93 percent of workers’ comp claims lead to a payout right away, according to one study. Of the 7 percent of claims initially denied, two-thirds are overturned and paid out within the year. However, this does not necessarily mean that the victim is fully compensated. You only “win” your workers’ comp case if you recover what you deserve.
What does it mean to “win” a workers’ comp case?
It is not enough for you to recover compensation in a workers’ comp case. Instead, it would be best if you recovered adequate compensation for your losses. Only if you are fully compensated for your losses can you “win” a workers’ comp case.
Workers’ compensation laws cover your losses by providing:
- medical treatment,
- disability benefits, and
- death or survival benefits, if the workplace accident was a fatal one.
You only “win” your claim if these workers’ compensation benefits cover what you have lost from the work-related injury.
If you get hurt on the job, your employer’s insurer will pay for your medical treatment.
While your case is pending, the workers’ compensation insurance company will cover your medical bills.
However, if your case settles in a compromise and release, your future medical expenses will be paid in a lump sum. It is incredibly important for this lump sum to cover your future medical care. If it does not, you will have to pay for it yourself, even though it is for a work injury.
You are also entitled to disability benefits. These pay a portion of the wages you are losing due to your injuries. Most states’ workers’ compensation laws provide you with up to a maximum of two-thirds of your average weekly wage.
While you recover from the injury, you are entitled to:
- temporary partial disability benefits, if you can work in a lesser capacity, or
- temporary total disability benefits, if you cannot work at all.
These temporary disability benefits last until:
- you return to work,
- your doctor says that you can return to work,
- your medical condition stabilizes and you reach maximum medical improvement (MMI), or
- you reach the statutory maximum amount of time for temporary disability benefits.
At this point, if you are still disabled, it is reclassified as a permanent disability. You can be entitled to:
- permanent partial disability benefits, which cover your loss in wages for not being able to return to your normal work, or
- permanent total disability benefits, which cover your wage loss for not being able to work at all.
When your case settles, all future disability benefits will be paid out. Winning your workers’ comp claim means settling it for an amount that adequately covers your wage loss.
If the workplace accident was fatal, the victim’s loved ones can be entitled to death benefits. These are typically:
- burial expenses, and
- a monetary payment to the victim’s dependents.
Winning a workers’ comp claim involving death benefits means securing adequate compensation for your significant losses.
What percentage of workers’ comp claims lead to a payout?
93 percent of workers’ compensation claims are processed and paid out. Of the remaining 7 percent denied, two-thirds are paid out after being overturned in the appeals process.
However, this does not mean that those 93 percent of claims paid out were victories for the hurt worker. They may have received far less in workers’ comp benefits than what they will need to recover from their workplace injury.
Unfortunately, years usually have to pass before it is clear that your settlement was enough.
Can I increase the odds that my workers’ compensation case wins?
You can do several things to increase the odds that you recover the workers’ comp you need and deserve.
You should report your injury immediately and notify your supervisor in writing. Your note or email to your supervisor should include:
- a brief description of your injury, and
- how you got hurt.
If possible, get witness statements from any coworkers or anyone else who saw the injury. This can be very valuable evidence that you got hurt on the job.
You should NOT understate your injury. Trying to reassure your boss or coworkers by saying it is not a bad injury can be natural. However, such a statement will be used against you during the workers’ compensation process.
You should visit the doctor right away. Delaying makes it seem as if the injury is not bad. It will also delay the diagnosis. Finally, connecting the injury to your workplace can make it more difficult. This is particularly true if your job makes an existing medical condition worse.
You should take the doctor’s advice and try to return to work. Workers’ compensation insurance carriers look for every reason they can to deny your claim or reduce its payout. It is not uncommon for them to claim that you are not taking your recovery seriously. Insurance adjusters will be on the lookout for any signs that you are exaggerating your impairment or shirking treatment, such as by skipping physical therapy sessions.
Finally, you should hire an experienced workers’ compensation attorney from a reputable law firm.
What can a workers’ compensation lawyer do to help?
An experienced workers’ comp attorney can ensure that your claim is strong and supported by evidence and medical records. They can gather evidence on your behalf and file the necessary paperwork.
Establishing an attorney-client relationship with a lawyer for your workers’ compensation claim can greatly affect your workers’ compensation settlement amount.
The legal advice of a workers’ comp lawyer can also drastically reduce the anxiety that the claims process can cause. Their prior experience providing legal representation to other injured workers can ensure that you get what you deserve.
 See California Labor Code 4653 LAB.
 See California Labor Code 4656 LAB (generally 104 weeks in a 5-year period).
 See California Labor Code 4701 LAB.
 Scott Van Voorhis, “Research: Workers’ Compensation Claim Denials Inch Upward,” Engineering News-Record (July 10, 2018).