If you have suffered a work injury and your claim has been accepted or even denied, there is a typically a chance that your workers’ compensation case can indeed settle for a lump sum amount. Let’s look at an example if your workers’ compensation claim is denied by the workers’ compensation carrier first. By issuing a Denial, the insurance carrier is letting you know that they are refusing to accept or pay for any portion of the claim that you are alleging…what this means is that they will not pay for any wage loss or medical treatment, period, end of story.
If your claim is denied, you can file what is known as a Claim Petition to appeal the Denial. If you file a Claim Petition, you really do need a lawyer’s help, as there are certain burdens that you must meet to win. The burdens include, but are not limited to Notice to your Employer. Did you give timely Notice of your work injury to a supervisor, foreman, or manager, not simply to a co-worker. Also, you will need a doctor who will be willing to testify on your behalf that you indeed suffered a disabling work injury, for which you are missing time from work. Without a doctor to back up your version of how the work injury occurred and what injuries you suffered as a result therefrom, you will not be successful in your case. So let’s just say that you can meet both of these burdens…..although your employer and their workers’ compensation carrier may have evidence to the contrary, all of the parties may decide to simply settle the case due to the uncertainties and length of time that the litigation can take, which by the way, is typically up to one year.
Once the parties decide to try to resolve the case, you as the injured worker must come up with a demand, with the help of your lawyer, then the workers’ compensation carrier on behalf of your employer will give an offer, of course, with the help of their lawyer. The parties can negotiate back and forth on their own, or get the help of a workers’ compensation judge to serve as a mediator. If you do have a workers’ compensation judge mediate the case, both parties will advise the judge of their strengths and weaknesses of their cases.
Although not always, but typically the cases will settle for a lump sum amount, and usually require the injured worker to resign from their job. The terms of all settlements are arrived at by what both parties agree to.
Now, let’s look at the situation where your claim has been accepted and you are receiving workers’ compensation wage loss and medical benefits, or even if the carrier has accepted the claim as a medical only (no wage loss). These cases have a better chance of resolving, as the workers’ comp. carrier is paying money on the claim, so they are “on the hook”, and the only way out for them is to either settle the claim or wait for a judge’s Decision stopping your benefits in some form, which could literally take, in some cases, years.
Whichever situation you or someone you know finds themselves in, it is always wise to seek out an experienced PA workers’ comp. attorney to help you negotiate a settlement, as this is what they do on a regular basis. Having that experience on your side can be the difference between an ok settlement and a really good settlement. It is your claim, it is your life, make the best and most comfortable choices possible for yourself and your family.