Tip # 6 – Understand What You Get From a Workers Comp Claim

Workers’ Comp is based on disability.

Many injured workers know someone who was injured at work and got a “big” settlement. But getting a big settlement on a workers comp claim means that the injured worker suffered a terrible impact to his life and his ability to work. It means a serious injury and lost money from being out of work. Serious injuries accepted by the insurance company usually take a long time before there is a settlement. Sometimes they will never settle. All settlements are voluntary, and there is no way to force the insurance company to pay more than they want to pay! However it happens, a settlement comes at the end of a workers’ comp case, and sometimes years after the injury.

An injured worker is entitled to only three types of payments from workers’ comp:

• Payment for medical treatment
• Payment for lost wages
• Payment for any permanent injuries

Medical treatment payments include the obvious: visits to the doctor, physical therapy, and hospitalization. It also includes things that you might not think of, including medical travel, broken eyeglasses, and payment for home care for some serious injuries. Payment for lost wages is to compensate the employee because he is either totally out of work or because he can’t make as much money as he used to before his injury. An out-of-work employee will receive weekly workers’ comp payments equaling two-thirds of his average wages. That is called the workers’ comp rate, and it never changes. If an injured employee can find other work but makes less money, he is entitled to two thirds of the amount he is losing from what he used to make.

If a worker has a permanent injury, and the doctor determines the amount of permanent injury (the percentage of damage to the body, also known as a rating), the insurance company must pay compensation for it. The amount the injured worker will receive is determined by the rating, the part of the body that was injured and the amount of the workers’ comp rate.

The date that an injured worker finishes healing from the injury is the most important date in his claim. That date is the first day that the injured worker can determine what type of payments they will receive. Some injured workers will not return to work because of their injury and will receive ongoing weekly benefits and not the payment of a rating. Most injured workers will go back to work but some will not be able to make as much money as before the injury, and they may choose to receive weekly wage loss payments. Still others may choose the amount of the rating, also paid in weekly payments. The law says that the worker gets to choose the option that gives him the most money. Determining which option that will be can take time and a lawyer to figure out.

There can be big differences in the amount of money different injured workers will receive for similar permanent injuries. Let’s compare two workers. The first one is a highly paid truck driver. He is 55 years old and right handed. When he hurts his right hand and can’t do the work he has done for 30 years, and can’t find any other work, he will likely receive ongoing weekly benefits and maybe a “big” settlement. The second one is a 30-year-old pharmacist. She suffers a similar injury to her right hand. Because she can return to her same job and make the same amount of money she did before she was hurt, she is in a very different position than the truck driver. The 30-year-old worker has less disability under the law because she will lose less money because of her injury.

David’s Workers Comp Claim

David’s work as an electrician in a manufacturing plant made him a good living. When he fell 25 feet and broke several bones, including one in his spine, he knew his days of doing that kind of work were over. He spent long days in physical therapy and long nights in pain. He thought the operation on his back was the worst thing he would ever have to go through but felt that it would end the pain and then he could go back to work. The nurse they sent with him to his doctor was pushy. She kept asking the doctor to send David back to work immediately, despite his pain.

READ MORE ABOUT DAVID’S WORKERS COMP CLAIM, AND GET OUR TOP 10 TIPS FOR WORKERS’ COMPENSATION CLAIMS IN NORTH CAROLINA BY DOWNLOADING A FREE COPY OF WORKERS COMP 101 HERE.