Guide to Evaluating Your Workers’ Compensation Claim

Guide to Evaluating Your Workers’ Compensation Claim
Guide to Evaluating Your Workers’ Compensation Claim
September 9th, 2020

Determining the Worth of Your Workers’ Compensation Claim

Workplace injuries can be painful both physically and financially. When suffering from a workplace injury, you may miss out on time at work, lose wages, and incur expenses for medical treatment. The situation may put you in financial distress. In such scenarios, workers’ compensation covers the loss of wages and medical bills. When you are injured at your workplace, you automatically become eligible for receiving workers’ compensation benefits from your employer’s insurer. You can accept the benefits if you are satisfied with what the insurance company has decided to pay you. If you feel that the compensation is unfair, you can negotiate a settlement with the insurance company or take your claim to court and go to a trial. However, it has been observed that in most cases, the employer’s insurance company is likely to push for an early settlement with a lowball offer. In addition, such insurance companies try to exploit your lack of knowledge in the area to avoid paying fair compensation. Therefore, if you are going for a workers’ compensation settlement, you should know the benefits and payouts you are entitled to.

Factors That Impact Workers’ Compensation Claim Settlement

The factors that determine the worth of your workers’ compensation claim are:

Severity of Injuries

A vital element that determines the cost of the claim is the types and severity of injuries you suffer. The value of your claim will increase if the injuries you have sustained require long-term treatment and surgery.

Your Ability to Work

The value of your workers’ compensation claim will increase if the injury leads to a permanent total or partial disability. In such cases, your employer will be required to compensate you for the past and future lost wages depending on what you earned before suffering from the injury.

Employer’s Liability Admission

If your employer has accepted that the injury occurred at the workplace due to their neglect or misconduct, then the value of your workers’ compensation will grow significantly. In addition, the admission of liability on the employer’s part will give you an edge when negotiating the claim with them.

Types of Settlements

There are two basic types of settlement arrangements that you can opt from:

  1. Lump-Sum Payment: In this arrangement, you sign a settlement agreement relinquishing certain rights in return for a one-time lump-sum payment negotiated with the insurance company or your employer.
  2. Structured Payment Agreement: When agreeing to a structured payment agreement, you will be receiving smaller payments over a definite period of time.

When choosing the lump-sum payment arrangement, you will have to estimate the future expenses you may incur for your treatment when negotiating the settlement amount. Unfortunately, this means you will be giving up your right to medical care in the future. Therefore, any medical expenses that arise due to workplace injury in the future will be your liability. On the other hand, opting for a structured settlement will ensure every medical expense you incur for treating an injury sustained in a workplace will be paid by your employer or their insurer.

Workers’ Benefits Settlement Amount Categories

Irrespective of the settlement arrangement you opt for, the workers’ compensation benefits that you should know about are:

Permanent Partial Disability Benefits

Permanent partial disability benefits are awarded if the workplace injuries result in a permanent impairment but do not leave the victim completely disabled. For example, if your workplace injury limits the work you can do, results in surgery, or impacts your body in a way that it can never return to the pre-injury state, then you are entitled to receiving permanent disability benefits. These benefits are awarded to compensate for the gradual loss of income that may be triggered when the disabilities begin to hinder your wage-earning capabilities. You can also demand permanent partial disability benefits if you have suffered permanent disfigurement and scarring.

These benefits are valued using a metric known as the permanent disability rating. The rating is assigned to you by the insurance company after a thorough medical examination. This rating forms the basis of evaluating the benefits as state laws use it to decide the compensation to be awarded to the plaintiff. Therefore, you should refer to your state laws and calculate the compensation you are eligible for. This will enable you to counter the insurance company’s starting settlement amount and recover higher compensation.

Permanent Total Disability

The rules used for calculating the compensation for permanent total disability vary from state to state. While some states use a different set of rules altogether, some states assign a permanent disability rating above a certain percentage to calculate the amount. Some state laws also make it mandatory for employers to award life pension awards in addition to permanent disability compensation.

However, if you have a permanent disability, it is in your best interest to hire a workers’ compensation attorney to handle the negotiations. The laws around permanent total disability are complicated and can have life-altering implications. Therefore, the situation warrants the expertise of a seasoned workers’ compensation attorney who can protect your rights and interests. You can know more about when to hire a workers’ compensation attorney here.

Temporary Total Disability

If your workplace injury forced you to take some time off work, you are entitled to receiving temporary total disability benefits. However, it can be the case that you did not receive these benefits in the past or the amount was too low. Therefore, you should consider these lost wages when negotiating a settlement.

Some state laws levy penalties on late payments of these benefits. This penalty is calculated as a percentage of the amount the employer owes you. It is best to consult a workers’ compensation attorney to understand if you were paid late or the compensation was too less.


If the workplace injury results in the death of an employee, their surviving family is entitled to receiving death benefits from the employer. While the laws vary from state to state, generally, death benefits involve a monthly payment of 2/3rd of the workers’ average wage to their family for a definite period of time that can span up to 25 years.

Guide to Evaluating Your Workers’ Compensation Claim

How Are Lost Wages Calculated?

Lost wages is a term used to define the money you lost due to injury-induced time off work. Although state laws vary, a common pattern followed across the country is:

  1. A base or average weekly wage of the injured employee is calculated by analyzing the wages earned during a specific period before the injury. For example, some states use data from 52 weeks before the injury, while some use data 13 weeks before the accident.
  2. State statutes have defined a fixed percentage of compensation an injured employee is applicable for based on their average weekly wage. Typically, the percentage varies from 66% to 75%. Therefore, the value of lost wages is calculated by multiplying the fixed percentage portion of the average weekly wage with time off work.

Are you planning to push for a workers’ compensation claim settlement? Then, it will be in your best interest to hire a workers’ compensation lawyer for your case. Fill in the form provided alongside, and we will help you find the best workers’ compensation attorney near you.

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