and totally disabled. This is known as Permanent Total Disability (PTD). In order to prove someone is PTD from a work injury, they must establish that they are incapable of work of any kind; even sedentary labor; and that no job exists within a 50-mile radius. The issue of determining whether someone is eligible for PTD benefits is beyond the scope of this article. We mention it only because such cases are ones in which the present value of the claim is determined and a settlement is paid amounting to half the present value; or even a little less.
Workers’ Comp Case Value
So, when is your workers’ comp case at a point where it would arguably have more value than at any other time? Your case would arguably have more value if the doctor you are seeing through the carrier recommends that you undergo surgery. If you choose to settle rather than undergo the surgery, you are much more likely to receive a higher amount than if you undergo surgery. Please bear in mind that in no way should you interpret the sentence regarding surgery and value to mean that we do not think anyone should undergo surgery. That is not the case. We will recommend that you undergo whatever treatment your doctor feels is medically necessary and that you are in favor of going through with. When it comes to treatment such as surgery, some people have no other source from which they would be able to pay for such treatment and they absolutely want to go through with it. Not only is that decision entirely agreeable with us, we are adamant about ensuring you understand that the settlement of your workers’ comp case is your decision. As you have probably gathered by now, settlements of workers’ comp claims can be a bit more complex than settlements in other areas of law. That is not always true, but there are indeed factors you will be informed of and must consider in making such a decision.
Another point that is important to understand concerns the amount of treatment you have that is paid for by the workers’ comp carrier. A workers’ comp case does not become more valuable as a result of someone undergoing numerous surgeries or otherwise having costly treatment performed. A workers’ comp claim does not necessarily become more valuable simply because it has remained open for an extended period of time. In fact, an injured employee is entitled to a maximum of 104 weeks of wage loss benefits. Well over 90% of those injured on the job won’t even come close to receiving 104 worth of wage loss benefits. However, if an employee is paid 104 weeks, they reach what is called statutory Maximum Medical Improvement (MMI). At that point, unless the employee is PTD, there is no longer any future wage loss exposure, as it would pertain to indemnity benefits. The carrier is obligated to pay for medical care and wage loss directly related to the job injury, and only that which is directly related to the job injury. If the major contributing cause of the injury and need for treatment is not the job injury, the treatment will not be authorized and no entitlement to benefits will exist.
One way to explain the evaluation of a workers’ comp case from a carrier’s perspective when a surgical recommendation has been made is to simply state that the carrier will either put the money in your pocket or the doctor’s pocket. Your choice. If you have an attorney representing you, carriers have data showing that the cases not only settle for more than they would if you attempted to settle on your own, the data reflects that the total cost of the claim when you, the claimant, are represented by an attorney, is significantly higher. This increase in the cost of the claim occurs because attorney involvement on your behalf most certainly helps ensure the carrier is paying all benefits you’re entitled to, 20% penalties on late payments of indemnity benefits, and ensuring that recommendations for medical care by your authorized treating physicians are indeed authorized by the carrier. Essentially, the carrier is no longer able to manipulate or otherwise take advantage of someone injured on the job as a result of the person’s lack of familiarity with Florida’s workers’ comp laws. The undeniable truth is that if workers’ comp insurance companies did what they were supposed to in the first place with respect to their obligation to provide benefits, representation of injured workers would not be an area of law any firm would practice.
Contact Dolman Law Group in one of the ways below to discuss your case with one of our experienced workers’ compensation attorneys.
Please feel free to contact us with any questions. You can reach us in one of these 4 ways:
Dolman Law Group
800 North Belcher Road
Clearwater, FL 33756