Workers' Compensation From Claim To Settlement: What To Expect
Not all workers' comp cases end up with a lump-sum settlement. Sometimes, hurt workers recover enough to return to their jobs after an injury. Settlements are usually part of workers' comp benefits only when the injury is so severe that it is expected to impact a worker permanently. To get a better idea of what it takes to get from an insurance claim to a settlement, read on.
You Have Reached MMI
Maximum medical improvement (MMI) is a term insurers use to describe injuries that are unlikely to improve anymore. Most workers' comp cases begin with some initial benefits like the coverage of medical expenses and a partial disability wage. Only when the injury fails to heal does the subject of a settlement arise.
The Independent Medical Examination (IME)
Once it has been determined that you have not been able to return to work, you may be asked to undergo an exam. The IME is performed by a doctor contracted by your employer's workers' comp insurer. The doctor will make a determination that could either send you back to work or mean you are considered to be permanently disabled. If you disagree with the decision, you have the right to file an appeal. It's strongly suggested that you speak to a workers' comp lawyer before you take further action, however.
Weekly Disability Benefits Stop
The disability wage will typically stop after an MMI determination. Rather than those wages, you are now eligible for a lump-sum payment from the workers' comp insurer. It's the amount of the settlement that is the issue. You must be paid enough to cover your income for the remainder of your working days until you reach retirement age.
Medical Treatment Costs
Medical costs are usually outrageous and you need to know what will happen to your medical benefits going forward. Workers' comp is overseen by your state, and how each state handles medical care varies. Some states include medical benefits in the settlement and some do not. If you are permanently disabled, chances are you are also eligible for Social Security Disability payments and thus Medicaid or Medicare as well. Don't agree to a settlement without knowing about the medical side of things.
It's important for hurt workers to know that settlements are entirely negotiable. The insurer does not have your best interests in mind, and they will offer you the smallest amount they think you will accept. Never try to negotiate with powerful insurers on your own. Speak to a workers' compensation lawyer about your future needs and have them handle the insurer.