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How Workers Compensation Insurance Companies Calculate Settlements?

Most people have a general idea of what a workers compensation settlement is.  But, what many people do not understand is how to reach a settlement and what the amount of a settlement should be.

How do you get a workers compensation settlement?

Probably the most important part to understand about a workers compensation settlement is that it is voluntary.  Settlement is voluntary on your part which means you do not have to settle.

Settlement is also voluntary on the part of the workers compensation insurance company.  They do not have to settle with you.  They could simply choose to keep your workers compensation case open.

Since settlement is voluntary, neither you nor the insurance company can go to court and force a settlement.  This means that you or your attorney have to negotiate and reach agreement with the insurance company in order to settle your case.

They want to know why does the insurance company determine that my case is worth a certain amount of money

Businesswoman in office using calculator and laptopHow do insurance companies calculate settlements?

One of the most important things to remember is that insurance companies are businesses.  Because of that, they are generally looking at their bottom line when they make decisions on workers compensation cases.

Since settlement is voluntary, they really have two options in your case.  One is to settle with you.  The other option is to not settle with you.  So, most insurance companies are going to look at what your case would probably cost if they did not settle with you in order to make the decision of how much they will offer in settlement.

What factors are insurance companies considering in deciding what it will cost if they do not settle my case?

The biggest factor the insurance company will probably look at is what costs they will incur if they do not settle your workers compensation case.  Most of the costs that the insurance company incurs are benefits that they pay to you or on your behalf.

They are going to look at whether they are going to have to pay you weekly temporary total disability checks in the future and how long they will likely have to pay you.The insurance company will also look at how much your future medical treatment for your injury is likely to cost.

A third factor the insurance company will consider is whether you will have some permanent impairment from your injury.  If so, the insurance company will likely have to pay you permanent partial disability benefits at some point so they should consider the cost of those when they evaluate your case for settlement.

The insurance company also incurs costs just keeping your case open.  They pay an adjuster to work on your case. Many times, the insurance company also hires an attorney, a nurse case manager, and/or an investigator to work on your case.  All of these things cost them money while your case stays open.

What does the insurance company do with all these different factors they consider?

Each one of these factors is a cost or potential cost to the insurance company.  The question for the insurance company is how much your case will likely cost them in the future.  So, they are going to try to figure out a total cost of your case by figuring out the cost of each one of these factors.

The insurance company wants to have a good idea of what your case will likely cost them if it stays open.  That helps them make their decision about what they should try to settle your case for.

Consider this example.  Let’s say the insurance company adds up all the factors mentioned above and decides that it will cost them $25,000 in the future if they keep your case open.  In that situation, the insurance company might be willing to pay you up to about $25,000 to settle your case.

But, they would not want to pay more than $25,000 because think they would come out better not settling.  Since settlement is voluntary, the insurance company always has the option of just keeping your case open.

Ultimately, getting the insurance company to pay more in settlement involves convincing them that your case will cost them a lot of money if they keep it open.  This generally requires a good understanding of Georgia workers compensation law.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families. To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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Jason Perkins

Workers' Compensation Attorney

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