Are you entitled to a workers’ compensation settlement? That is a good question that many people ask me.
The short answer to that question is that you are not necessarily “entitled” to a settlement. Most people who are injured at work do end up receiving a settlement, but a settlement is something different than what most people think.
This articles discusses what a settlement is. It also discusses when you should consider settlement and important issues that relate to settlement of a workers’ compensation claim.
Can I Go To Court and Get a Case Settlement?
Settling a workers’ compensation case is different than settling a car wreck or other type of personal injury case. In a car wreck case, the individual who is injured can go to court and get a decision from a jury. That decision generally will be awarded in a lump sum.
In a Georgia workers’ compensation case, you can also go to court. But, there is no way to get a judge or a jury to award you a lump sum amount for the entire value of your case by going to court. The only way to get a lump sum awarded is to agree upon a settlement with the workers’ compensation insurance company.
If I Cannot Get a Settlement by Going to Court, How Do I Settle my Case?
Settlement has to be an agreement. This means it must be voluntary. You cannot force the insurance company to settle. They cannot force you to settle.
When injured workers settle their cases, they are really agreeing to sell the insurance company the potential workers’ compensation benefits that theymight receive in the future. In exchange, the insurance company agrees to pay them a certain amount of money.
The reason that you are not necessarily entitled to a settlement is that settlement requires agreement with the employer and insurance company. If the insurance company does not want to settle, you cannot make them settle.
But, the insurance company also cannot make you settle. If the insurance company does not want to pay you the amount that you want to take for your case, then they cannot make you settle with them.
Can I Change My Mind After I Settle?
Settlement of your worker’ compensation case is final. That is probably the most important thing you need to know.
Once the Georgia State Board of Workers’ Compensation has approved your settlement, there is probably nothing that can change it. If you need more medical treatment or miss more time from work than expected after settlement of your case, you cannot come back and ask for more money.
This means you need to carefully consider settlement of your case before making a final decision. You do need to understand that a Georgia workers’ compensation settlement is not final until the State Board approves it. Before then, either side can back out.
What Are Some of the Factors I Should Consider?
You can settle your case at any time. However, you cannot change your mind once your settlement is approved by the State Board. So, you want to have a good understanding of what future benefits you will probably receive from the workers’ compensation insurance company before deciding what you should accept to settle your case.
Some of the factors that you want to consider in deciding what to settle for include the following:
- Temporary total disability or temporary partial disability benefits (commonly known as TTD and TPD) – these are benefits that the insurance company owes you when you are out of work because of your injury or working but earning less money because of your injury.
- Medical benefits – the insurance company is responsible for paying for medical treatment needed as a result of your injury. Some medical costs that are most common in workers’ compensation claim are surgery, physical therapy, pain medication, MRIs, x-rays, and other forms of medical treatment and testing.
- Permanent partial disability benefits – these are benefits that the insurance company pays when the doctor says that you have some permanent impairment as a result of your injury. Georgia law currently requires the doctor to use the American Medical Association’s Guide to the Evaluation of Permanent Impairment, 5th edition, when determining the percentage of permanent impairment.
- Whether the insurance company owes you any past due benefits
- How long you will draw workers’ compensation benefits in the future
What about Pain and Suffering?
Clients often ask me about getting paid for what they have gone through because of their injuries. Sometimes, you can have a workers’ compensation case and a personal injury case from the same incident. In a personal injury case, you can get paid for pain and suffering. Georgia workers’ compensation law does not cover pain and suffering.
Clearly, injuries cause pain. Many of my clients experience severe pain because of their injuries. It is frustrating to tell them that they cannot get money from workers’ compensation for pain and suffering.
I wish I could force the workers’ compensation insurance company to pay my clients for the pain they experience. You may even run across an attorney who will promise you they will get you paid for pain and suffering in a workers’ compensation case. Unfortunately, that is an empty promise because the law does not allow payment for pain in suffering in a Georgia workers’ compensation case.
If workers’ compensation does not pay for pain and suffering, does it pay anything similar?
The closest that workers’ compensation gets to paying for pain and suffering is permanent partial disability (PPD) benefits. These benefits are not paid to you because of the pain that you currently experience or have experienced. You receive PPD because the doctor says that you have a permanent impairment as a result of your injury.
Is it fair that people are not paid for the pain that they experience when they are injured at work? I don’t think so. Unfortunately, there are many things that I think are unfair about Georgia’s workers’ compensation system.
Do I Have To Settle My Case?
You never have to settle your case. Settlement is voluntary.
Even if you eventually decide to settle your case, you do not have to settle it now. You do not have to settle it next month. You want to make sure you are ready when you decide to settle.
Do I Need An Attorney To Settle My Workers’ Compensation Case?
You can settle your workers’ compensation case without an attorney. But, it is very difficult to make the right decision about settlement without consulting an attorney.
The evaluation of a case for settlement is a very complex process. It requires a good understanding of what is likely to happen under Georgia law in the future if you do not settle your case. I would always recommend consulting with a workers’ compensation attorney before settlement. Then, you decide whether you should hire an attorney.
What Factors Should I Consider To Decide Whether Now Is a Good Time To Settle My Case?
One factor that is important to consider is how accurately you can predict how your injury will affect you in the future. Settlement of a Georgia workers’ compensation case is mostly about how your injury will affect you down the road.
You can settle your case immediately after getting hurt at work. Doing that would be a bad decision.
Settlement of a case should involve an evaluation of what will happen in the future. You could not accurately predict what sort of medical treatment you are going to need for your injury right after it happens. You also would not know how long you will be out of work. Because of that, you might end up settling for a lot less than you should.
Wait Until You Have A Good Understanding of Your Injury
A good time to consider settlement of your case is when you have a good understanding of how your injury will affect you in the future. You might know this just a few months after your injury at work. However, in most cases involving serious work injuries, it takes much longer to get a good understanding.
If your work injury is one where the treating doctor recommends surgery, you will almost always want to wait until after you have had the surgery before considering settlement. Before you have the surgery, you will not have as good an understanding of any permanent effects that the work injury will have on you.
Long Term Disability and Settlement
Some people receive both long term disability and workers’ compensation benefits for an injury. The long term disability policy should define the benefits provided by long term disability insurance. Most of the time, long term disability and workers’ compensation benefits affect each other. Usually, one of these two benefits will be reduced.
While each long term disability insurance policy is different, settlement of a workers’ compensation claim can change the effect that workers’ compensation benefits and long term disability benefits have on each other. It is very important to consider how settlement of your workers’ compensation claim would affect any long term disability benefits.
This will require a careful review of your long term disability insurance policy because each long term disability policy is different.
Social Security Disability and Settlement
Workers’ compensation can affect Social Security Disability benefits. Settlement of your case may affect Social Security Disability benefits as well. Individuals become eligible for Social Security Disability benefits by filing a claim with the Social Security Administration.
When an injured worker qualifies for Social Security Disability benefits, Social Security Disability may reduce the benefits because the injured worker is also receiving workers’ compensation benefits. This does not happen in all cases. Social Security has a formula that determines when a benefit reduction happens.
If Social Security reduces your benefits, settlement sometimes can reduce or completely do away with the benefit reduction.
It is important to understand how Social Security calculates the reduction in benefits. There are several factors that go into this. Having the right language in your settlement paperwork gives you the best chance of having the Social Security benefit reduction go away after settlement.
Medicare and Settlement
One final factor to consider in settlement is Medicare. An individual usually becomes eligible for Medicare at age 65 or thirty months after the date of disability as determined by the Social Security Administration for Social Security Disability purposes.
Medicare eligibility or even an expectation of Medicare eligibility is important when considering settlement of a workers’ compensation claim. The reason it is important is that Medicare requires injured workers, employers, and insurance companies to consider Medicare’s interests when settling a claim. Medicare does not want to pay for medical treatment for which the workers’ compensation insurance company should have paid.
For people considering a workers’ compensation settlement, this means that extra care must be taken when that person is Medicare eligible or will soon be. It also means that money may need to be “set aside” from any settlement to pay for possible future medical treatment.
Settlement Is Final
There are many factors to consider when making a decision about settlement. You only get one shot. Make sure the insurance company fully compensates you for how your injury will affect you in the future if and when you settle.