Odds of winning a workers’ comp case – A PI lawyer explains

Posted on January 24, 2023

There is data indicating that around 93 percent of workers’ compensation cases lead to al least some benefits being paid. However, “winning” a workers’ comp claim does not just mean receiving benefits. It also means receiving adequate compensation to cover all of your

• medical expenses,
• rehabilitation, and
• lost wages.

Many workers who receive benefits are still under-compensated. However, there are things that you can do to increase your odds of “winning” adequate compensation.

What does it mean to “win” a workers’ comp case?

Winning a workers’ compensation case means recovering enough to cover your

• medical expenses,
• lost wages, and
• vocational rehabilitation.

Just because you have received some workers’ comp benefits does not necessarily mean that you have received enough. The amount you received may not be enough to fully compensate you for your losses.

This means that the study that estimated that only 7 percent of workers’ compensation claims were denied¹ is misleading. Many of the 93 percent of cases that led to an award or settlement may not have recovered enough.

For example: Bill falls off a ladder at work and gets hurt. While workers’ compensation covers most of his medical treatment, he still pays $5,000 out of his own pocket for physical therapy. He also loses $25,000 in wages. He settles his workers’ compensation claim, but only receives $10,000. While he recovered some benefits, he has hardly “won” his case.

How much is the average workers’ comp settlement?

The average payout for workers’ comp claims that were initially accepted was $10,153 in 2017. For claims that were initially denied by workers’ compensation insurance companies, it was $15,694. These averages, though, varied widely depending on the state where the accident happened. For example, initially accepted claims averaged

• $16,833 in California, but only
• $7,226 in Florida.²

However, averages can be misleading because there is no such thing as an “average” workers’ compensation claim. Some claims involve serious or even fatal injuries. Far more workers’ comp claims are for minor injuries where you make a full recovery. Some of the claims involving severe injuries, though, may settle for substantially less because there are factual disputes over whether the injury is covered by workers’ comp.

As a result, comparing your workers’ compensation benefits to the average settlement does not tell you whether you “won” or “lost” your case. What matters is whether your benefits package sufficiently compensates you for your particular losses.

Under workers’ compensation law, you deserve:

• medical benefits to cover the medical costs of your personal injury, and
• disability benefits to cover a part of your average weekly wage that was lost due to your impairment.

Those disability benefits can take 4 forms:

1. temporary partial disability, for wage reductions while you were recovering,
2. temporary total disability, for complete loss of income while you were recovering,
3. permanent partial disability, for future lost wages due to an impairment that will keep you from working without restrictions, and
4. permanent total disability, for complete loss of income due to disabilities that keep you from working, at all.

These disability payments can be made in a structured settlement amount, or paid all at once in a lump sum.

What can I do to increase the value of my workers’ comp claim?

There are several steps that you can take that can increase the value of your workers’ comp claim. They are:

1. report your injury immediately,
2. do not downplay your injuries,
3. go to the doctor immediately,
4. document everything,
5. be careful when talking to an insurance adjuster, and
6. hire an experienced workers’ compensation attorney.

1. Report your injury immediately

Reporting your injury as soon as it happens is essential. It can avoid a wrongful denial that lengthens your case, and can prevent the workers’ comp insurer from arguing that the injury was not job-related.

Some employers have specific instructions for how to report a workplace injury. In many cases, though, it suffices to email your supervisor and inform them of the injury. It can help to include the names of witnesses or coworkers who saw the incident.

If you fail to report the injury, or delay for too long, it can give your employer’s workers’ comp insurer an opening to deny the claim. They will likely argue that the delayed report means that you actually got hurt off the job and are wrongfully claiming workers’ comp. They may also argue that the late report violated company policy and deny the claim, or argue that the delay makes it impossible to verify whether the accident happened on the worksite.

2. Do not downplay the severity of your injuries

Many workers downplay the severity of their injuries in the immediate aftermath of an accident. They may do this in an attempt to reassure their supervisor that they will be back at work very soon.

However, statements like, “It’s okay, it’s just my bad knee,” or “I’m okay, it doesn’t hurt too much and I can still work” will be used against you in a subsequent workers’ compensation claim. The insurer will argue that the injury

• was an aggravation of a preexisting one,
• was not a workplace injury, or
• that it is not as severe as you are making it seem, now.

It is far better to let a doctor determine how badly you were hurt.

3. Immediately go to the doctor

You can also increase your likelihood of recovering adequate compensation by going to the doctor right away.

If you delay in getting medical attention, it can be more difficult to prove that what you suffered was a work-related injury. By seeing a doctor immediately, it lets the doctor more reliably connect the injury to something that happened on the worksite.

Getting immediate medical attention also helps to indicate that the injuries are not minor. Workers’ compensation insurance companies tend to point to any delay between the injury and the doctor’s visit as a sign that it was not a big deal. If the injury was serious, they often say, you would have gone right away. Because you did not, it is a minor injury.

4. Document everything

Documenting everything can also help you win your workers’ compensation claim. This includes:

• medical bills,
• a timeline of hours missed from work,
• the notification you sent to your employer about getting hurt,
• a detailed report of what you remembered happening in the accident, and
• notes about all phone calls you have regarding the incident, including the name of the person you talked with and the time of the phone call.

Some of these documents, like the medical records detailing the medical care you received, will go to prove how much compensation you deserve. Others provide important details about the accident. Still others prevent the workers’ comp insurer from raising some common defenses to the claim, such as the defense that you did not notify your employer.

If your state’s wiretapping laws allow for it, recording all phone calls you have about the accident can be helpful.

5. Be careful with the insurance adjuster

After the accident, the workers’ compensation insurance company will send an insurance adjuster to investigate the incident. They will document everything that they can that might reduce the payout, including any statements that you make about the incident.

Saying anything that downplays your injuries or injects doubt into your claim that it was workplace-related will be used against you. Those statements will be reflected in the initial settlement offer that the insurance adjuster makes.

Many workers’ comp lawyers recommend that their clients not talk to the adjuster. Instead, you can refer the adjuster to your lawyer.

6. Hire a workers’ compensation lawyer

Probably the best way to increase your odds of getting a good settlement that covers your losses is to hire an experienced workers’ comp attorney from a reputable law firm. Lawyers who have provided legal representation to victims like you before will know how to press a claim under their state’s workers’ compensation act.

Their legal advice will also give you a good idea of the compensation that you are entitled to receive and the defenses that insurers will raise as they try to block you from getting it.

Injured workers who establish an attorney-client relationship with an experienced attorney increase both the likelihood of receiving a workers’ compensation settlement, and increase the settlement amount that they do end up receiving.

1. Scott Van Voorhis, “Research: Workers’ Compensation Claim Denials Inch Upward.” Engineering News-Record (July 10, 2018).
2. Same.