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Workers’ compensation insurers can offer a settlement at any point in the claims process. It can happen as early as a few days after your claim, or as late as a year after it. Many factors can impact when the offer is made, but the severity of your injuries are a major influence. If accepted, the settlement ends the case.
How early will workers’ comp cases settle?
Workers’ comp cases can settle very quickly after the injury. In some cases, they can settle within a few days of making your claim. This can happen if the extent of your injuries are very clear and it is easy to see how much compensation you deserve. It can also happen if your employer’s insurer thinks that you will accept a quick settlement that does not reflect your losses.
How long can the settlement process take?
In some cases, workers’ comp insurers do not make an offer to settle the case for nearly a year. Sometimes they will do this because there is uncertainty about how much your medical expenses will be. This can happen if you have not reached maximum medical improvement (MMI) yet. Other times, they will do this because they think that you will be willing to accept a lower amount if they delay long enough for you to feel financial pressure to settle.
Occasionally, insurers may not make a settlement offer, at all. This happens most often when the insurer denies the claim for workers’ compensation. If you appeal the denial, the insurance provider may refuse to settle the case in the hope that their denial will get upheld on appeal.
What factors can change the workers’ compensation settlement timeline?
There are numerous factors that can influence the settlement timeline for workers’ comp cases. 2 of the most important are:
- the willingness of the parties to compromise, and
- whether there are factual disputes about what happened or about your injuries.
Willingness to compromise
If the parties are willing to compromise, it will speed up the settlement process. Some workers’ comp insurers are known for fighting for every dollar to protect their bottom line. Others have a reputation for making fair settlement offers. Unfortunately, many employers are drawn to insurers that payout less because those companies generally have lower premiums. Workers’ comp cases with these insurers may take longer because their settlement offers are too low. They may even be willing to delay the case to increase the financial pressure you feel to settle for an inadequate amount.
The settlement timeline can also speed up if you are willing to accept a lower amount than you may be entitled to receive. You may not receive compensation for all of your losses. However, you will receive that compensation more quickly.
Factual disputes about the case
Any factual disputes can slow down a workers’ compensation case. The 2 most important types of factual disputes in a workers’ comp claim are:
- whether the claim was correctly denied, and
- how much compensation you deserve for your injuries.
Some workplace injuries are not covered by workers’ compensation. Claims for compensation for these injuries can be denied coverage. These include injuries:
- that were self-inflicted,
- sustained while you were committing a crime,
- that resulted from drug or alcohol use, or
- that happened while you were fighting, joking around, or roughhousing with someone else.
When it appears that your injuries are not covered, the workers’ comp insurer will rarely offer a settlement. This can extend the length of the case. Only as evidence gets discovered that resolves this factual dispute will the case move towards a settlement.
More often, factual disputes will concern your medical expenses and medical care. This is especially common when your injuries:
- are severe,
- will lead to lasting disabilities, impairments, or debilitations, or
- still require medical attention.
If you have not reached MMI, yet, then you will still accumulate medical expenses in the future. The amount of these future medical bills is still uncertain. That uncertainty is a factual dispute that can lengthen the case. You may think that you should be compensated for certain upcoming medical procedures. The insurer may deny that they are medically necessary. Whether they are necessary or not, and how much they will cost if they are necessary, are questions that can slow down the settlement process.
Are there different types of settlements?
There are 2 different ways to settle a workers’ compensation claim:
- by stipulation and award, or
- by a compromise and release.
A stipulation and award creates an ongoing relationship with your employer’s insurance company. The insurer agrees to pay for any future medical care that you need and that is related to the injury. If those medical costs end up being higher or lower than expected, the insurer will pay them, anyway.
In a compromise and release, the insurer will offer you a lump sum of money. That settlement amount is a negotiated sum that reflects your losses from the work-related injury. It can come in a single payment or in a structured settlement. It aims to cover an injured employee’s:
- future disability payments,
- future medical expenses, and
- out-of-pocket expenses still owed by the insurer.
Once the lump sum payment is made, the workers’ compensation claim closes. The compromise and release ends the case. If you make a compromise and release, but then you find that your future medical treatment will end up costing more than you had expected, you will find yourself undercompensated by the payout from the lump sum settlement agreement.
What will a workers’ comp settlement cover?
All workers’ compensation settlements aim to cover your:
- lost wages, and
- medical expenses.
Lost wages are covered by disability benefits. Any reductions in your wages or income while you were recovering come in temporary disability benefits. If your injury has stabilized and you have reached MMI, but are still unable to work in your prior capacity, you will receive permanent disability benefits. If you are unable to work at all, your workers’ comp benefits can be for total disability.
Workers’ compensation law also provides medical benefits that cover your medical bills from the injury.
Injured workers can maximize the workers’ compensation benefits that they receive by hiring an experienced workers’ compensation attorney from a reputable law firm to represent them throughout the process. A workers’ compensation lawyer’s legal advice can help you recover what you really deserve.
About the Author
Neil Shouse
A former Los Angeles prosecutor, attorney Neil Shouse graduated with honors from UC Berkeley and Harvard Law School (and completed additional graduate studies at MIT). He has been featured on CNN, Good Morning America, Dr Phil, Court TV, The Today Show and Court TV. Mr Shouse has been recognized by the National Trial Lawyers as one of the Top 100 Criminal and Top 100 Civil Attorneys.
