Most people have some idea of what a workers compensation settlement is. They understand that it is money paid to them by the insurance company that compensates them in some way for their injury at work.
But, many people do not understand the specific of how a settlement is calculated. Is there an amount assigned under Georgia’s workers compensation laws for each different type of injury? Is there a settlement formula that number are plugged into to determine a total settlement?
The workers compensation laws in Georgia do not assign a specific settlement amount for each type of injury or have a formula created to determine settlement amounts. But, parts of the law can be used to create a formula that will determine an appropriate settlement range for your case.
Before we get into that, there are a couple of important things to understand.
- You never have to settle your workers compensation case
- If you do settle your case and that settlement is approved by the Georgia State Board of Workers’ Compensation, the settlement is final and is almost impossible to undo. So, you or an attorney representing you needs to have a good understanding of workers compensation settlements so you make the right decision regarding settlement
Will the insurance adjuster tell me how much my case is worth?
Yes and no. The insurance adjuster may tell you what they are willing to pay on your case, but that is almost never going to be what your case is worth. The reason this is the case is that insurance companies want to pay you as little as possible when it comes to settlement.
You may wonder why that is. Insurance companies are generally for profit businesses. They make money by taking in insurance premiums from their customers and investing them. When someone gets hurt, they have to pay out money.
Since they are for profit businesses, they generally want to make more money. They do this in two ways:
- By taking in more premiums and investing them well
- By paying out less money to people who get hurt
Since an insurance company makes more money when they pay out less to someone that gets hurt, their goal in their cases is going to be to pay out as little as possible. So, if they can settle your case for less money, they will try to do so.
Because of this, the insurance company has an incentive to convince you that you should settle your case for less money than you really should. That leads to them trying to convince you to take less money in settlement than you really should.
Can I force the insurance company to pay a settlement?
No. You cannot force the insurance company to settle with you. But, they cannot force you to settle either. In Georgia, both you and the insurance company have to agree in order to reach a settlement of your case.
Can a judge or jury award me a workers compensation settlement?
No. In Georgia, you cannot go to court and get a judge or a jury to award you a workers compensation settlement.
A judge does approve workers compensation settlements. But, the judge only approves settlements that have been agreed upon.
You can go to court in front of a workers compensation judge to get benefits to which you are entitled under the workers compensation law. This happens when the insurance company refuses to pay the benefits you should be receiving.
Also, requesting a workers compensation hearing does motivate an insurance company to settle in certain situations. However, there are other situations where it can actually discourage the insurance company from settling with you.
Does my injury determine how much my workers compensation case is worth?
Your injury has some effect on how much your workers compensation case is worth, but it does not determine the amount. There are other factors that are more important to the settlement value range of your case than the type of injury you suffered.
This concept seems really strange. Many people would expect the severity of your injury to determine your case’s settlement value. After all, if you have a more severe injury, shouldn’t your case be worth more money?
The reason that the severity of your injury does not determine the settlement value range of your case is that insurance companies pay settlements based more on what they believe your case is going to cost them in the future than based on what happened to you. Sometimes, you can suffer a really severe injury but have a great recovery from that injury. At other times, an injury that seems more minor can cause lifelong problems.
How do I calculate the settlement value of my workers compensation case?
It is quite tricky to do correctly. As I mentioned earlier, the laws in Georgia do not assign a settlement value to your case but they can be used to create a formula that gives a settlement value range.
So, how do you use them to do that? You have to have a very good understanding of Georgia’s workers compensation laws and how those laws are going to determine what benefits you are going to receive in the future. Unless you specialize in handling workers compensation cases, that is very hard to do.
Why is that? Because it requires knowing all the ins and outs of the law and how they play out in particular cases. Here are a few examples of some of those ins and outs that can have a big impact on settlement:
- How much are you receiving in workers compensation checks? Is it the correct amount? Is your check amount going to get reduced in the future because of a Form WC-104 or a return to light duty work?
- Do you have a fair workers compensation doctor? Is that doctor going to release you to go back to full duty work or give you permanent work restrictions? If your doctor is not fair, what are your options for getting your doctor changed and what are your chances of success?
- Will you have a permanent partial disability rating for your injury? If so, what will it be? If your workers compensation doctor has already assigned a PPD rating, is it correct and, if not, how can you get it changed to the correct rating?
- How severe is your injury? Is there a chance that it qualifies for a catastrophic designation which could remove some of the limits that otherwise apply to Georgia workers compensation benefits?
For me, it is most helpful to compare this to car repairs. I can jump off a battery and do a few other minor things, but I will admit that I know a very limited amount about car engines.
If my car breaks down or has a noise that concerns me, I am not going to try to fix it myself. I am going to take it to a mechanic, an expert, to figure out what is wrong and repair it.
The workers compensation law is a lot like that car engine. There are a few parts of Georgia’s workers compensation laws that are easy to understand, but there are also a lot of small, complicated parts that make a big difference in how it works. If you do not understand how all of those small parts of the law work, they will have a large effect on the benefits you receive including any settlement.
Can a workers compensation attorney calculate the value of my workers compensation case?
Yes. I do this all the time for people that I represent. I created a workers compensation settlement calculator that I use to determine the settlement value range of cases. I use my knowledge and this calculator to do settlement evaluations for my clients.
Once I complete those evaluations, I have a detailed discussion with my client about my evaluation and explain it to them. I answer any questions that they have. Then, we discuss what number they find acceptable regarding settlement (this part is very important because my clients get my advice but then actually get to make the decision about what their bottom line is on settlement).
Once that is done, the second part of my job on settlement is to negotiate with the insurance company. When I am doing that, my job is to make sure I get the insurance company to offer as much as possible.
This is the other part of where I get to use my knowledge of Georgia’s workers compensation law. I talk to the insurance company about why my client’s case will cost them a lot in the future. Being able to demonstrate these future costs motivates the insurance company to offer more money in settlement.